Benefits of Upper Extremity Exercises
Condition: Muscle Weakness
MeSH terms: Muscle Weakness
Study type: Interventional

Summary: 
      Pt will be provided with a upper extremity exercise program that will be completed daily
      during their session with occupational therapy. During the session the Activity Measure-Post
      Acute Care and an activity tolerance chart will be completed. The data from the outcome
      measures will be used to determine if there is a benefit to completing a daily exercise
      program.
    

Detailed description: 
      Study Design This is an evidence-based project based on current research from a literature
      search. It is a case series design. Patients will be selected from the medical intensive care
      unit and will be provided with a daily upper extremity exercise program that will be
      completed in addition to standard interventions such as completion of activities of daily
      living. Currently therapist within the intensive care unit have the ability to provide upper
      extremity exercise programs but there is no set standard of care in place for this exercises
      to be done on a daily basis with patients.

      Subject Selection Patients for this project will be selected from the medical intensive care
      unit at Upstate University Hospital. The physical therapist working in the medical intensive
      care unit will provide patients with a handout highlighting the project. Patients will be
      instructed to have their nurse contact the co-investigator through Vocera. Patients will be
      required to sign a consent form to voluntarily participate in this project. Patients will be
      expected to engage in an initial evaluation that can take up to an hour. Participation in
      daily treatment session will also be expected during a patients stay in the hospital.
      Treatment session can last from 30-60 minutes each day and will continue throughout a
      patients stay in the medical intensive care unit or a maximum of six weeks, which is the
      duration of the implementation phase of this project.

      Statistical Methods, Data Analysis and Interpretation Quantitative data will be collected
      through the use of the Activity Measures Post Acute Care, manual muscle testing and the
      activity-tracking sheet. Information collected from the Activity Measures Post Acute Care
      will be used to determine if there were improvements in the level of assist for activities of
      daily living (dressing, bathing, toileting). The scores from the manual muscle testing will
      be used to determine improvements in upper extremity strength, while the data collected from
      the activity-tracking chart will be used to see the improvements in activity tolerance.
      Comparison of data for the manual muscle testing will use information from the initial
      evaluation and at the time of discharge from the medical intensive care unit. The Activity
      Measures Post Acute Care and the activity-tracking chart will be performed at each session
      and data will be compared over the span of the patients stay in the medical intensive care
      unit.

      Study Procedures Pre-Intervention Procedures

        -  Request and obtain permission from the Director of therapy at Upstate Hospital. Received
           on 5/31/2016

        -  Request and obtained permission for the use of the Activity Measure Post Acute Care
           assessment.

        -  Completed the CITI training that is a requirement for IRB approval at Upstate Hospital.

        -  Discuss purpose of the project and review the recruitment handout with Physical
           therapist in the medical intensive care unit.

        -  Develop and photocopy recruitment handout for Physical therapist.

        -  Develop a set of 5 upper extremity exercises that patients will participate in daily
           developed in Physio-Tools. These exercises will be specialized to clients' needs.

      Implementation of project

        -  The physical therapist on the medical intensive care unit will conduct a physical
           therapy initial evaluation at which time the patient will be informed of the evidence
           based project-taking place via a handout provided by the physical therapist.

        -  The co- investigator will be notified of patient's interest in the project by nursing
           calling the primary investigator on Vocera.

        -  The consent interview will be conducted by the co-investigator only. Prior to completion
           of the initial occupational therapy evaluation, a discussion of the project with the
           patient will take place to answer any questions that may have come up. Following that
           discussion participants will sign the informed consent

        -  The co- investigator will perform an initial occupational therapy evaluation that will
           assess a patient's ability to complete functional transfers, upper body strength through
           manual muscle testing and abilities in performing activities of daily living to
           determine a functional baseline. The outcome measure that will be used to assess
           activities of daily living is the Activity Measure-Post Acute Care assessment.

        -  Patients will be provided with an upper extremity exercise program developed in
           Physio-Tools. Physio Tools has an extensive library of exercises. Each exercise can be
           customized by number of sets and reps, and by resistance. There will be a set of 5
           exercises focused on increasing upper body strength. The 5 exercises chosen will be
           based off the needs of the patient determined by their scores from the manual muscle
           testing.

        -  Patients will be asked to engage in the exercise program on a daily basis during their
           stay in the intensive care unit. Patients will complete exercises under supervision from
           the co- investigator during regularly scheduled therapy sessions. During that time
           patients will be provided with education on proper technique for performing exercises as
           well as having vitals monitored to ensure safety.

        -  While completing the exercise program the co- investigator will track the active minutes
           while the patient is engaged in the exercise and track the inactive minutes while at
           rest. This will allow for a comparison from session to session to rate if activity
           tolerance is improving.

        -  Participants will complete this program one time a day during regular therapy sessions.
           As their tolerance improves patients may be asked to increase the repetitions and/or may
           be provided with a resistance band to make it more challenging.

        -  To complete the whole exercise program should take 30 minutes a session; this time also
           includes rest breaks. Therapy sessions will take place 5 times a week for the full time
           that the patient is in the medical intensive care unit.

        -  The exercise program will be completed each session with the co- investigator. During a
           therapy session, participants will be asked to engage in activities of daily living.
           These tasks include dressing, bathing, toileting and grooming.

        -  During the initial evaluation the patient will determine which activities of daily
           living they will need to complete in order to be able to safely discharge home. Adaptive
           equipment for activities of daily living will be provided as needed. To be successful
           with activities of daily living within the hospital setting, adaptive equipment such as
           bedside commodes, raised toilet seats and rolling walkers will be provided to assist in
           achieving independence.

        -  During this 6 week long project the Activity Measure-Post Acute Care measure, manual
           muscle testing and the tracking or active and inactive minutest will be completed at
           each session.
    

Intervention name(s): upper extremity exercise program
Intervention type(s): Other
Intervention description(s): five exercises to improve upper extremity strength and endurance will be provided to patients, shoulder flexion, abduction/adduction, elbow flexion/extension, internal/external rotation
Other intervention name(s): exercise program
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment