Araştırma Makalesi
Acute Effects of Proprioceptive Neuromuscular Facilitation Compared to Active Range of Motion Exercises on Respiratory and Hemodynamic Responses in Critically Ill Patients: A Pilot Study
Öz
Purpose: Proprioceptive Neuromuscular Facilitation (PNF) is a widely used rehabilitation approach. However, there are limited studies examining the effect of PNF in a critical care setting. Therefore, we aimed to investigate the acute effects of PNF-based exercises compared to active range of motion (ROM) exercises on respiratory and hemodynamic responses in critically ill patients.
Material and Methods: Twenty-one spontaneously breathing non-intubated adult critically ill patients were randomly assigned to either PNF-based exercise group (n=10) or active ROM exercise group (n=11). Respiratory rate (RR; breath/min), peripheral oxygen saturation (SpO2; %), heart rate (HR; beat/min), systolic blood pressure (SBP; mmHg), diastolic blood pressure (DBP; mmHg) and mean blood pressure (MBP; mmHg) were measured using bedside monitoring system. The dyspnea severity and perceived exertion of patients were evaluated using the 0-10 numeric rating scale. Data were recorded at before, immediately after, and 5 minutes after (recovery) each exercise session.
Results: Two-way repeated-measures ANOVA revealed that there were no clinically significant differences between groups in RR (breath/min), SpO2 (%), HR (beat/min), SBP (mmHg), DBP (mmHg), and MBP (mmHg) variables, the severity of dyspnea (score) and perceived exertion (score) (P>0.05).
Conclusion: In the treatment of spontaneously breathing non-intubated patients, exercises based on the PNF technique can be safely performed in terms of respiratory and hemodynamic responses compared to active ROM exercises in a critical care setting.
Anahtar Kelimeler
Critically ill patients Proprioceptive Neuromuscular Facilitation Physiotherapy
Etik Beyan
The study was carried out with the approval of Dokuz Eylul University Non-Interventional Research Ethics Committee (Date: 15.06.2017, Decision No: 2017/16-16).
Destekleyen Kurum
None.
Teşekkür
The authors would like to thank Ersin Avci (Physiotherapist, MSc) for patient follow-up in the present study.
Kaynakça
- Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand. JAMA 2014; 11:1308-1316.
- Hermans G, van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit–acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014;190:410-420.
- González-Seguel F, Letelier-Bernal R. Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review, Phys Ther 2024;104:pzae048.
- Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med 2009;37:337-346.
- Yang Z, Wang X, Wang F, Peng Z, Fan Y. A systematic review and meta-analysis of risk factors for intensive care unit acquired weakness. Medicine (Baltimore) 2022;101:e31405.
- Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials. Crit Care 2009;13:1-8.
- Matsuoka A, Yoshihiro S, Shida H, et al. Effects of mobilization within 72 h of ICU admission in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. J Clin Med 2023; 12:5888.
- Zang K, Chen B, Wang M, et al. The effect of early mobilization in critically ill patients: a meta‐analysis. Nurs Crit Care 2020;25:360-367.
- Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36:2238-2243.
- Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther 2012;23:5-13.
- Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest 2013;144:825-847.
- Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, van der Schaaf M. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29:1051-1063.
- de Assis ISA, Luvizutto GJ, Bruno ACM, de Souza LAPS. The Proprioceptive Neuromuscular Facilitation Concept in Parkinson Disease: A Systematic Review and Meta-Analysis. J Chiropr Med 2020;19:181-187.
- Tedla JS, Sangadala DR. Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact 2019;19:482-491.
- Gunning E, Uszynski MK. Effectiveness of the proprioceptive neuromuscular facilitation method on gait parameters in patients with stroke: a systematic review. Arch Phys Med Rehabil 2019; 100:980-986.
- Smedes F, Heidmann M, Schäfer C, Fischer N, Stępień A. The proprioceptive neuromuscular facilitation-concept; the state of the evidence, a narrative review. Physical Therapy Reviews 2016;21:17-31.
- Adler S, Beckers D, Buck M, editors. PNF in practice: an illustrated guide. Springer; 2007.
- Mayr VD, Dünser MW, Greil V, et al. Causes of death and determinants of outcome in critically ill patients. Crit Care 2006;10:R154.
- Mankad D, Trivedi S, Bhatt JP. Role of Proprioceptive Neuromuscular Facilitation Techniques of Respiration in Mechanically Ventilated Patients – A Systematic Review of Clinical Evidence. Int J Health Sci Res 2024; 14:51-64.
- Shevtsova NA, Marchenko V, Bezdudnaya T. Modulation of respiratory system by limb muscle afferents in intact and injured spinal cord. Front Neurosci 2019;13:289.
- dos Santos LJ, de Aguiar Lemos F, Bianchi T, et al. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials 2015;16:1-6.
- Nordon-Craft A, Schenkman M, Ridgeway K, Benson A, Moss M. Physical therapy management and patient outcomes following ICU-acquired weakness: a case series. J Neurol Phys Ther 2011;35:133-140.
- Coutinho WM, dos Santos LJ, Fernandes J, Vieira SRR, Forgiarini Junior LA, A. Dias AS. Acute effect of the use of cycle ergometer during physical therapy treatment in mechanically ventilated critically ill patients. Fisioter Pesqui 2016;23:278-288.
- Cornelius WL, Craft-Hamm K. Proprioceptive neuromuscular facilitation flexibility techniques: acute effects on arterial blood pressure. Phys Sportsmed 1988;16:152-161.
- Yakut E, Arikan H. Effects of upper and lower extremities proprioceptive neuromuscular facilitation techniques on hemodynamic responses. Turk J Physiother Rehabil 2001; 12:11-15.
- Dai X, Hummel SL, Salazar JB, Taffet GE, Zieman S, Schwartz JB. Cardiovascular physiology in the older adults. J Geriatr Cardiol 2015;12:196-201.
- de Jonghe B, Sharshar T, Lefaucheur J-P, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288:2859-2867.
- Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-1344.
- Kisner C, Colby LA, Borstad J, editors. Therapeutic exercise: foundations and techniques. F.A. Davis Company, Philadelphia, Pennsylvania; 2017.
- Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care 1998;7:200-204.
- Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive Care Med 2008;34:1188-1199.
- Ehrman JK, Kerrigan D, Keteyian S, editors. Advanced Exercise Physiology: Essential Concepts and Applications. Human Kinetics; 2018.
- Pereira MP. Proprioceptive neuromuscular facilitation does not increase blood pressure of healthy elderly women. Physiother Theory Pract 2012;28:412-416.
- Costa e Silva G, Di Masi F, Paixão A, et al. Effects of Proprioceptive Neuromuscular Facilitation Stretching and Static Stretching on Cardiovascular Responses. JEP online 2013; 16:117-125.
- da Silva AA, Lobato AN, Pereira EN, et al. Cardiovascular and relative exertion perceived response during proprioceptive neuromuscular facilitation exercise associated to pulley. MTB&Rehab Journal 2014;12:358-363.
- Gültekin Z, Kin-Isler A, Sürenkök Ö. Hemodynamic and lactic acid responses to proprioceptive neuromuscular facilitation exercise. J Sports Sci Med 2006;5:375-380.
- Cornelius WL, Jensen RL, Odell ME. Effects of PNF stretching phases on acute arterial blood pressure. Can J Appl Physiol 1995;20:222-229.
- Rahman ZHA, Muhamad N. Effects of proprioceptive neuromuscular facilitation (PNF) on cardiovascular responses on young adults. Asian Journal of Medicine and Health Sciences 2021;4:193-203.
- Nedergaard HK, Haberlandt T, Reichmann PD, Toft P, Jensen HJ. Patients’ opinions on outcomes following critical illness. Acta Anaesthesiol Scand 2018;62:531-539.
- Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017;43:531-542.
- Jakhar N, Sikka G, Chaudhry D. Ventilatory effect of Proprioceptive Neuromuscular Facilitation patterns in critically ill patients: A brief review. International Journal of Science & Healthcare Reseacrh 2024;9:143-157.
- Liu K, Yu X, Cui X. Effects of proprioceptive neuromuscular facilitation stretching combined with aerobic training on pulmonary function in COPD patients: A randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2021;13:969-977.
Acute Effects of Proprioceptive Neuromuscular Facilitation Compared to Active Range of Motion Exercises on Respiratory and Hemodynamic Responses in Critically Ill Patients: A Pilot Study
Öz
Kaynakça
- Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand. JAMA 2014; 11:1308-1316.
- Hermans G, van Mechelen H, Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit–acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014;190:410-420.
- González-Seguel F, Letelier-Bernal R. Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review, Phys Ther 2024;104:pzae048.
- Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med 2009;37:337-346.
- Yang Z, Wang X, Wang F, Peng Z, Fan Y. A systematic review and meta-analysis of risk factors for intensive care unit acquired weakness. Medicine (Baltimore) 2022;101:e31405.
- Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials. Crit Care 2009;13:1-8.
- Matsuoka A, Yoshihiro S, Shida H, et al. Effects of mobilization within 72 h of ICU admission in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. J Clin Med 2023; 12:5888.
- Zang K, Chen B, Wang M, et al. The effect of early mobilization in critically ill patients: a meta‐analysis. Nurs Crit Care 2020;25:360-367.
- Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36:2238-2243.
- Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther 2012;23:5-13.
- Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest 2013;144:825-847.
- Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, van der Schaaf M. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29:1051-1063.
- de Assis ISA, Luvizutto GJ, Bruno ACM, de Souza LAPS. The Proprioceptive Neuromuscular Facilitation Concept in Parkinson Disease: A Systematic Review and Meta-Analysis. J Chiropr Med 2020;19:181-187.
- Tedla JS, Sangadala DR. Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact 2019;19:482-491.
- Gunning E, Uszynski MK. Effectiveness of the proprioceptive neuromuscular facilitation method on gait parameters in patients with stroke: a systematic review. Arch Phys Med Rehabil 2019; 100:980-986.
- Smedes F, Heidmann M, Schäfer C, Fischer N, Stępień A. The proprioceptive neuromuscular facilitation-concept; the state of the evidence, a narrative review. Physical Therapy Reviews 2016;21:17-31.
- Adler S, Beckers D, Buck M, editors. PNF in practice: an illustrated guide. Springer; 2007.
- Mayr VD, Dünser MW, Greil V, et al. Causes of death and determinants of outcome in critically ill patients. Crit Care 2006;10:R154.
- Mankad D, Trivedi S, Bhatt JP. Role of Proprioceptive Neuromuscular Facilitation Techniques of Respiration in Mechanically Ventilated Patients – A Systematic Review of Clinical Evidence. Int J Health Sci Res 2024; 14:51-64.
- Shevtsova NA, Marchenko V, Bezdudnaya T. Modulation of respiratory system by limb muscle afferents in intact and injured spinal cord. Front Neurosci 2019;13:289.
- dos Santos LJ, de Aguiar Lemos F, Bianchi T, et al. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials 2015;16:1-6.
- Nordon-Craft A, Schenkman M, Ridgeway K, Benson A, Moss M. Physical therapy management and patient outcomes following ICU-acquired weakness: a case series. J Neurol Phys Ther 2011;35:133-140.
- Coutinho WM, dos Santos LJ, Fernandes J, Vieira SRR, Forgiarini Junior LA, A. Dias AS. Acute effect of the use of cycle ergometer during physical therapy treatment in mechanically ventilated critically ill patients. Fisioter Pesqui 2016;23:278-288.
- Cornelius WL, Craft-Hamm K. Proprioceptive neuromuscular facilitation flexibility techniques: acute effects on arterial blood pressure. Phys Sportsmed 1988;16:152-161.
- Yakut E, Arikan H. Effects of upper and lower extremities proprioceptive neuromuscular facilitation techniques on hemodynamic responses. Turk J Physiother Rehabil 2001; 12:11-15.
- Dai X, Hummel SL, Salazar JB, Taffet GE, Zieman S, Schwartz JB. Cardiovascular physiology in the older adults. J Geriatr Cardiol 2015;12:196-201.
- de Jonghe B, Sharshar T, Lefaucheur J-P, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288:2859-2867.
- Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-1344.
- Kisner C, Colby LA, Borstad J, editors. Therapeutic exercise: foundations and techniques. F.A. Davis Company, Philadelphia, Pennsylvania; 2017.
- Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care 1998;7:200-204.
- Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive Care Med 2008;34:1188-1199.
- Ehrman JK, Kerrigan D, Keteyian S, editors. Advanced Exercise Physiology: Essential Concepts and Applications. Human Kinetics; 2018.
- Pereira MP. Proprioceptive neuromuscular facilitation does not increase blood pressure of healthy elderly women. Physiother Theory Pract 2012;28:412-416.
- Costa e Silva G, Di Masi F, Paixão A, et al. Effects of Proprioceptive Neuromuscular Facilitation Stretching and Static Stretching on Cardiovascular Responses. JEP online 2013; 16:117-125.
- da Silva AA, Lobato AN, Pereira EN, et al. Cardiovascular and relative exertion perceived response during proprioceptive neuromuscular facilitation exercise associated to pulley. MTB&Rehab Journal 2014;12:358-363.
- Gültekin Z, Kin-Isler A, Sürenkök Ö. Hemodynamic and lactic acid responses to proprioceptive neuromuscular facilitation exercise. J Sports Sci Med 2006;5:375-380.
- Cornelius WL, Jensen RL, Odell ME. Effects of PNF stretching phases on acute arterial blood pressure. Can J Appl Physiol 1995;20:222-229.
- Rahman ZHA, Muhamad N. Effects of proprioceptive neuromuscular facilitation (PNF) on cardiovascular responses on young adults. Asian Journal of Medicine and Health Sciences 2021;4:193-203.
- Nedergaard HK, Haberlandt T, Reichmann PD, Toft P, Jensen HJ. Patients’ opinions on outcomes following critical illness. Acta Anaesthesiol Scand 2018;62:531-539.
- Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017;43:531-542.
- Jakhar N, Sikka G, Chaudhry D. Ventilatory effect of Proprioceptive Neuromuscular Facilitation patterns in critically ill patients: A brief review. International Journal of Science & Healthcare Reseacrh 2024;9:143-157.
- Liu K, Yu X, Cui X. Effects of proprioceptive neuromuscular facilitation stretching combined with aerobic training on pulmonary function in COPD patients: A randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2021;13:969-977.
Toplam 42 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Yoğun Bakım, Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mayıs 2025 |
| Gönderilme Tarihi | 16 Ağustos 2024 |
| Kabul Tarihi | 18 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 9 Sayı: 2 |
