@Article{info:doi/10.2196/54451,
author="Heels-Ansdell, Diane
and Kelly, Laurel
and O'Grady, Heather K
and Farley, Christopher
and Reid, Julie C
and Berney, Sue
and Pastva, Amy M
and Burns, Karen EA
and D'Aragon, Fr{\'e}d{\'e}rick
and Herridge, Margaret	S
and Seely, Andrew
and Rudkowski, Jill
and Rochwerg, Bram
and Fox-Robichaud, Alison
and Ball, Ian
and Lamontagne, Francois
and Duan, Erick H
and Tsang, Jennifer
and Archambault, Patrick M
and Verceles, Avelino C
and Muscedere, John
and Mehta, Sangeeta
and English, Shane W
and Karachi, Tim
and Serri, Karim
and Reeve, Brenda
and Thabane, Lehana
and Cook, Deborah
and Kho, Michelle E",
title="Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="28",
volume="13",
pages="e54451",
keywords="rehabilitation; mechanical ventilation; cycle ergometry; critical illness; exercise therapy; recovery of function",
abstract="Background: Survivors of critical illness are at risk of developing physical dysfunction following intensive care unit (ICU) discharge. ICU-based rehabilitation interventions, such as early in-bed cycle ergometry, may improve patients' short-term physical function. Objective: Before unblinding and trial database lock, we describe a prespecified statistical analysis plan (SAP) for the CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) randomized controlled trial (RCT). Methods: CYCLE is a 360-patient, international, multicenter, open-label, parallel-group RCT (1:1 ratio) with blinded primary outcome assessment at 3 days post-ICU discharge. The principal investigator and statisticians of CYCLE prepared this SAP with approval from the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes (including adverse events) and describes the planned primary, secondary, and subgroup analyses. The primary outcome of the CYCLE trial is the Physical Function Intensive Care Unit Test-scored (PFIT-s) at 3 days post-ICU discharge. The PFIT-s is a reliable and valid performance-based measure. We plan to use a frequentist statistical framework for all analyses. We will conduct a linear regression to evaluate the primary outcome, incorporating randomization as an independent variable and adjusting for age (≥65 years versus <65 years) and center. The regression results will be reported as mean differences in PFIT-s scores with corresponding 95{\%} CIs and P values. We consider a 1-point difference in PFIT-s score to be clinically important. Additionally, we plan to conduct 3 subgroup analyses: age (≥65 years versus <65 years), frailty (Baseline Clinical Frailty Scale ≥5 versus <5), and sex (male versus female). Results: CYCLE was funded in 2017, and enrollment was completed in May 2023. Data analyses are complete, and the first results were submitted for publication in 2024. Conclusions: We developed and present an SAP for the CYCLE RCT and will adhere to it for all analyses. This study will add to the growing body of evidence evaluating the efficacy and safety of ICU-based rehabilitation interventions. Trial Registration: ClinicalTrials.gov NCT03471247; https://clinicaltrials.gov/ct2/show/NCT03471247 and NCT02377830; https://clinicaltrials.gov/ct2/show/NCT02377830 International Registered Report Identifier (IRRID): RR1-10.2196/54451 ",
issn="1929-0748",
doi="10.2196/54451",
url="https://www.researchprotocols.org/2024/1/e54451",
url="https://doi.org/10.2196/54451"
}