What is the effect of passive movements on joint stiffness in intensive care unit patients?

For the purposes of this study, the intervention for the side of the body allocated to receive passive movements will involve the treating intensive care unit (ICU) physiotherapist moving the participant’s elbow and ankle joints through a full range of motion. These two joints were selected for the intervention based on previous research and our own anecdotal experience in ICU regarding which joints seem to get stiff most frequently, and the ease of measurement of range of motion. The intensity, frequency and duration of the intervention, as follows, is based on a treatment protocol used in a previous published study and survey responses reported previously. We elected to use a relatively intensive passive movement regimen as we want to maximise the likelihood of finding a treatment effect. Passive movements will be given to the elbow and ankle joints on the allocated side for 10 minutes each in the morning and afternoon, five days per week (weekdays). It is anticipated that participants will require the intervention for at least a two week period, though there is no mandatory minimum intervention duration. The intervention for the ankle joint will involve dorsiflexion (with knee in extension and flexion), plantarflexion, inversion and eversion through the available range of motion. For the elbow joint the intervention will involve flexion, extension, pronation and supination through the available range of motion. No force will be used at the end of joint range. As per usual clinical practice, no specific advice will be given to the treating physiotherapists regarding cadence of movements. Adherence with the provision of this intervention will be recorded on a purpose-designed form. In keeping with usual clinical practice, the passive movements intervention (to the ankle and elbow on the allocated side of the body) will continue until the participant is able to actively and independently move their ankles and elbows (both sides) through a full range of motion. The time point at which this occurs will be recorded. If the treating physiotherapist believes the participant is able to actively and independently move their ankles and elbow through a full range of motion (and thus no longer requires the passive movements intervention), this decision will be assessed, at the request of the treating physiotherapist, by another blinded physiotherapist. This assessment will comprise: (1) conscious state, using the Glasgow Coma Scale (score greater or equal to 13; e.g. opens eyes to speech, confused, obeys commands); (2) muscle power at ankles and elbows (greater than or equal to 3 out of 5, manual muscle test); (3) visual assessment that participant can independently move his/her ankles and elbows through a full range of motion. Other physiotherapy interventions (e.g. sitting out of bed, standing, walking) will continue as indicated, as per usual clinical practice, throughout the study period. If the participant is unable to actively and independently move their ankles and elbows through a full ROM by study completion (4 weeks), the clinical trial will still cease at this time point. If the participant is transferred out of ICU before study completion, the passive movements intervention will continue to be provided (if required) in the general ward and outcomes will be recorded as per the study protocol. Control side The side of the body allocated as the control side will not receive any passive movements by a physiotherapist as per standard practice our ICU.