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Critically Ill, Mechanically VentilatedPhase 3TEAM(III)NCT03133377

Treatment of Invasively Ventilated Adults With Early Activity and Mobilisation

A Phase 3 study testing Early activity and mobilisation in people with Critically Ill, Mechanically Ventilated, run by Australian and New Zealand Intensive Care Research Centre at 49 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial 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… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Critically Ill, Mechanically Ventilated
What is being tested?
Early activity and mobilisation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
750 participants
Where
49 sitesin 5 countries
Study dates
28 Feb 2018to 10 Nov 2022
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18 years or older.
  • Intubated and expected to remain invasively mechanically ventilated the day after tomorrow.
  • Sufficient cardiovascular stability to make mobilisation potentially possible, as indicated by:
  • the absence of current brady-arrhythmia requiring pharmacological support
  • a current ventricular rate ≤ 150 bpm
  • most recent lactate ≤ 4.0 mmol/L
Show all 14Show fewer
  • 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.
  • most recent cardiac index ≥ 2.0 L/min/m2 (where measured)
  • no current requirement for VA ECMO
  • Sufficient respiratory stability to make mobilisation potentially possible, as indicated by:
  • current FiO2 ≤ 0.6
  • current PEEP ≤ 16 cm H20
  • an absence of current requirement for NO, prone ventilation, neuromuscular blockers, ventilation, prostacyclin, VV ECMO or HFOV
  • current RR ≤ 45 bpm

Who cannot join

  • Dependent for activities of daily living in the month prior to current ICU admission (gait aids are acceptable).
  • Documented cognitive impairment.
  • Proven or suspected acute primary brain pathology (e.g. traumatic brain injury, stroke, hypoxic brain injury).
  • Proven or suspected spinal cord injury or other neuromuscular disease that will result in permanent or prolonged weakness (not including ICU acquired weakness).
  • Has rest in bed orders and/or has bilateral non-weight bearing orders for the lower limbs.
  • Life expectancy less than 180 days due to a chronic or underlying medical condition.
Show all 10Show fewer
  • 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.
  • Unable to communicate in the official local language.
  • This is not the first ICU admission in the index hospital admission.
  • Fulfilled all inclusion criteria and none of the exclusion criteria ≥ 72 hours

Trial locations and contacts

49 sites in 5 countries.

49 sites in 5 countries

Australia28 sites
  • Royal Adelaide Hospital

    Adelaide, South Australia

  • Sunshine Coast University Hospital

    Birtinya, Queensland

  • Mater Health

    Brisbane, Queensland

  • Mater Private Hospital

    Brisbane, Queensland

  • Caboolture Hospital

    Caboolture, Queensland

  • Royal Prince Alfred Hospital

    Camperdown, New South Wales, 2050

  • The Prince Charles Hospital

    Chermside West, Queensland

  • Geelong Hospital - Barwon Health

    Geelong, Victoria, 3220

  • Launceston General Hospital

    Launceston, Tasmania

  • St Vincent's Hospital Melbourne

    Melbourne, Victoria, 3065

  • Austin Health

    Melbourne, Victoria

  • Cabrini Health

    Melbourne, Victoria

  • Epworth Richmond

    Melbourne, Victoria

  • Western Health

    Melbourne, Victoria

  • Royal Melbourne Hospital

    Melbourne

  • Sir Charles Gairdner Hospital

    Nedlands, Western Australia

  • Fiona Stanley Hospital

    Perth, Western Australia, 6150

  • Royal Perth Hospital

    Perth, Western Australia

  • Alfred Hospital

    Prahran, Victoria, 3004

  • Redcliffe Hospital

    Redcliffe, Queensland

  • Rockhampton Hospital

    Rockhampton, Queensland

  • St John of God Hospital

    Subiaco, Western Australia

  • St George Hospital

    Sydney, New South Wales, 2217

  • John Hunter Hospital

    Sydney, New South Wales

  • Royal North Shore Hospital

    Sydney, New South Wales

  • Toowoomba Hospital

    Toowoomba, Queensland

  • Wollongong Hospital

    Wollongong, New South Wales

  • Princess Alexandra Hospital

    Woolloongabba, Queensland

Other trials in Australia

United Kingdom9 sites
  • Bristol Royal Infirmary

    Bristol

  • Frimley Park Hospital

    Frimley

  • University Hospital Lewisham

    Lewisham

  • King's College Hospital

    London

  • Nottingham University Hospitals

    Nottingham

  • Royal Berkshire Hospital

    Reading

  • Morriston Hospital

    Swansea

  • Royal Cornwall Hospital

    Truro

  • Queen Elizabeth Hospital Woolwich

    Woolwich

Other trials in United Kingdom

New Zealand5 sites
  • Auckland City Hospital (CVICU)

    Auckland

  • Auckland City Hospital (DCCM)

    Auckland

  • Waikato Hospital

    Hamilton

  • Tauranga Hospital

    Tauranga

  • Wellington Hospital

    Wellington

Other trials in New Zealand

Ireland4 sites
  • Beacon Hospital

    Dublin

  • St Vincent's Hospital

    Dublin

  • Galway Hospital

    Galway

  • Tallaght Hospital

    Tallaght

Other trials in Ireland

Germany3 sites
  • The Charité

    Berlin

  • Universitätsklinikum Leipzig

    Leipzig

  • Klinikum rechts der Isar der Technischen Universität Mϋnchen

    Munich

Other trials in Germany

About this study

Official 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

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.

Read the detailed description

The TEAM Trial is a definitive phase III multi-centre randomised controlled trial in mechanically ventilated patients. Supported by compelling preliminary data, the trial will determine whether early activity and mobilisation during mechanical ventilation improves days alive and at home at 6 months compared to standard care. Recruiting 750 patients, this will be the largest trial ever conducted of early mobilisation.

Patients allocated to the early activity and mobilisation protocol (intervention group) will be assessed by a physiotherapist daily during the ICU stay to determine the highest level of mobility. This will determine the dosage and type of exercise that will be delivered, led by the physiotherapist with assistance from the multidisciplinary team. For both groups, concomitant care will be guided by the treating clinician. In addition, all post-ICU patient management will be at the discretion of the patient's ward-based treating physicians.

Patients will be randomized via web-based system and de-identified data will be collected on the following: baseline demographics; comorbidities; sedatives, analgesics, corticosteroids and neuromuscular blockers; pain/sedation/delirium scores; tracheostomy, intubation and renal replacement therapy. The intervention will be administered during the ICU stay upto 28days and the Day 180 follow up will be conducted centrally.

Being tested
Early activity and mobilisation
Keywords
Early activity and mobilization, rehabilitation, intensive care
Medical subject headings
Critical Illness, Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Early activity and mobilisationBehavioural

    The early activity and mobilisation intervention is comprised of exercises based on a reproducible, physiological approach using both strength and functional activities

Study groups in NCT03133377
Study groupRoleWhat they receive
Early activity and Mobilisation interventionExperimentalPatients 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.
Receives: Behavioral: Early activity and mobilisation
Standard of careNo interventionThe 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.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of days alive and out of hospital

    Any days spent in rehabilitation or a nursing home counted as days in hospital

    Measured: between randomisation and 180 days

Secondary outcomes (7)
  1. All-cause mortality

    Measured: From date of randomisation up to180days.

  2. Time from randomisation until death

    Measured: From date of randomisation unitl date of death from all cause, censored at 180days

  3. Ventilator-free days

    patients who die prior to day 28 will be assigned zero ventilator-free days

    Measured: From date of randomisation until day 28

  4. ICU-free days

    patients who die prior to day 28 will be assigned zero ICU-free days

    Measured: From date of randomisation until day 28

  5. Quality of life and health status measured using the European Quality of Life 5 Dimensions 5 Level (EQ5D-5L)

    Measured: Assessed at 180days

  6. Independent activities of daily living measured with Barthel Activities of Daily Living (ADL) Index and The Lawton Instrumental Activities of Daily Living Scale (IADL)

    Measured: Assessed at 180days

  7. Generic function and disability measured with the World Health Organisation's Disability Assessment Schedule (WHODAS)

    Measured: Assessed at 180days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Apr 2017
  2. Study start28 Feb 2018
  3. Primary completion18 May 2022
  4. Study completion10 Nov 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
750 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03133377
Sponsor's protocol ID
TEAM U1111-1195-3567
Acronym
TEAM(III)
Status last verified
Dec 2023
First submitted
10 Apr 2017
Last updated
18 Dec 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

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.

    PubMed 26968024
  • 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.

    PubMed 27864615
  • 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.

    PubMed 27707476
  • Higgins AM, Lee YY, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ, Hodgson CL; Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) Study Investigators. The Cost-Effectiveness of Early Active Mobilization During Mechanical Ventilation in the ICU: An Economic Evaluation Alongside the Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) Trial. Crit Care Med. 2025 Sep 1;53(9):e1725-e1735. doi: 10.1097/CCM.0000000000006715. Epub 2025 May 27.

    PubMed 40439527
  • Broadley T, Serpa Neto A, Bailey M, Bellomo R, Brickell K, Buhr H, Gabbe BJ, Gould DW, Harrold M, Hurford S, Iwashyna TJ, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ, Higgins AM, Hodgson CL; TEAM Trial Investigators. Adverse events during and after early mobilisation: A post hoc analysis of the TEAM trial. Aust Crit Care. 2025 May;38(3):101156. doi: 10.1016/j.aucc.2024.101156. Epub 2025 Jan 17.

    PubMed 39826257
  • Presneill JJ, Bellomo R, Brickell K, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna T, Neto AS, Nichol A, Schaller SJ, Sivasuthan J, Tipping C, Webb S, Young P, Hodgson CL; TEAM Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. Crit Care Resusc. 2023 Oct 18;23(3):262-272. doi: 10.51893/2021.3.OA3. eCollection 2021 Sep 6.

    PubMed 38046085
  • 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.

    PubMed 36286256

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Early activity and mobilisation in people with Critically Ill, Mechanically Ventilated, run by Australian and New Zealand Intensive Care Research Centre at 49 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 14 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 49 sites in Australia, United Kingdom, New Zealand, Ireland, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of days alive and out of hospital (time frame: between randomisation and 180 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03133377, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Dec 2023.

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