Acute and Critical Care

Original Articles

Nursing
Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial: Mohammad Ali Zakeri, Adnan Rashid Aziz, Elham Rahiminezhad, Mahlagha Dehghan; Acute Crit Care. 2024;39(1):78-90. Published online December 13, 2023; DOI: https://doi.org/10.4266/acc.2023.00416

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Background
Muscle weakness is prevalent in intensive care patients. This study focused on comparing the effects of massage and range of motion (ROM) exercises on muscle strength and intensive care unit-acquired weakness (ICU-AW) among patients with coronavirus disease 2019 (COVID-19).
Methods
This study was a randomized clinical trial that recruited patients (n=45) with COVID-19 admitted to the ICU and divided them into three groups (ROM exercises, massage, and control). We evaluated muscle strength and ICU-AW in the arms and legs using a hand dynamometer. The Medical Research Council sum score was determined before and after the intervention.
Results
The study findings were that 0%, 20%, and 100% of the participants in the ROM exercises, massage, and control groups had ICU-AW on the 7th day of ICU admission. The ROM exercise group had greater muscle strength in the hands and legs than the massage and control groups, and the massage group had greater muscle strength than the control group.
Conclusions
Massage and ROM exercises could improve muscle strength and reduce ICU-AW in COVID-19 patients admitted to the ICU.

Citations

Citations to this article as recorded by

Rehabilitation in critically ill patients with COVID-19 infection: A systematic review and meta-analysis
Julie C. Reid, Joanna S. Semrau, Heather K. O'Grady, Jen Hoogenes, Jeniszka Gill, Hibaa Hasan, Sophie von Teichman, Yelena Bogdanova, Shannon McKenney, Olivia Sokol, Tania J. Pereira, Vanessa Campes Dannenberg, Christopher Farley, Jose Colleti Junior, Ama
Australian Critical Care.2026; 39(1): 101500. CrossRef
Interventions for adult survivors discharged from the intensive care unit: a scoping review
Tong Wu, Fanghong Yan, Guoli Zhang, Rongrong Zhao, Guotian Peng, Ruiyi Sun, Yuxia Ma, Lin Han, Jinping Liu
BMJ Open.2025; 15(8): e096634. CrossRef
Physical Therapist-Led Therapeutic Exercise and Mobility in Adult Intensive Care Units: A Scoping Review of Operational Definitions, Dose Progression, Safety, and Documentation
Kyeongbong Lee
Journal of Clinical Medicine.2025; 14(24): 8948. CrossRef

Neurology
Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial: Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow; Acute Crit Care. 2022;37(3):295-302. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01767

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Abstract PDF Supplementary Material

Background
To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.
Methods
In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).
Results
A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.
Conclusions
In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.

Citations

Citations to this article as recorded by

Properties of testosterone transdermal gel in restoring serum testosterone levels in critically ill patients: the TestICU-1 pilot study
Claire Dupuis, Konstantinos Bachoumas, Charlotte Oris, Sasha Eisenberg, Bruno Pereira, Yves Boirie, Nicolas Farigon, Vincent Sapin, Lise Bernard, Ruddy Richard, Frédéric Costes, Mireille Adda, Bertrand Souweine
Journal of Critical Care.2026; 92: 155339. CrossRef
Effects of Nandrolone Decanoate on Muscle Strength, Body Composition and Bone Density: A Systematic Review and Meta‐Analysis
Konstantinos Prokopidis, Theocharis Ispoglou, Trevor Thompson, Dolores Sanchez‐Rodriguez, Anna Marie Hergelegiu, Cafer Balci, Mariana Alves, Damiano Pizzol, Joseph McLean, Pinar Soysal, Brigid Unim, Antonio Cherubini, Nicola Veronese
Journal of Cachexia, Sarcopenia and Muscle.2026;[Epub] CrossRef
Addressing metabolic demands during veno‐venous extracorporeal life support: A narrative review
Daniel T. Lammers, Perry Wiseman, Nafis Deen, Sarita Thanedar, Nawsin Baset, Gongkai Liu, Jeffrey D. DellaVolpe, Linda E. Sousse
Journal of Parenteral and Enteral Nutrition.2026;[Epub] CrossRef
High vs low protein intake in chronic critical illness: A systematic review and meta-analysis
Sílvia Castro, A. Tomé, C. Granja, A. Macedo, A. Binnie
Clinical Nutrition ESPEN.2025; 65: 249. CrossRef
Muscle growth and anabolism in intensive care survivors (GAINS 2.0): Protocol for a multi-centre randomised; placebo controlled clinical trial of nandrolone in deconditioned adults recovering from critical illness
Matthew Anstey, Ed Litton, Maryam Habibi, Lisa Van der Lee, Robert Palmer, Natalie Tran, Bianca Mammana, Stacey Scheepers, Annamaria Palermo, Xavier Fiorilla, Bhaumik Mevavala, Adrian Regli, Angela Jacques, Bradley Wibrow, Francesco Sessa
PLOS ONE.2025; 20(2): e0315170. CrossRef
Effects of growth hormone and anabolic steroids, in critically ill patients admitted to the intensive care unit: a systematic review and meta-analysis
Chris G. H. Veenker, Beynur B. Redzhebov, Sanne E. Hoeks, Lucas T. van Eijk, Michel M. R. F. Struys, Olivier de Hon, Nico L. U. van Meeteren, Gertrude J. Nieuwenhuijs-Moeke
Scientific Reports.2025;[Epub] CrossRef

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