Improving Recovery and Outcomes Every Day After the ICU (IMPROVE): A Randomized Controlled Trial.

Area of Science:

• Critical care medicine
• Neuroscience
• Rehabilitation

Background:

• Intensive care unit (ICU) delirium survivors often experience long-term cognitive deficits.
• Web-based interventions offer a scalable approach to post-ICU recovery.

Purpose of the Study:

• To evaluate the impact of a 12-week combined cognitive and physical training program on cognitive performance in older adults who have survived ICU delirium.
• To assess effects on physical function, mental health, and quality of life.

Main Methods:

• A prospective, four-arm randomized controlled trial was conducted across four ICU sites.
• 153 adult ICU patients aged 50+ with delirium were randomized into four groups: physical exercise-cognitive training (PE-CT), physical exercise-cognitive control (PE-CC), stretching control-cognitive training (SC-CT), or stretching control-cognitive control (SC-CC).
• Cognitive function was primarily assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at 3 and 6 months post-intervention.

Main Results:

• No significant improvements were observed in cognitive, physical, mental health, or quality of life measures across the intervention groups at 3 or 6 months.
• The SC-CT group showed a statistically significant worsening in cognitive scores compared to the SC-CC group at both 3 and 6 months.
• The PE-CC group also demonstrated a statistically significant decline in cognitive scores compared to the SC-CC group at 6 months.

Conclusions:

• The web-based combined cognitive and physical training intervention, as tested in the IMPROVE trial, did not improve cognitive, physical, or mental health outcomes in ICU delirium survivors.
• Unexpectedly, cognitive training components were associated with a decline in cognitive performance from baseline to 3 months post-intervention.