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Exploring axial muscle performance with the supine bridging activity across critical illness recovery: A prospective observational study
(Medwave Estudios Limitada, 2025-10-23)
Juan Enrique Lee-Goic
;
Felipe Muñoz-Muñoz
;
Cristofer Hermosilla
;
Nicole Peña-Leon
;
Felipe Castillo-Merino
<jats:p>Introduction Limb and respiratory muscle weakness acquired in the intensive care unit (ICU) are commonly associated with long-term functional impairments. However, the extent to which axial muscles might be affected remains poorly understood. Therefore, this study aims to explore the association between axial muscle performance assessed through a supine bridging activity and physical function across critical illness recovery. Secondarily, we investigated the predictability of the supine bridging activity with the walking ability. Methods Prospective observational study of patients who walked independently before admission and were mechanically ventilated for 48 hours in a Chilean medical ICU. The assessment session, conducted on awakening, ICU discharge, and high-dependency unit (HDU) discharge, included the supine bridging activity (performance scored from 0 to 5, with higher scores representing better performance, and lifting duration in seconds) and walking ability. Performance over-time was compared by Friedman’s test for multiple comparisons (Bonferroni corrections). Logistic regressions were used to explore the association of supine bridging activity with in-hospital walking ability. We also produced a Receiver Operating Characteristic curve for the predictability of walking ability. Results We enrolled 33 adults, completing 86 supine bridging activity assessments across time points. Supine bridging activity performance improved significantly over time, with a median (P25 to P75) of 2 (1 to 4) on awakening, 3 (1 to 5) at ICU discharge, and 5 (2 to 5) at HDU discharge (p<0.001). Higher supine bridging activity scores on awakening were associated with a significantly higher likelihood of walking at HDU discharge (odds ratio). Lifting >14.5 seconds during the supine bridging activity at awakening predicted walking ability at HDU discharge (area under the curve=0.77). Conclusions Supine bridging activity performance on awakening was associated with walking ability post ICU discharge, with potential implications on rehabilitation interventions aimed at improving axial muscle strength from early stages of critical illness.</jats:p>
2
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Visual attention during non-immersive virtual reality balance training in older adults with mild to moderate cognitive impairment: an eye-tracking study
(Frontiers Media SA, 2025-10-21)
Marcos Maldonado-Díaz
;
Gonzalo Jara-Vargas
;
Felipe González-Seguel
Older adults with cognitive impairment often present with balance deficits, reduced walking speed, and attentional difficulties—particularly in executive function. These challenges increase fall risk and complicate traditional rehabilitation approaches. Eye-tracking technology offers an objective way to evaluate attention by analyzing oculomotor behavior during tasks, but its use in clinical rehabilitation contexts is still limited.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>The aim of this study is to investigate visual attention using eye-tracking metrics during a non-immersive virtual reality-based balance training program in older adults with mild to moderate cognitive impairment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was an exploratory pilot study with a prospective, descriptive cohort, based on a non-controlled, quasi-experimental design of seven older adults with mild to moderate cognitive impairment. Each patient underwent VR-based balance training using Rehametrics<jats:sup>®</jats:sup> software, while their attention was assessed via eye-tracking (Tobii Pro TX300). Clinical assessments included the Mini-BESTest, Functional Gait Assessment, 6-Minute Walk Test, 4-Meter Walk Test, and Montreal Cognitive Assessment (MoCA). Eye-tracking data focused on fixation patterns, microsaccades, and pupil diameter as indicators of attentional processing.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Patients showed a small numerical increase, without reaching statistical significance in task difficulty progression (<jats:italic>p</jats:italic> = 0.016), lower limb endurance (<jats:italic>p</jats:italic> = 0.016), and single-leg support time (<jats:italic>p</jats:italic> = 0.031). Clinical tests revealed a slight increase, though results were not statistically significant in balance and walking speed (<jats:italic>p</jats:italic> = 0.063). Eye-tracking data indicated increased fixation stability and decreased pupil diameter, suggesting more efficient attention allocation during motor tasks.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Eye-tracking provided valuable metrics into attentional behavior during balance training in older adults with cognitive impairment. Its integration into non-immersive virtual reality rehabilitation may help better understand and address cognitive-motor interactions. Further studies with larger samples are needed to confirm these preliminary findings.
Scopus© Citations 2 1
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Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study
(2024)
Felipe Muñoz-Muñoz
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LEPPE ZAMORA, JAIME ESTEBAN
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Felipe González-Seguel
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CASTRO AVILA, ANA CRISTINA
<jats:p>Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.</jats:p>
Scopus© Citations 2 2
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Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review
(2024)
Felipe González-Seguel
;
Renato Letelier-Bernal
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (&gt;48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IGs) and the comparator groups (CGs) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n = 7), progressive mobility (n = 6), leg cycling (n = 3), tilt table (n = 1), and multicomponent (n = 6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG.</jats:p> </jats:sec> <jats:sec> <jats:title>Impact</jats:title> <jats:p>The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit.</jats:p> </jats:sec>
19Scopus© Citations 10
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Evaluación del funcionamiento físico en cuidados críticos: encuesta nacional en más de 90 centros chilenos durante la pandemia por COVID-19
(2022)
Felipe González-Seguel
;
Camilo Cáceres-Parra
16Scopus© Citations 1
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Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults
(2022)
Felipe González-Seguel
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Agustín Camus-Molina
;
Macarena Leiva-Corvalán
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Kirby P. Mayer
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LEPPE ZAMORA, JAIME ESTEBAN
<jats:sec> <jats:title>Purpose:</jats:title> <jats:p>We evaluated the feasibility of quantification of physical activity (PA) and sedentary behaviors (SB) using actigraphy during an entire intensive care unit (ICU) length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A prospective study was performed in a 12-bed ICU. Triaxial accelerometers were fitted on the right ankle of mechanically ventilated adults. Twenty accelerometers were available to guarantee uninterrupted actigraphy recording 24 hours/day. Data were analyzed: (1) between awakening and ICU discharge to quantify daytime PA/SB and (2) between admission and ICU discharge to quantify day/nighttime inactivity. Secondarily, we assessed the relationship between inactivity/SB and clinical variables.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Thirty patients were enrolled, obtaining 5477 recording hours. No patient reported discomfort or injury. The median (min-max) delay time between admission and accelerometer installation was 2.1 (0.0-11.9) hours. Actigraphy recording duration was 5.4 (2.2-34.4) days. The time spent in SB and PA (percentage of minutes per hour) was 94.7% and 5.3%, respectively. PA was stratified by light, moderate, and vigorous levels equating to 91.8%, 7.7%, and 0.5%, respectively. Inactivity time (<jats:italic toggle="yes">r</jats:italic> = 0.991, <jats:italic toggle="yes">P</jats:italic> ≤ .001) and SB (<jats:italic toggle="yes">r</jats:italic> = 0.859, <jats:italic toggle="yes">P</jats:italic> ≤ .001) were strongly correlated with ICU length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Quantifying PA levels with continuous monitoring through actigraphy is feasible, demonstrating prolonged periods of inactivity/SB. This study highlights that uninterrupted actigraphy could contribute to pursuing the optimal dose and the intervention fidelity of the ICU mobilization in the subsequent clinical trials.</jats:p> </jats:sec>
1
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Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults
(2022)
Felipe González-Seguel
;
Agustín Camus-Molina
;
Macarena Leiva-Corvalán
;
Kirby P. Mayer
;
Jaime Leppe
<jats:sec> <jats:title>Purpose:</jats:title> <jats:p>We evaluated the feasibility of quantification of physical activity (PA) and sedentary behaviors (SB) using actigraphy during an entire intensive care unit (ICU) length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A prospective study was performed in a 12-bed ICU. Triaxial accelerometers were fitted on the right ankle of mechanically ventilated adults. Twenty accelerometers were available to guarantee uninterrupted actigraphy recording 24 hours/day. Data were analyzed: (1) between awakening and ICU discharge to quantify daytime PA/SB and (2) between admission and ICU discharge to quantify day/nighttime inactivity. Secondarily, we assessed the relationship between inactivity/SB and clinical variables.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Thirty patients were enrolled, obtaining 5477 recording hours. No patient reported discomfort or injury. The median (min-max) delay time between admission and accelerometer installation was 2.1 (0.0-11.9) hours. Actigraphy recording duration was 5.4 (2.2-34.4) days. The time spent in SB and PA (percentage of minutes per hour) was 94.7% and 5.3%, respectively. PA was stratified by light, moderate, and vigorous levels equating to 91.8%, 7.7%, and 0.5%, respectively. Inactivity time (<jats:italic toggle="yes">r</jats:italic> = 0.991, <jats:italic toggle="yes">P</jats:italic> ≤ .001) and SB (<jats:italic toggle="yes">r</jats:italic> = 0.859, <jats:italic toggle="yes">P</jats:italic> ≤ .001) were strongly correlated with ICU length of stay.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Quantifying PA levels with continuous monitoring through actigraphy is feasible, demonstrating prolonged periods of inactivity/SB. This study highlights that uninterrupted actigraphy could contribute to pursuing the optimal dose and the intervention fidelity of the ICU mobilization in the subsequent clinical trials.</jats:p> </jats:sec>
2
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Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol
(2023)
Ruvistay Gutierrez-Arias
;
Dawid Pieper
;
Peter Nydahl
;
Felipe González-Seguel
;
Yorschua Jalil
<jats:sec><jats:title>Introduction</jats:title><jats:p>Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence-Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>osf.io/kxwq9.</jats:p></jats:sec>
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Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS
(2021)
Felipe González-Seguel
;
Juan José Pinto-Concha
;
Nadine Aranis
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LEPPE ZAMORA, JAIME ESTEBAN
6Scopus© Citations 30
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Effectiveness of physical rehabilitation interventions in critically ill patients—A protocol for an overview of systematic reviews
(2023)
Ruvistay Gutierrez-Arias
;
Peter Nydahl
;
Dawid Pieper
;
Felipe González-Seguel
;
Yorschua Jalil
<jats:sec id="sec001"> <jats:title>Introduction</jats:title> <jats:p>Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Discussion</jats:title> <jats:p>The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Registration number</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023389672" xlink:type="simple">CRD42023389672</jats:ext-link>.</jats:p> </jats:sec>
20Scopus© Citations 1

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