Mechanical VentilationREPOrtNCT07093125
Rehabilitation Practices in Critically Ill Patients Receiving Invasive Mechanical Ventilation in the Intensive Care Unit.
An observational study of Mechanical Ventilation and Pulmonary Rehabilitation, run by Universita degli Studi di Genova at 1 site in Italy.
Trial summary
This international, multicenter, observational study aims to describe rehabilitation practices in Intensive Care Units (ICUs) worldwide. The primary objective is to provide an overview of current rehabilitation strategies used in ICUs globally. Read more about this study
- Who is it for?
- Ages 16 to 100 years
- Conditions the study is for
- Mechanical Ventilation, Pulmonary Rehabilitation, Intensive Care Units (ICUs)
- How many people
- 2,400 participants
- Where
- 1 siteItaly
- Study dates
- 1 Oct 2025to 1 Oct 2029
- How long will I take part?
- 28 Days
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
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 16 to 100 years
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: The study population will comprise adult patients admitted to Intensive Care Units (ICUs) located in cities and countries participating in the study. Eligible patients will be adult patients requiring invasive mechanical ventilation for at least 48 hours and who can be candidate for rehabilitation during ICU stay. Enrolment will be conducted in accordance with applicable local regulations, including the provision of informed consent by the patient or their legally authorized representative.
Who may be able to join
- Patients admitted to a participating ICU
- Adult patients (aged 16 years or older, depending on local regulations for the definition of "adults")
- Patients who have received invasive ventilation for at least 48 hours
- Patients who have obtained written informed consent from the patient or next of kin (if local legislation demands so)
Who cannot join
- Patients admitted for withdrawn of life sustain therapy
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Marcus J Schultz, MD, PhD contact
Italy1 site, 1 recruiting
- Recruiting
IRCCS Ospedale Policlinico San Martino
Genova, Italy, 16132
Denise Battaglini, MD, PhD, +39 010 5554970, denise.battaglini@unige.it
Denise Battaglini, MD, PhD
About this study
Official title: An Observational Study on Rehabilitation Practices in the ICU for Critically Ill Patients Undergoing Invasive Mechanical Ventilation - Report (REPOrt)
This international, multicenter, observational study aims to describe rehabilitation practices in Intensive Care Units (ICUs) worldwide.
The primary objective is to provide an overview of current rehabilitation strategies used in ICUs globally.
Read more
Secondary objectives include assessing the relationship between rehabilitation and key ICU outcomes such as ICU and hospital mortality, length of stay, duration of invasive ventilation, extubation failures, and long-term outcomes including quality of life and functional performance 28 days post-ICU discharge.
The study will also compare rehabilitation practices across different geographic and economic regions to identify potential disparities. The study is structured into three modules, with participation contingent on local resources and feasibility.
The BASIC Module (mandatory for all centers) gathers fundamental data on rehabilitation practices and their association with patient outcomes.
The EXTENDED Module (optional) collects more detailed information on the type, timing, duration, and safety of rehabilitation interventions, including passive exercises, active mobilization, respiratory therapies, dysphagia training, occupational therapy, and cognitive support.
The EXTENDED FOLLOW-UP Module (optional) evaluates the patient's quality of life and functional recovery 28 days after ICU discharge. By examining global rehabilitation practices and their impact on patient outcomes, this study aims to improve rehabilitation strategies in ICUs, contributing to better patient care, recovery, and long-term health outcomes.
Read the detailed description
- Background --- Critically ill patients often develop intensive care unit (ICU)-acquired weakness (AW), which is defined as clinically detectable weakness without any other plausible explanation. Approximately 40% of these patients experience ICU-AW, associated with higher mortality and long-term morbidity. Early mobilization is an effective rehabilitation strategy that improves both short- and long-term outcomes, reducing hospital stays and enhancing functional recovery. Various rehabilitation interventions-such as mobilization, exercise, respiratory physiotherapy, dysphagia training, occupational therapy, physical activity, and cognitive support-are beneficial but remain underused due to resource limitations. Studies demonstrate improved outcomes with these interventions, emphasizing the role of rehabilitation professionals in the ICU. However, some studies question the effectiveness of these time-consuming and labor-intensive measures, indicating a need for further research. Identifying patient characteristics and detailed intervention information (modality, duration, intensity, frequency) is crucial for effective therapy prescription. The study aims to investigate rehabilitation practices in ICUs globally, focusing on critically ill patients on invasive ventilation who often develop ICU-acquired weakness (ICU-AW). This condition is associated with increased mortality and long-term morbidity. Rehabilitation interventions, including mobilization, physical activity, respiratory physiotherapy, and cognitive support, have shown benefits but remain underutilized.
- Methods --- Study Design and Setting ---- REPOrt is a prospective, international, multicenter, observational cohort study in critically ill invasively ventilated patients, utilizing three modules in which centers can participate, contingent on local capabilities. The practice of rehabilitation can only be studied reliably through a prospective observational study. The study enrollment is planned to start in 2025; the total enrollment period will be 120 days per center. This study will be conducted with the support of the Protective Ventilation Network (PROVE Network) (www.provenetwork.org), in partnership with national and international ICU societies and research institutions. Potentially interested ICUs will be identified. All ICUs that care for adult critically ill invasively ventilated patients can participate in REPOrt. If a hospital has more than one ICU, each ICU can participate as long as patients cared for are adults > 16 years of age (or >18, depending on local rules). The Research Office will handle the list of participating locations as well as the list of primary investigators from each participating institution. Each center interested in participation must submit the study for approval to the local IRB. Adherence to local legislation concerning informed consent will be ensured, including protocols for determining who may provide informed consent in cases where a patient is deemed incapable of doing so themselves. Since this is an observational study, concomitant participation and institutional enrollment in other observation and intervention studies are acceptable.
- Participants --- Patients are eligible for participation if they are admitted to a participating ICU; are adult patients according to local regulations (e.g., aged >16 or >18 depending on local rules); have received invasive ventilation for at least 48 hours; and after written informed consent from the patient or next of kin has been obtained (depending on legislation, and only if rules demand so). Exclusion criteria include withdrawal of life-sustaining treatment.
- Aims of the study and evaluation items --- The primary aim is to describe rehabilitation prevalence and practices in ICUs worldwide. --- Secondary aims include determining the association of rehabilitation and respiratory physiotherapy with typical ICU outcomes, including ICU and hospital length of stay; ICU and hospital mortality; duration of mechanical ventilation, expressed as ventilator-free days and alive at day 28 after ICU admission; and functional outcomes. Additional aims include determining the association of rehabilitation and respiratory physiotherapy with quality of life and functional performance at 28 days after ICU discharge.
- Endpoints --- - Basic information on rehabilitation practices and ICU outcomes (length of stay, duration of ventilation, complications, death). - Granular data on rehabilitative interventions (type, timing, duration, deliverers, safety assessment). - Quality of life and functional performance at 28 days after ICU discharge.
- Data sources and measurements --- Data collected in the study will be captured on an electronic case report form (eCRF) developed in the REDCAP Platform, using an identity code (pseudonym) for patients from countries governed by the General Data Protection Regulation (GDPR) (i.e., European countries). After a patient's eCRF is finalized and approved by the local investigator, anonymization occurs: the identification number is removed, making it impossible to trace back to the patient. Data obtained in the research will be placed immediately into a separate online database for individuals from countries not subjected to the laws.
- Data Collection --- The following data will be collected: - ICU Admission (Day 0): [patient baseline information \& pre-hospital status; essential pre-hospital features including SAPS II score; Sequential Organ Failure Assessment (SOFA Score); invasive and non-invasive mechanical ventilation settings; sedation \& muscle relaxants; vital signs; temperature; arterial blood gas analysis; delirium and pain assessment; hemodynamic monitoring; general rehabilitation assessment]. - During ICU Stay (Days 0, 3, 7, 14, and ICU discharge): [level of cooperation: S5Q scale; muscle strength using MRC scale; daily intervention duration; types of interventions: passive and active interventions; respiratory physiotherapy specifics; monitoring serious adverse events during interventions]. - ICU Discharge: [outcome assessment: patient pronation; ventilator weaning; airway management; monitoring for any ICU complications]. - 28-Day Follow-Up (Day 28): [post-discharge location; evaluate living arrangements; health assessments; clinical frailty scale; quality of life assessments using the EQ-5D-5L scale; and Modified Rankin Scale (mRS); mortality assessment]. This study is divided into three modules, according to the different aims described above: - BASIC module - to capture basic information on rehabilitation practice worldwide and simple ICU and hospital outcomes, including length of stay in ICU and hospital; duration of ventilation and weaning; airway management; ICU complications, and death. - EXTENDED module - to capture granular data on type, timing, and duration of rehabilitative interventions, who delivers them, and safety assessment. In this module, the focus is on the following rehabilitation interventions: passive interventions (passive exercises, stretching, cycling, electro muscular stimulation, continuous passive motion, etc.); active interventions (exercise therapy, activities of daily living training, mobilization, cycling, etc.); active and passive respiratory physiotherapy (positioning, airways clearance techniques, lung expansion exercises, end-positive airway pressure devices, active cycle of breathing techniques, forced expiratory techniques, assisted or stimulated cough maneuvers, insufflation/exsufflation, inhaled therapy, etc.); and adjunctive techniques (dysphagia training, swallow screening test, cognitive/psychological therapy). - EXTENDED FOLLOW-UP module - to capture quality of life and functional performance at 28 days after ICU discharge.
- Methods for Center Recruitment, Patient Enrollment, and Bias Prevention --- Center Recruitment --- Participating centers will be recruited through a combination of formal private invitations, leveraging established networks from previous studies, and utilizing personal connections within the field of intensive care and rehabilitation. This multi-faceted approach aims to ensure a diverse representation of centers across Europe and beyond, including both large and small institutions.
- Enrollment Strategy --- Invasively ventilated patients will be screened for eligibility over a predefined period of 120 days, with enrollment managed by each center according to local coordinator preferences. Each participating center is expected to enroll between 20 and 40 patients, helping to achieve a comprehensive sample size of approximately 1,200 to 2,400 patients across 60 centers. This range ensures sufficient data to analyze various rehabilitation practices and their clinical outcomes while minimizing the risk of bias.
- Preventing Bias --- To prevent bias from larger centers that may dominate the study, strategies will include: 1) capped enrollment; and 2) diverse center selection.
- Sample Size --- Considering the exploratory nature of this global study and to ensure robust findings, the aim is to enroll approximately 1,200 to 2,400 patients across 60 participating centers. The sample size is based on epidemiological assumption that around 40% of invasively ventilated patients receive rehabilitation. Considering a +/- 2 margin or error, a minimum 2,305 patients are required. Accounting for an anticipated 5% dropout rate, the target enrollment increases to 2,426 patients, which is rounded to 2,400 for practical purposes.
- Statistical Analysis --- A detailed statistical analysis plan is available in the approved protocol.
- Monitoring and Reporting --- National coordinators will oversee the integrity of ethical approval for their country, the data collected, ensuring adherence to standardized protocols and regulations, ensuring compliance with study protocols, and maintaining data integrity. Regular communication will be established among centers to monitor enrollment progress and address any disparities. National coordinators will facilitate communication between centers and provide support for patient enrollment. Each center will designate a lead investigator to oversee local recruitment efforts and ensure accurate data collection. Lead investigators will be responsible for providing ethical approval to the national coordinator and reporting enrollment numbers and any challenges faced during the process.
- Data Validation and Registry Procedures --- To ensure high data quality and reliability of findings, a multi-tiered data validation process will be implemented. These procedures include: 1) Automated data validation rules, including logic checks programmed into the electronic data capture system to validate data entries at the point of data capture: Range checks (e.g., systolic blood pressure between 70-250 mmHg); Format checks (e.g., dates in YYYY-MM-DD format); and Required field enforcement. 2) Manual data review: Periodic manual review of data entries will be conducted by data managers to identify and rectify anomalies not captured by automated rules. 3) Registry access control: Tiered access privileges will be implemented to ensure that only authorized personnel can enter, edit, or approve data.
- Site Monitoring and Auditing --- Site initiation visits may be conducted to train local site teams on study protocols, data entry procedures, and quality expectations if needed. Routine monitoring visits are planned on a remote basis and will occur at regular intervals. Key activities include: 1) Review of source documents; 2) Verification of informed consent processes; 3) Cross-checking data entered into the registry with original records. Audits will be performed to: 1) Verify compliance with study protocol, SOPs, and regulatory requirements; 2) Identify systemic issues and recommend corrective actions
- Data Checks and Consistency Rules --- The data management system will incorporate robust automated checks to identify: 1) Logical inconsistencies (e.g., a male patient marked as pregnant); 2) Temporal inconsistencies (e.g., date of diagnosis after date of death); 3) Missing or duplicate data entries; 4) Interdependent data field checks, ensuring consistency across related variables (e.g., values of Peak pressure on the ventilator above 30 cmH2O or below 10 cmH2O). All detected anomalies will generate queries for site clarification and resolution before data locking in the REDcap system.
- Source Data Verification --- To ensure accuracy and completeness, a proportion of entered data will undergo source data verification, using 1) Random sampling strategy: Some participants will be selected based on enrollment numbers and data risk profiles; 2) Verification process: Comparison of electronic registry (eCRF) data with original case report forms (oCRF), medical records, or other source documentation; 3) Documentation of discrepancies and resolution through a tracked audit trail. Electronic monitoring systems and audit trail logs will be utilized.
- Data Dictionary --- A comprehensive Data Dictionary is available in the appendix of the approved protocol and within each variable in the REDcap system. It will be implemented throughout the study and includes: 1) Variable names and descriptions with clear definitions and purposes of each data element; 2) Coding systems used [e.g., Driving pressure (DP or ΔP) indicates the difference between plateau pressure (Pplat) and positive end-expiratory pressure (PEEP) on the ventilator. Pplat is obtained with an inspiratory pause on the ventilator, to obtain the pressure at the end of inspiration when gas flow has stopped. It is measured in cmH2O]; 3) Acceptable value ranges and units (e.g., mmHg or kPa); 4) Data types and formats. The data dictionary will be updated as needed and made available to all study participants.
- Standard Operating Procedures (SOPs) --- Comprehensive SOPs will guide all aspects of registry operation and ensure consistency and regulatory compliance. Key SOPs include: 1) Patient recruitment and consent: Guidance on ethical and standardized procedures for engaging and enrolling study participants will be guaranteed, with National Coordinators responsible for ensuring consistency and compliance with local regulations; 2) Data collection and entry, including step-by-step instructions for CRF completion with clear definitions, data entry timelines, and handling of missing or ambiguous data; 3) Data management, including data cleaning, validation, backup, and storage; 4) Adverse event reporting, including reportable events, timeframes, and escalation pathways; 5) Monitoring and auditing, including site monitoring schedules, audit plans, and reporting procedures; 6) Change management: amendments to the protocol, CRFs, or registry software, including version control and stakeholder notification will be communicated to all participants regularly.
- Conditions
- Mechanical Ventilation, Pulmonary Rehabilitation, Intensive Care Units (ICUs), Quality of Life (QOL), Outcome Assessment, Extubation Failure
- Keywords
- Pulmonary rehabilitation, Mechanical Ventilation, Intensive Care Unit (ICU), Rehabilitation Outcomes
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Adult patients admitted in ICU and on mechanical ventilation for at least 48 hours | Adult patients who can be candidated to rehabilitation during ICU stay |
What is being measured
The primary outcome is the main question the study is designed to answer.
Proportion of patients receiving at least one rehabilitation intervention
Rehabilitation is defined as the delivery of at least one documented intervention during ICU stay, including passive mobilization, active mobilization, or respiratory physiotherapy (active or passive), reported as percentage (%).
Measured: From ICU admission (Day 0) until ICU discharge (up to Day 365)
Secondary outcomes (12)
Proportion of patients receiving each type of rehabilitation intervention
Percentage of patients receiving each predefined type of rehabilitation intervention, including passive mobilization, active mobilization, passive respiratory physiotherapy, active respiratory physiotherapy, occupational therapy, dysphagia management, and cognitive or psychological support. Categories are not mutually exclusive.
Measured: From ICU admission until ICU discharge (up to Day 365)
Duration of rehabilitation interventions per day (minutes)
Duration in minutes of rehabilitation interventions per day, separated into (1) mobilization and (2) respiratory physiotherapy. Minutes per day (median [IQR]).
Measured: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU length of stay
Length of stay in the ICU
Measured: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU mortality
Mortality during ICU stay
Measured: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU complications
Complications during ICU stay, expressed as percentage (%), defined as neurological complications, infective complications, respiratory complications, deep venous thrombosis, cardiovascular complications, pressure ulcers.
Measured: From ICU admission (Day 0) until ICU discharge (up to day 365)
Invasive mechanical ventilation duration during ICU stay
Duration of invasive mechanical ventilation during ICU stay
Measured: From ICU admission (Day 0) until ICU discharge (up to Day 28)
Hospital length of stay
Length of stay in the Hospital
Measured: From Hospital admission until Hospital discharge (up to Day 365)
Hospital mortality
Mortality during Hospital stay
Measured: From Hospital admission until Hospital discharge (up to Day 365)
Mortality at 28 Days post-ICU discharge
Mortality at Day 28
Measured: From ICU discharge to Day 28 post-ICU discharge
Quality of life (EQ-5D-5L scale) at 28 Days post-ICU discharge
The Quality of Life outcome will be assessed using EQ-5D-5L/EQ-VAS scale (Grade 0 to 100) where 0 corresponds to the worst health a patient can immagine and 100 corresponds to best health a patient can immagine.
Measured: From ICU discharge to Day 28 post-ICU discharge
Clinical Frailty at 28 Days post-ICU discharge
The frailty outcome will be assessed using Clinical Frailty Scale (Grade 1 to 9) where 1 corresponds to very fit and 9 corresponds to terminally ill.
Measured: From ICU discharge to Day 28 post-ICU discharge
Disability at 28 Days post-ICU discharge
Disability using modified Rankin Scale (Grade 0 to 6) where 0 indicates no symptoms and 6 indicates patient's death.
Measured: From ICU discharge to Day 28 post-ICU discharge
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Jul 2025
- Study start1 Oct 2025
- Primary completion1 Oct 2028 (estimated)
- Study completion1 Oct 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Mechanical VentilationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 2,400 participants (estimated)
- Target duration
- 28 Days
Sponsor and investigators
- Lead sponsor
- Universita degli Studi di Genova
- Sponsor type
- University, hospital or other
- Collaborators
- Amsterdam UMC, location VUmc
- Responsible party
- Principal investigator, Denise Battaglini, Universita degli Studi di Genova
- Investigators
- Denise Battaglini, MD, PhD, Principal investigator, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, ItalyMarcus J Schultz, MD, PhD, Study chair, Amsterdam University Medical Centers, Amsterdam, The NetherlandsRik Gosselink, PT, PhD, Study chair, University of Leuven, Leuven, BelgiumSabrine N.T. Hemmes, MD, PhD, Study chair, Amsterdam University Medical Centers, Amsterdam, The NetherlandsCarol L. Hodgson, PhD FACP FAHMS BAppSc(PT) MPhi, Study chair, Alfred Hospital, Melbourne, VIC, AustraliaRicardo Kenji Nawa, MD, PhD, Study chair, Hospital Israelita Albert Einstein, São Paulo, SP, BrazilIrene Schiavetti, PhD, Study chair, University of Genoa, ItalyAry Serpa Neto, MD, PhD, Study chair, Monash University, Melbourne, VIC, Australia
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07093125
- Sponsor's protocol ID
- Liguria: 419/2024 - id 14164
- Acronym
- REPOrt
- Status last verified
- Sep 2026
- First submitted
- 21 May 2025
- Last updated
- 15 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: European regulations for data sharing and privacy
Publications
Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, Schonhofer B, Stiller K, van de Leur H, Vincent JL. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. doi: 10.1007/s00134-008-1026-7. Epub 2008 Feb 19.
PubMed 18283429TEAM 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 36286256Tipping 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 27864615Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9. Epub 2009 May 14.
PubMed 19446324Van Aerde N, Meersseman P, Debaveye Y, Wilmer A, Gunst J, Casaer MP, Bruyninckx F, Wouters PJ, Gosselink R, Van den Berghe G, Hermans G. Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study. Intensive Care Med. 2020 Jun;46(6):1184-1193. doi: 10.1007/s00134-020-05927-5. Epub 2020 Jan 22.
PubMed 31970446Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008 Aug 1;178(3):261-8. doi: 10.1164/rccm.200712-1829OC. Epub 2008 May 29.
PubMed 18511703Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, Pronovost PJ, Needham DM. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med. 2014 Apr;42(4):849-59. doi: 10.1097/CCM.0000000000000040.
PubMed 24247473Appleton RT, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes: A systematic review. J Intensive Care Soc. 2015 May;16(2):126-136. doi: 10.1177/1751143714563016. Epub 2014 Dec 18.
PubMed 28979394
Study at a glance
From the registry record, last updated by the sponsor on 15 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- An Observational Study on Rehabilitation Practices in the ICU for Critically Ill Patients Undergoing Invasive Mechanical Ventilation - Report (REPOrt)
- ClinicalTrials.gov ID
- NCT07093125
- Acronym / sponsor ID
- REPOrt / Liguria: 419/2024 - id 14164
- Conditions
- Mechanical Ventilation, Pulmonary Rehabilitation, Intensive Care Units (ICUs), Quality of Life (QOL), Outcome Assessment, Extubation Failure
- Keywords
- Pulmonary rehabilitation, Mechanical Ventilation, Intensive Care Unit (ICU), Rehabilitation Outcomes
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 2,400 participants (estimated)
- Lead sponsor
- Universita degli Studi di GenovaUniversity, hospital or other
- Collaborators
- Amsterdam UMC, location VUmc
- Study start
- 1 Oct 2025 (actual)
- Primary completion
- 1 Oct 2028 (estimated)
- Study completion
- 1 Oct 2029 (estimated)
- First posted
- 30 Jul 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This international, multicenter, observational study aims to describe rehabilitation practices in Intensive Care Units (ICUs) worldwide.
The primary objective is to provide an overview of current rehabilitation strategies used in ICUs globally.
Secondary objectives include assessing the relationship between rehabilitation and key ICU outcomes such as ICU and hospital mortality, length of stay, duration of invasive ventilation, extubation failures, and long-term outcomes including quality of life and functional performance 28 days post-ICU discharge.
The study will also compare rehabilitation practices across different geographic and economic regions to identify potential disparities. The study is structured into three modules, with participation contingent on local resources and feasibility.
The BASIC Module (mandatory for all centers) gathers fundamental data on rehabilitation practices and their association with patient outcomes.
The EXTENDED Module (optional) collects more detailed information on the type, timing, duration, and safety of rehabilitation interventions, including passive exercises, active mobilization, respiratory therapies, dysphagia training, occupational therapy, and cognitive support.
The EXTENDED FOLLOW-UP Module (optional) evaluates the patient's quality of life and functional recovery 28 days after ICU discharge. By examining global rehabilitation practices and their impact on patient outcomes, this study aims to improve rehabilitation strategies in ICUs, contributing to better patient care, recovery, and long-term health outcomes.
Detailed description
- Background --- Critically ill patients often develop intensive care unit (ICU)-acquired weakness (AW), which is defined as clinically detectable weakness without any other plausible explanation. Approximately 40% of these patients experience ICU-AW, associated with higher mortality and long-term morbidity. Early mobilization is an effective rehabilitation strategy that improves both short- and long-term outcomes, reducing hospital stays and enhancing functional recovery. Various rehabilitation interventions-such as mobilization, exercise, respiratory physiotherapy, dysphagia training, occupational therapy, physical activity, and cognitive support-are beneficial but remain underused due to resource limitations. Studies demonstrate improved outcomes with these interventions, emphasizing the role of rehabilitation professionals in the ICU. However, some studies question the effectiveness of these time-consuming and labor-intensive measures, indicating a need for further research. Identifying patient characteristics and detailed intervention information (modality, duration, intensity, frequency) is crucial for effective therapy prescription. The study aims to investigate rehabilitation practices in ICUs globally, focusing on critically ill patients on invasive ventilation who often develop ICU-acquired weakness (ICU-AW). This condition is associated with increased mortality and long-term morbidity. Rehabilitation interventions, including mobilization, physical activity, respiratory physiotherapy, and cognitive support, have shown benefits but remain underutilized.
- Methods --- Study Design and Setting ---- REPOrt is a prospective, international, multicenter, observational cohort study in critically ill invasively ventilated patients, utilizing three modules in which centers can participate, contingent on local capabilities. The practice of rehabilitation can only be studied reliably through a prospective observational study. The study enrollment is planned to start in 2025; the total enrollment period will be 120 days per center. This study will be conducted with the support of the Protective Ventilation Network (PROVE Network) (www.provenetwork.org), in partnership with national and international ICU societies and research institutions. Potentially interested ICUs will be identified. All ICUs that care for adult critically ill invasively ventilated patients can participate in REPOrt. If a hospital has more than one ICU, each ICU can participate as long as patients cared for are adults > 16 years of age (or >18, depending on local rules). The Research Office will handle the list of participating locations as well as the list of primary investigators from each participating institution. Each center interested in participation must submit the study for approval to the local IRB. Adherence to local legislation concerning informed consent will be ensured, including protocols for determining who may provide informed consent in cases where a patient is deemed incapable of doing so themselves. Since this is an observational study, concomitant participation and institutional enrollment in other observation and intervention studies are acceptable.
- Participants --- Patients are eligible for participation if they are admitted to a participating ICU; are adult patients according to local regulations (e.g., aged >16 or >18 depending on local rules); have received invasive ventilation for at least 48 hours; and after written informed consent from the patient or next of kin has been obtained (depending on legislation, and only if rules demand so). Exclusion criteria include withdrawal of life-sustaining treatment.
- Aims of the study and evaluation items --- The primary aim is to describe rehabilitation prevalence and practices in ICUs worldwide. --- Secondary aims include determining the association of rehabilitation and respiratory physiotherapy with typical ICU outcomes, including ICU and hospital length of stay; ICU and hospital mortality; duration of mechanical ventilation, expressed as ventilator-free days and alive at day 28 after ICU admission; and functional outcomes. Additional aims include determining the association of rehabilitation and respiratory physiotherapy with quality of life and functional performance at 28 days after ICU discharge.
- Endpoints --- - Basic information on rehabilitation practices and ICU outcomes (length of stay, duration of ventilation, complications, death). - Granular data on rehabilitative interventions (type, timing, duration, deliverers, safety assessment). - Quality of life and functional performance at 28 days after ICU discharge.
- Data sources and measurements --- Data collected in the study will be captured on an electronic case report form (eCRF) developed in the REDCAP Platform, using an identity code (pseudonym) for patients from countries governed by the General Data Protection Regulation (GDPR) (i.e., European countries). After a patient's eCRF is finalized and approved by the local investigator, anonymization occurs: the identification number is removed, making it impossible to trace back to the patient. Data obtained in the research will be placed immediately into a separate online database for individuals from countries not subjected to the laws.
- Data Collection --- The following data will be collected: - ICU Admission (Day 0): [patient baseline information \& pre-hospital status; essential pre-hospital features including SAPS II score; Sequential Organ Failure Assessment (SOFA Score); invasive and non-invasive mechanical ventilation settings; sedation \& muscle relaxants; vital signs; temperature; arterial blood gas analysis; delirium and pain assessment; hemodynamic monitoring; general rehabilitation assessment]. - During ICU Stay (Days 0, 3, 7, 14, and ICU discharge): [level of cooperation: S5Q scale; muscle strength using MRC scale; daily intervention duration; types of interventions: passive and active interventions; respiratory physiotherapy specifics; monitoring serious adverse events during interventions]. - ICU Discharge: [outcome assessment: patient pronation; ventilator weaning; airway management; monitoring for any ICU complications]. - 28-Day Follow-Up (Day 28): [post-discharge location; evaluate living arrangements; health assessments; clinical frailty scale; quality of life assessments using the EQ-5D-5L scale; and Modified Rankin Scale (mRS); mortality assessment]. This study is divided into three modules, according to the different aims described above: - BASIC module - to capture basic information on rehabilitation practice worldwide and simple ICU and hospital outcomes, including length of stay in ICU and hospital; duration of ventilation and weaning; airway management; ICU complications, and death. - EXTENDED module - to capture granular data on type, timing, and duration of rehabilitative interventions, who delivers them, and safety assessment. In this module, the focus is on the following rehabilitation interventions: passive interventions (passive exercises, stretching, cycling, electro muscular stimulation, continuous passive motion, etc.); active interventions (exercise therapy, activities of daily living training, mobilization, cycling, etc.); active and passive respiratory physiotherapy (positioning, airways clearance techniques, lung expansion exercises, end-positive airway pressure devices, active cycle of breathing techniques, forced expiratory techniques, assisted or stimulated cough maneuvers, insufflation/exsufflation, inhaled therapy, etc.); and adjunctive techniques (dysphagia training, swallow screening test, cognitive/psychological therapy). - EXTENDED FOLLOW-UP module - to capture quality of life and functional performance at 28 days after ICU discharge.
- Methods for Center Recruitment, Patient Enrollment, and Bias Prevention --- Center Recruitment --- Participating centers will be recruited through a combination of formal private invitations, leveraging established networks from previous studies, and utilizing personal connections within the field of intensive care and rehabilitation. This multi-faceted approach aims to ensure a diverse representation of centers across Europe and beyond, including both large and small institutions.
- Enrollment Strategy --- Invasively ventilated patients will be screened for eligibility over a predefined period of 120 days, with enrollment managed by each center according to local coordinator preferences. Each participating center is expected to enroll between 20 and 40 patients, helping to achieve a comprehensive sample size of approximately 1,200 to 2,400 patients across 60 centers. This range ensures sufficient data to analyze various rehabilitation practices and their clinical outcomes while minimizing the risk of bias.
- Preventing Bias --- To prevent bias from larger centers that may dominate the study, strategies will include: 1) capped enrollment; and 2) diverse center selection.
- Sample Size --- Considering the exploratory nature of this global study and to ensure robust findings, the aim is to enroll approximately 1,200 to 2,400 patients across 60 participating centers. The sample size is based on epidemiological assumption that around 40% of invasively ventilated patients receive rehabilitation. Considering a +/- 2 margin or error, a minimum 2,305 patients are required. Accounting for an anticipated 5% dropout rate, the target enrollment increases to 2,426 patients, which is rounded to 2,400 for practical purposes.
- Statistical Analysis --- A detailed statistical analysis plan is available in the approved protocol.
- Monitoring and Reporting --- National coordinators will oversee the integrity of ethical approval for their country, the data collected, ensuring adherence to standardized protocols and regulations, ensuring compliance with study protocols, and maintaining data integrity. Regular communication will be established among centers to monitor enrollment progress and address any disparities. National coordinators will facilitate communication between centers and provide support for patient enrollment. Each center will designate a lead investigator to oversee local recruitment efforts and ensure accurate data collection. Lead investigators will be responsible for providing ethical approval to the national coordinator and reporting enrollment numbers and any challenges faced during the process.
- Data Validation and Registry Procedures --- To ensure high data quality and reliability of findings, a multi-tiered data validation process will be implemented. These procedures include: 1) Automated data validation rules, including logic checks programmed into the electronic data capture system to validate data entries at the point of data capture: Range checks (e.g., systolic blood pressure between 70-250 mmHg); Format checks (e.g., dates in YYYY-MM-DD format); and Required field enforcement. 2) Manual data review: Periodic manual review of data entries will be conducted by data managers to identify and rectify anomalies not captured by automated rules. 3) Registry access control: Tiered access privileges will be implemented to ensure that only authorized personnel can enter, edit, or approve data.
- Site Monitoring and Auditing --- Site initiation visits may be conducted to train local site teams on study protocols, data entry procedures, and quality expectations if needed. Routine monitoring visits are planned on a remote basis and will occur at regular intervals. Key activities include: 1) Review of source documents; 2) Verification of informed consent processes; 3) Cross-checking data entered into the registry with original records. Audits will be performed to: 1) Verify compliance with study protocol, SOPs, and regulatory requirements; 2) Identify systemic issues and recommend corrective actions
- Data Checks and Consistency Rules --- The data management system will incorporate robust automated checks to identify: 1) Logical inconsistencies (e.g., a male patient marked as pregnant); 2) Temporal inconsistencies (e.g., date of diagnosis after date of death); 3) Missing or duplicate data entries; 4) Interdependent data field checks, ensuring consistency across related variables (e.g., values of Peak pressure on the ventilator above 30 cmH2O or below 10 cmH2O). All detected anomalies will generate queries for site clarification and resolution before data locking in the REDcap system.
- Source Data Verification --- To ensure accuracy and completeness, a proportion of entered data will undergo source data verification, using 1) Random sampling strategy: Some participants will be selected based on enrollment numbers and data risk profiles; 2) Verification process: Comparison of electronic registry (eCRF) data with original case report forms (oCRF), medical records, or other source documentation; 3) Documentation of discrepancies and resolution through a tracked audit trail. Electronic monitoring systems and audit trail logs will be utilized.
- Data Dictionary --- A comprehensive Data Dictionary is available in the appendix of the approved protocol and within each variable in the REDcap system. It will be implemented throughout the study and includes: 1) Variable names and descriptions with clear definitions and purposes of each data element; 2) Coding systems used [e.g., Driving pressure (DP or ΔP) indicates the difference between plateau pressure (Pplat) and positive end-expiratory pressure (PEEP) on the ventilator. Pplat is obtained with an inspiratory pause on the ventilator, to obtain the pressure at the end of inspiration when gas flow has stopped. It is measured in cmH2O]; 3) Acceptable value ranges and units (e.g., mmHg or kPa); 4) Data types and formats. The data dictionary will be updated as needed and made available to all study participants.
- Standard Operating Procedures (SOPs) --- Comprehensive SOPs will guide all aspects of registry operation and ensure consistency and regulatory compliance. Key SOPs include: 1) Patient recruitment and consent: Guidance on ethical and standardized procedures for engaging and enrolling study participants will be guaranteed, with National Coordinators responsible for ensuring consistency and compliance with local regulations; 2) Data collection and entry, including step-by-step instructions for CRF completion with clear definitions, data entry timelines, and handling of missing or ambiguous data; 3) Data management, including data cleaning, validation, backup, and storage; 4) Adverse event reporting, including reportable events, timeframes, and escalation pathways; 5) Monitoring and auditing, including site monitoring schedules, audit plans, and reporting procedures; 6) Change management: amendments to the protocol, CRFs, or registry software, including version control and stakeholder notification will be communicated to all participants regularly.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Target follow-up
- 28 Days
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Adult patients admitted in ICU and on mechanical ventilation for at least 48 hours | – | –Adult patients who can be candidated to rehabilitation during ICU stay |
Who may qualify
- Ages
- 16 to 100 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- The study population will comprise adult patients admitted to Intensive Care Units (ICUs) located in cities and countries participating in the study. Eligible patients will be adult patients requiring invasive mechanical ventilation for at least 48 hours and who can be candidate for rehabilitation during ICU stay. Enrolment will be conducted in accordance with applicable local regulations, including the provision of informed consent by the patient or their legally authorized representative.
Key inclusion criteria (4 listed)
- Patients admitted to a participating ICU
- Adult patients (aged 16 years or older, depending on local regulations for the definition of "adults")
- Patients who have received invasive ventilation for at least 48 hours
- Patients who have obtained written informed consent from the patient or next of kin (if local legislation demands so)
Key exclusion criteria (1 listed)
- Patients admitted for withdrawn of life sustain therapy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Proportion of patients receiving at least one rehabilitation intervention
Time frame: From ICU admission (Day 0) until ICU discharge (up to Day 365)
Rehabilitation is defined as the delivery of at least one documented intervention during ICU stay, including passive mobilization, active mobilization, or respiratory physiotherapy (active or passive), reported as percentage (%).
12 secondary outcomes
Proportion of patients receiving each type of rehabilitation intervention
Time frame: From ICU admission until ICU discharge (up to Day 365)
Duration of rehabilitation interventions per day (minutes)
Time frame: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU length of stay
Time frame: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU mortality
Time frame: From ICU admission (Day 0) until ICU discharge (up to day 365)
ICU complications
Time frame: From ICU admission (Day 0) until ICU discharge (up to day 365)
Invasive mechanical ventilation duration during ICU stay
Time frame: From ICU admission (Day 0) until ICU discharge (up to Day 28)
Hospital length of stay
Time frame: From Hospital admission until Hospital discharge (up to Day 365)
Hospital mortality
Time frame: From Hospital admission until Hospital discharge (up to Day 365)
Mortality at 28 Days post-ICU discharge
Time frame: From ICU discharge to Day 28 post-ICU discharge
Quality of life (EQ-5D-5L scale) at 28 Days post-ICU discharge
Time frame: From ICU discharge to Day 28 post-ICU discharge
Clinical Frailty at 28 Days post-ICU discharge
Time frame: From ICU discharge to Day 28 post-ICU discharge
Disability at 28 Days post-ICU discharge
Time frame: From ICU discharge to Day 28 post-ICU discharge
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Sep 2026.
- Results publication: PubMed 18283429Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, Schonhofer B, Stiller K, van de Leur H, Vincent JL. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. doi: 10.1007/s00134-008-1026-7. Epub 2008 Feb 19.
- Results publication: PubMed 36286256TEAM 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.
- Results publication: PubMed 27864615Tipping 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.
- Results publication: PubMed 19446324Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9. Epub 2009 May 14.
- Results publication: PubMed 31970446Van Aerde N, Meersseman P, Debaveye Y, Wilmer A, Gunst J, Casaer MP, Bruyninckx F, Wouters PJ, Gosselink R, Van den Berghe G, Hermans G. Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study. Intensive Care Med. 2020 Jun;46(6):1184-1193. doi: 10.1007/s00134-020-05927-5. Epub 2020 Jan 22.
- Results publication: PubMed 18511703Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008 Aug 1;178(3):261-8. doi: 10.1164/rccm.200712-1829OC. Epub 2008 May 29.
- Results publication: PubMed 24247473Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, Pronovost PJ, Needham DM. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med. 2014 Apr;42(4):849-59. doi: 10.1097/CCM.0000000000000040.
- Results publication: PubMed 28979394Appleton RT, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes: A systematic review. J Intensive Care Soc. 2015 May;16(2):126-136. doi: 10.1177/1751143714563016. Epub 2014 Dec 18.
- Individual participant dataSharing planned: No. European regulations for data sharing and privacy
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Marcus J Schultz, MD, PhD contact
Denise Battaglini, MD, PhD principal investigator
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
Marcus J Schultz, MD, PhD study chair
Amsterdam University Medical Centers, Amsterdam, The Netherlands
Rik Gosselink, PT, PhD study chair
University of Leuven, Leuven, Belgium
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Mechanical Ventilation and Pulmonary Rehabilitation, run by Universita degli Studi di Genova at 1 site in Italy.
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 4 inclusion and 1 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: looking for participants now, as of the sponsor's last update on 15 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. 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.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Denise Battaglini, MD, PhD (+39 010 5554970, denise.battaglini@unige.it), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Proportion of patients receiving at least one rehabilitation intervention (time frame: From ICU admission (Day 0) until ICU discharge (up to Day 365)). 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 NCT07093125, which also lists 8 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 15 Sep 2026.