***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Cognitive impairment after critical illness is common and debilitating . We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness . Methods We r and omized 87 medical and surgical ICU patients with respiratory failure and /or shock in a 1:1:2 manner to three groups : usual care , early once-daily physical therapy , or early once-daily physical therapy plus a novel , progressive , twice-daily cognitive therapy protocol . Cognitive therapy included orientation , memory , attention , and problem-solving exercises , and other activities . We assessed feasibility outcomes of the early cognitive plus physical therapy intervention . At 3 months , we also assessed cognitive , functional , and health-related quality of life outcomes . Data are presented as median ( interquartile range ) or frequency ( % ) . Results Early cognitive therapy was a delivered to 41/43 ( 95 % ) of cognitive plus physical therapy patients on 100 % ( 92–100 % ) of study days beginning 1.0 ( 1.0–1.0 ) day following enrollment . Physical therapy was received by 17/22 ( 77 % ) of usual care patients , by 21/22 ( 95 % ) of physical therapy only patients , and 42/43 ( 98 % ) of cognitive plus physical therapy patients on 17 % ( 10–26 % ) , 67 % ( 46–87 % ) , and 75 % ( 59–88 % ) of study days , respectively . Cognitive , functional , and health-related quality of life outcomes did not differ between groups at 3-month follow-up . Conclusions This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy . Future work to determine optimal patient selection , intensity of treatment , and benefits of cognitive therapy in the critically ill is needed Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes Objectives : To investigate whether a daily exercise session , using a bedside cycle ergometer , is a safe and effective intervention in preventing or attenuating the decrease in functional exercise capacity , functional status , and quadriceps force that is associated with prolonged intensive care unit stay . A prolonged stay in the intensive care unit is associated with muscle dysfunction , which may contribute to an impaired functional status up to 1 yr after hospital discharge . No evidence is available concerning the effectiveness of an early exercise training intervention to prevent these detrimental complications . Design : R and omized controlled trial . Setting : Medical and surgical intensive care unit at University Hospital Gasthuisberg . Patients : Ninety critically ill patients were included as soon as their cardiorespiratory condition allowed bedside cycling exercise ( starting from day 5 ) , given they still had an expected prolonged intensive care unit stay of at least 7 more days . Interventions : Both groups received respiratory physiotherapy and a daily st and ardized passive or active motion session of upper and lower limbs . In addition , the treatment group performed a passive or active exercise training session for 20 mins/day , using a bedside ergometer . Measurements and Main Results : All outcome data are reflective for survivors . Quadriceps force and functional status were assessed at intensive care unit discharge and hospital discharge . Six-minute walking distance was measured at hospital discharge . No adverse events were identified during and immediately after the exercise training . At intensive care unit discharge , quadriceps force and functional status were not different between groups . At hospital discharge , 6-min walking distance , isometric quadriceps force , and the subjective feeling of functional well-being ( as measured with “ Physical Functioning ” item of the Short Form 36 Health Survey question naire ) were significantly higher in the treatment group ( p < .05 ) . Conclusions : Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity , self-perceived functional status , and muscle force at hospital discharge Introduction The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors . Methods We conducted a single-center , assessor-blinded , r and omized controlled trial . One hundred and fifty participants were stratified and r and omized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult . The intervention group received intensive exercises in the ICU and the ward and as out patients . Participants were assessed at recruitment , ICU admission , hospital discharge and at 3- , 6- and 12-month follow-up . Physical function was evaluated using the Six-Minute Walk Test ( 6MWT ) ( primary outcome ) , the Timed Up and Go Test and the Physical Function in ICU Test . Patient-reported outcomes were measured using the Short Form 36 Health Survey , version 2 ( SF-36v2 ) and Assessment of Quality of Life ( AQoL ) Instrument . Data were analyzed using mixed models . Results The a priori enrollment goal was not reached . There were no between-group differences in demographic and hospital data , including acuity and length of acute hospital stay ( LOS ) ( Acute Physiology and Chronic Health Evaluation II score : 21 vs 19 ; hospital LOS : 20 vs 24 days ) . No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge . However , exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group . Conclusions Further research examining the trajectory of improvement with rehabilitation is warranted in this population .Trial registration The trial was registered with the Australian New Zeal and Clinical Trials Registry ACTRN12605000776606 ABSTRACT Objective : To evaluate the effects that passive cycling exercise , in combination with conventional physical therapy , have on peripheral muscle strength , duration of mechanical ventilation , and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital . Methods : This was a r and omized clinical trial involving 38 patients ( ≥ 18 years of age ) on mechanical ventilation who were r and omly divided into two groups : control ( n = 16 ) , receiving conventional physical therapy ; and intervention ( n = 22 ) , receiving conventional physical therapy and engaging in passive cycling exercise five days per week . The mean age of the patients was 46.42 ± 16.25 years , and 23 were male . The outcomes studied were peripheral muscle strength , as measured by the Medical Research Council scale , duration of mechanical ventilation , and length of hospital stay . Results : There was a significant increase in peripheral muscle strength ( baseline vs. final ) in both groups ( control : 40.81 ± 7.68 vs. 45.00 ± 6.89 ; and intervention : 38.73 ± 11.11 vs. 47.18 ± 8.75 ; p < 0.001 for both ) . However , the range of increase in strength was higher in the intervention group than in the control group ( 8.45 ± 5.20 vs. 4.18 ± 2.63 ; p = 0.005 ) . There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay . Conclusions : The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients . ( Clinical Trials.gov Identifier : NCT01769846 [ http://www . clinical trials.gov/ ] Background : Systematic review s of early rehabilitation within intensive care units have highlighted the need for robust multi‐centre r and omised controlled trials with longer term follow up . This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5 days and to assess the impact on possible long term outcome measures for use in a definitive trial . Methods : Patients admitted to a large UK based intensive care unit and invasively ventilated for ≥5 days were r and omised to the rehabilitation intervention or st and ard care on a 1:1 basis , stratified by age and SOFA score . The rehabilitation intervention involved a structured programme , with progression along a functionally based mobility protocol according to set safety criteria . Results : 103 out of 128 eligible patients were recruited into the trial , achieving an initial recruitment rate of 80 % . Patients in the intervention arm mobilized significantly earlier ( 8 days vs 10 days , p = 0.035 ) , at a more acute phase of illness ( SOFA 6 vs 4 , p < 0.05 ) and reached a higher level of mobility at the point of critical care discharge ( MMS 7 vs 5 , p < 0.01 ) . Conclusion : We have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care . HighlightsThe introduction of an earlier and enhanced rehabilitation was feasible for patients ' ventilated ≥5 daysWhen introduced , patients were mobilised earlier and in a more acute phase of their illness , Earlier mobilisation led to patients achieving higher levels of mobility at the point of critical care dischargeThis positive impact was seen despite the previous successful implementation of a quality improvement project in the BACKGROUND muscle wasting is associated with a detrimental outcome in older people . Muscle strength measurements could be useful as part of a clinical evaluation of oldest old patients to determine who are most at risk of accelerated decline in the near future . OBJECTIVE this study aim ed to assess if h and grip strength predicts changes in functional , psychological and social health among oldest old . DESIGN the Leiden 85-plus Study is a prospect i ve population -based follow-up study . SUBJECTS five-hundred fifty-five , all aged 85 years at baseline , participated in the study . METHODS h and grip strength was measured with a h and grip strength dynamometer .  Functional , psychological and social health were assessed annually . Baseline data on chronic diseases were obtained from the treating physician , pharmacist , electrocardiogram and blood sample analysis . RESULTS at age 85 , lower h and grip strength was correlated with poorer scores in functional , psychological and social health domains ( all , P < 0.001 ) . Lower baseline h and grip strength predicted an accelerated decline in activities of daily living ( ADL ) and cognition ( both , P < or= 0.001 ) , but not in social health ( P > 0.30 ) . CONCLUSION poor h and grip strength predicts accelerated dependency in ADL and cognitive decline in oldest old . Measuring h and grip strength could be a useful instrument in geriatric practice to identify those oldest old patients at risk for this accelerated decline BACKGROUND Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit ( SICU ) . Attempts to mobilise critically ill patients early after surgery are frequently restricted , but we tested whether early mobilisation leads to improved mobility , decreased SICU length of stay , and increased functional independence of patients at hospital discharge . METHODS We did a multicentre , international , parallel-group , assessor-blinded , r and omised controlled trial in SICUs of five university hospitals in Austria ( n=1 ) , Germany ( n=1 ) , and the USA ( n=3 ) . Eligible patients ( aged 18 years or older , who had been mechanically ventilated for < 48 h , and were expected to require mechanical ventilation for ≥24 h ) were r and omly assigned ( 1:1 ) by use of a stratified block r and omisation via restricted web platform to st and ard of care ( control ) or early , goal -directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score ( SOMS ) algorithm ( intervention ) , which describes patients ' mobilisation capacity on a numerical rating scale ranging from 0 ( no mobilisation ) to 4 ( ambulation ) . We had three main outcomes hierarchically tested in a prespecified order : the mean SOMS level patients achieved during their SICU stay ( primary outcome ) , and patient 's length of stay on SICU and the mini-modified functional independence measure score ( mmFIM ) at hospital discharge ( both secondary outcomes ) . This trial is registered with Clinical Trials.gov ( NCT01363102 ) . FINDINGS Between July 1 , 2011 , and Nov 4 , 2015 , we r and omly assigned 200 patients to receive st and ard treatment ( control ; n=96 ) or intervention ( n=104 ) . Intention-to-treat analysis showed that the intervention improved the mobilisation level ( 
    Output:
    
Early mobilization appears to decrease the incidence of ICU-AW , improve the functional capacity , and increase the number of ventilator-free days and the discharged-to-home rate for patients with a critical illness in the ICU setting