Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Controlled Trial of Rehabilitation Following Critical Illness: A Short Term Feasibility and Follow-Up Pilot Study
Brief Summary: The principal research question to be answered by this study is whether an exercise based rehabilitative intervention following critical illness can generate improvements in exercise capacity and quality of life beyond current (usual) care. The investigators will also aim to demonstrate that such an intervention is both practical and cost-effective.


Options:
A: Inclusion Criteria

1. Patients intubated and mechanical ventilated for \< 72 hours
2. Age \> 18 years
3. Baseline independent functional status as assessed by a Barthel Index score \> 70 collected from a proxy reflecting baseline health 2 weeks prior to critical illness

Exclusion Criteria

1. Rapidly evolving neurological/neuromuscular disease
2. Cardiac arrest
3. Irreversible conditions with six month mortality estimated at \> 50%
4. Elevated intracranial pressure
5. Multiple absent limbs (precluding complete musculoskeletal examination)
6. Enrollment in another trial
B: Inclusion Criteria:

* Adult (age \> or = 18) patients admitted to the Medical ICU
* Respiratory failure requiring mechanical ventilation \> or = 5 days
* Reasonable expectation for a subsequent return of mental status

Exclusion Criteria:

* Patient's family, physician, or both not in favor of aggressive treatment of patient or presence of an advanced directive to withhold life-sustaining treatment
* Pregnancy
* Admitted to ICU from outside hospital
* New or pre-existing diagnosis causing current neuromuscular weakness
* Profound and uncorrectable hypokalemia or hypophosphatemia \[K \< 2.5 or P \< 1.0 throughout enrollment window\]
* Inability to assess muscle strength in more than six muscle groups in at least two extremities \[Bilateral amputation (BKA or AKA), severe burns, skin lesions or dressings limiting ability of examiner to access and forcibly resist movement of the patients extremities\]
* Inability to communicate or follow commands of the examiner \[persistent coma, severe MRDD (mental retardation and developmental disabilities) or continuing necessary medication use that impairs consciousness (i.e. narcotics), non-English speaker\]
* Concurrent enrollment in another clinical trial involving steroids \> 20 mg/day prednisone equivalent for \> 3 days, neuromuscular blockade for \> 24 hours or any aminoglycosides.
* Prisoner or other subject where legal surrogate decision maker is in question
C: Inclusion Criteria:

* Age \>18 years AND admitted to critical care unit
* Ventilated \>48-hours (via endotracheal tube) OR received continuous non- invasive ventilation (NIV)/non-invasive continuous positive airways pressure (CPAP)
* Admitted to ICU \> 48-hours and evidence of SIRS
* Glasgow Coma Score (GCS) 15 (of 15) AND Abbreviated Mini-Mental Test Score (AMMTS) \>/= 8 (of 10) on enrolment into rehabilitation programme
* Mobilising on ward to a degree sufficient as to begin a majority of proposed exercises. Clinical stability for observed exercise as judged by trial team is a prerequisite.
* Participant willingness to complete a programme of exercise based therapy aimed at reducing weakness and shortness of breath: subjective weakness or dyspnoea relative to their pre-admission state is implicit

Exclusion Criteria:

* Patients referred for terminal care or prognosis likely to be less than 12-months
* Unstable coronary artery syndrome
* Limb amputation (given special requirement for orthotics/rehabilitation)
* Critical peripheral vascular disease awaiting re-vascularisation procedure (or claudication distance \<100 metres)
* Stroke with hemiparesis (likely need for specialised rehabilitation/stay on stroke unit)
* Severe, disabling locomotor problem or severe burns, which prevent effective participation in the exercises contained in the rehabilitation programme.
* Psychiatric disease necessitating anti-psychotic medication, deliberate drug overdose as the admitting ICU indication, ongoing treatment for drug or alcohol addiction, persons of no fixed abode post-discharge
* Patients undergoing renal haemodialysis (given the associated commitment to outpatient attendance)
* Extra contractual ICU referral (only if distance greater than suitable for twice weekly travel)

Additional exclusion criteria for muscle biopsy samples:

* Coagulopathy e.g. warfarin use
D: Inclusion Criteria:

* 45 years of age and over with an intensive care stay of five days or more

Exclusion Criteria:

* Physically not capable of engaging with the practical requirements of the study

Answer: C