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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03133377
Registration number
NCT03133377
Ethics application status
Date submitted
10/04/2017
Date registered
28/04/2017
Titles & IDs
Public title
Treatment of Invasively Ventilated Adults With Early Activity and Mobilisation
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Scientific title
A Prospective Multicentre Phase III Randomised Controlled Trial of Early Activity and Mobilisation Compared With Standard Care in Invasively Ventilated Patients in Intensive Care
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Secondary ID [1]
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TEAM U1111-1195-3567
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Universal Trial Number (UTN)
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Trial acronym
TEAM(III)
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Critically Ill, Mechanically Ventilated
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
BEHAVIORAL - Early activity and mobilisation
Experimental: Early activity and Mobilisation intervention - Patients will be assessed daily by an ICU physiotherapist using the ICU Mobility Scale (IMS) to determine the dosage and type of active exercises the patient will receive, using the early activity and mobilisation protocol. This protocol is hierarchical, with the objective of each intervention session beginning with the highest level of activity possible for the longest time possible, which then steps down to lower levels of activity if the patient fatigues. The intervention will be administered on all days in which the patient is admitted to ICU during the index hospitalisation, censored at 28days after.
No intervention: Standard of care - The control group will receive standard care from physiotherapy staff not involved in delivering the intervention. We have previously established that standard care in Australia for a patient receiving prolonged IMV (control group intervention) frequently involves no active exercise out of bed.
BEHAVIORAL: Early activity and mobilisation
The early activity and mobilisation intervention is comprised of exercises based on a reproducible, physiological approach using both strength and functional activities
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Intervention code [1]
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BEHAVIORAL
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Number of days alive and out of hospital
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Assessment method [1]
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Any days spent in rehabilitation or a nursing home counted as days in hospital
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Timepoint [1]
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between randomisation and 180 days
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Secondary outcome [1]
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All-cause mortality
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Assessment method [1]
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Timepoint [1]
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From date of randomisation up to180days.
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Secondary outcome [2]
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Time from randomisation until death
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Assessment method [2]
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Timepoint [2]
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From date of randomisation unitl date of death from all cause, censored at 180days
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Secondary outcome [3]
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Ventilator-free days
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Assessment method [3]
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patients who die prior to day 28 will be assigned zero ventilator-free days
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Timepoint [3]
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From date of randomisation until day 28
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Secondary outcome [4]
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ICU-free days
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Assessment method [4]
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patients who die prior to day 28 will be assigned zero ICU-free days
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Timepoint [4]
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From date of randomisation until day 28
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Secondary outcome [5]
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Quality of life and health status measured using the European Quality of Life 5 Dimensions 5 Level (EQ5D-5L)
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Assessment method [5]
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Timepoint [5]
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Assessed at 180days
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Secondary outcome [6]
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Independent activities of daily living measured with Barthel Activities of Daily Living (ADL) Index and The Lawton Instrumental Activities of Daily Living Scale (IADL)
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Assessment method [6]
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Timepoint [6]
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Assessed at 180days
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Secondary outcome [7]
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Generic function and disability measured with the World Health Organisation's Disability Assessment Schedule (WHODAS)
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Assessment method [7]
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Timepoint [7]
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Assessed at 180days
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Eligibility
Key inclusion criteria
1. Aged 18 years or older.
2. Intubated and expected to remain invasively mechanically ventilated the day after tomorrow.
3. Sufficient cardiovascular stability to make mobilisation potentially possible, as indicated by:
1. the absence of current brady-arrhythmia requiring pharmacological support
2. a current ventricular rate = 150 bpm
3. most recent lactate = 4.0 mmol/L
4. current combined noradrenaline/adrenaline infusion rate of = 0.2 mcg/kg/min, OR if noradrenaline/adrenaline infusion rate has increased by more than 25% in the last 6 hours, dose must be <0.1 mcg/kg/min.
5. most recent cardiac index = 2.0 L/min/m2 (where measured)
6. no current requirement for VA ECMO
4. Sufficient respiratory stability to make mobilisation potentially possible, as indicated by:
1. current FiO2 = 0.6
2. current PEEP = 16 cm H20
3. an absence of current requirement for NO, prone ventilation, neuromuscular blockers, ventilation, prostacyclin, VV ECMO or HFOV
4. current RR = 45 bpm
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Dependent for activities of daily living in the month prior to current ICU admission (gait aids are acceptable).
2. Documented cognitive impairment.
3. Proven or suspected acute primary brain pathology (e.g. traumatic brain injury, stroke, hypoxic brain injury).
4. Proven or suspected spinal cord injury or other neuromuscular disease that will result in permanent or prolonged weakness (not including ICU acquired weakness).
5. Has rest in bed orders and/or has bilateral non-weight bearing orders for the lower limbs.
6. Life expectancy less than 180 days due to a chronic or underlying medical condition.
7. Death is deemed inevitable as a result of the current illness and either the patient or treating clinical or substitute decision maker are not committed to full active treatment.
8. Unable to communicate in the official local language.
9. This is not the first ICU admission in the index hospital admission.
10. Fulfilled all inclusion criteria and none of the exclusion criteria = 72 hours
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
28/02/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
10/11/2022
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Sample size
Target
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Accrual to date
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Final
750
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,TAS,VIC,WA
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Recruitment hospital [1]
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Royal Prince Alfred Hospital - Camperdown
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St George Hospital - Sydney
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John Hunter Hospital - Sydney
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Royal North Shore Hospital - Sydney
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Wollongong Hospital - Wollongong
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Sunshine Coast University Hospital - Birtinya
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Mater Health - Brisbane
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Mater Private Hospital - Brisbane
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Caboolture Hospital - Caboolture
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The Prince Charles Hospital - Chermside West
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Redcliffe Hospital - Redcliffe
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Rockhampton Hospital - Rockhampton
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Toowoomba Hospital - Toowoomba
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Princess Alexandra Hospital - Woolloongabba
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Royal Adelaide Hospital - Adelaide
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Launceston General Hospital - Launceston
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Geelong Hospital - Barwon Health - Geelong
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St Vincent's Hospital Melbourne - Melbourne
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Austin Health - Melbourne
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Cabrini Health - Melbourne
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Epworth Richmond - Melbourne
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Western Health - Melbourne
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Alfred Hospital - Prahran
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Sir Charles Gairdner Hospital - Nedlands
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Fiona Stanley Hospital - Perth
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Royal Perth Hospital - Perth
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St John of God Hospital - Subiaco
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Recruitment hospital [28]
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Royal Melbourne Hospital - Melbourne
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Recruitment postcode(s) [1]
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2050 - Camperdown
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Recruitment postcode(s) [2]
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2217 - Sydney
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Recruitment postcode(s) [3]
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- Sydney
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- Wollongong
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Recruitment postcode(s) [5]
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- Birtinya
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- Brisbane
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- Caboolture
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- Chermside West
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- Redcliffe
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- Rockhampton
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- Toowoomba
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- Woolloongabba
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- Adelaide
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- Launceston
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3220 - Geelong
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Recruitment postcode(s) [16]
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3065 - Melbourne
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Recruitment postcode(s) [17]
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- Melbourne
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Recruitment postcode(s) [18]
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3004 - Prahran
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Recruitment postcode(s) [19]
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- Nedlands
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Recruitment postcode(s) [20]
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6150 - Perth
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Recruitment postcode(s) [21]
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- Perth
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Recruitment postcode(s) [22]
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- Subiaco
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Recruitment outside Australia
Country [1]
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Germany
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Berlin
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Germany
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Leipzig
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Germany
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Munich
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Ireland
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Dublin
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Ireland
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Galway
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Ireland
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Tallaght
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New Zealand
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Auckland
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New Zealand
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Hamilton
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New Zealand
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Tauranga
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New Zealand
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Wellington
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United Kingdom
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Bristol
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United Kingdom
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Frimley
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United Kingdom
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Lewisham
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United Kingdom
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London
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United Kingdom
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Nottingham
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United Kingdom
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Reading
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United Kingdom
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Swansea
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United Kingdom
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Truro
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United Kingdom
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State/province [19]
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Woolwich
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Funding & Sponsors
Primary sponsor type
Other
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Name
Australian and New Zealand Intensive Care Research Centre
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Address
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Other collaborator category [1]
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Other
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Name [1]
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National Health and Medical Research Council, Australia
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Address [1]
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Other collaborator category [2]
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Other
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Name [2]
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ANZICS Clinical Trials Group
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Address [2]
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Other collaborator category [3]
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Other
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Name [3]
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Medical Research Institute of New Zealand
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Address [3]
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Other collaborator category [4]
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Other
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Name [4]
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Intensive Care National Audit & Research Centre
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Address [4]
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Ethics approval
Ethics application status
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Summary
Brief summary
The aim of this study is to evaluate the effect of early activity and mobilisation during prolonged IMV on the composite outcome "days alive and out of hospital to day 180". The effect of the intervention on mortality, physical, cognitive and psychological function at 180 days, as well as cost-effectiveness of the intervention, will also be evaluated. The study will also explore process of care measures and baseline physiology and ICU mobility outcomes. The hypothesis is that, in ICU patients expected to require prolonged IMV, early activity and mobilisation increases the number of days alive and at home to day 180 when compared with standard care.
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Trial website
https://clinicaltrials.gov/study/NCT03133377
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Trial related presentations / publications
Hodgson CL, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, Gabbe B, Harrold M, Higgins A, Iwashyna TJ, Papworth R, Parke R, Patman S, Presneill J, Saxena M, Skinner E, Tipping C, Young P, Webb S; Trial of Early Activity and Mobilization Study Investigators. A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in the ICU. Crit Care Med. 2016 Jun;44(6):1145-52. doi: 10.1097/CCM.0000000000001643. Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017 Feb;43(2):171-183. doi: 10.1007/s00134-016-4612-0. Epub 2016 Nov 18. Iwashyna TJ, Hodgson CL. Early mobilisation in ICU is far more than just exercise. Lancet. 2016 Oct 1;388(10052):1351-1352. doi: 10.1016/S0140-6736(16)31745-7. No abstract available. TEAM Study Investigators and the ANZICS Clinical Trials Group; Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med. 2022 Nov 10;387(19):1747-1758. doi: 10.1056/NEJMoa2209083. Epub 2022 Oct 26.
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Public notes
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Contacts
Principal investigator
Name
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Carol Hodgson, Prof
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Address
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ANZIC-RC
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03133377