Purpose: to investigate the effect of Whole-body vibration versus neuro-muscular electrical stimulation on patients with intensive care-acquired weakness. Methods: Sixty patients with Intensive Care Unit-acquired weakness (ICU AW) from both genders will be recruited and randomly assigned into two groups, Group A and Group B. Group A will include 30 patients who will practice Whole body vibration for two weeks twice daily in addition to their plan of treatment. Group B will include 30 patients who will receive neuromuscular electrical stimulation for two weeks, twice daily, in addition to their plan of treatment. All patients will be evaluated pre- and post-treatment for the MRC score, creatine phosphokinase, and total muscle strength and skeletal muscle thickness
A) Procedure for evaluation: The practical section of the study will be undertaken in 2 weeks (two sessions per day). Measurements will be taken before the start of the training program then after the end of the 2-week training program in the following manner: 1. Manual muscle test (MMT) and medical research council score (MRC): will be used to assess muscle strength. 2. Laboratory investigations for CPK: Blood serum samples will be collected. For each sample, 5 mL of blood will be drawn for laboratory analyses to detect damage in skeletal muscle. 3. Strength Testing with Dynamometry: A Handheld Dynamometer will be used to assess the skeletal muscle strength objectively. 4. Skeletal muscle ultrasonography: will be used to assess the size and thickness of muscles. B) Training procedures: All patients in both groups will receive their plan of treatment in addition to the training program for each group as follows: Group (A) patients in this group will participate in Whole Body Vibration (WBV) training for 2 weeks, two sessions per day (total 14 sessions) in addition to their plan of treatment. Group (B) patients in this group will participate in neuromuscular electrical stimulation (NMES) training for 2 weeks, two sessions per day ( total 14 sessions), in addition to their plan of treatment. C) The statistical analysis will be conducted by using the SPSS statistical package program version 25 for Windows (SPSS, Inc., Chicago, IL). Quantitative descriptive statistics data, including the mean and standard deviation, will be used to describe the data. Multivariate analysis of variance (MANOVA) will be used to compare the tested major dependent variables of interest. A mixed-design 2 x 2 MANOVA test will be used to detect within-group changes and between-group differences. The Bonferroni correction test will be used for pairwise comparison within and between groups of the tested dependent variables, whose P-value will be significant from the MANOVA test. The significance level for all statistical analyses will be set at p\<0.05.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Whole body vibration will be applied twice daily for two weeks. The patients will be in the supine position during the entire intervention, and no changes in body position will take place to avoid any influence on hemodynamic parameters and vital signs. Following baseline measurements, patients will be mobilized passively for 6 minutes as a warm-up. whole body vibration treatment will be initiated, consisting of a vibration plate device will placed under the patient's feet, with resistance to the end of the bed. The patient's hips and knees will be flexed at about 20°. An elastic strip will provide pressure on the knees, pushing the patient's feet against the vibration device. Whole body vibration sessions took 15 minutes, with 9 minutes of clear vibration time. The vibration frequency will be 25 HZ and the amplitude of 2 mm
Neuromuscular electrical stimulation will be applied twice daily for two weeks. 20 min per muscle group bilaterally on eight different muscle groups (triceps surau (calf muscle), Quadriceps, Hamstring, biceps brachii, triceps brachii, wrist extensors and shoulder abductors). We will never stimulate counteracting muscle groups at the same time. Electrical impulses of 350 μs duration will be applied at a frequency of 50 Hz. Electrical current will be increased until muscle contraction can be visible or palpable, which can be tolerable and does not cause pain or discomfort, and then it will be maintained at this level for the remainder of the session.
critical care department (DR. Sherief Mokhtar unit) in kasr Al-Ainy medical school, Cairo, Egypt.
Cairo, Cairo Governorate, Egypt
Manual muscle test (MMT)
manual muscle testing will be assessed bilaterally, including tibialis anterior, triceps surau, Quadriceps, hamstrings, biceps brachii, triceps brachii, and wrist extensors. these muscles will be assessed in 5 grades of muscle testing, where grade zero means no contraction and grade five means active movement through the full range of motion against full applied resistance against gravity
Time frame: At baseline and post two weeks
Medical Research Council (MRC)
The MRC scale will be used for early detection of muscle strength, as it has a score ranging from 0 to 60, where \< 48 means significant weakness
Time frame: At baseline and post two weeks
change of Creatine phosphokinase (CPK-MM)
The Beckman Unicel DxC800 method will be used for measuring serum CPK-MM
Time frame: change from baseline CPK-MM level at 2 weeks
muscle strength
Handheld dynamometry (HHD) will be used to measure the muscle strength of the selected muscles by quantifying the force generated when a person pushes or pulls against a stationary device.
Time frame: At baseline and post two weeks
Muscle thickness
Skeletal muscle ultrasonography will be used to assess muscle thickness
Time frame: at baseline and post 2 weeks
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