Implementing In-bed Cycle Ergometry for Mechanically Ventilated Patients using the Rehabilitation Treatment Specification System.

In-bed cycle ergometry is a safe, feasible, and reliable method of providing in-bed physical rehabilitation for patients with critical illness in the intensive care unit. It is a complex intervention that requires specific clinical decision-making skills to identify suitable patients, close coordination with the team to deliver the intervention, and ongoing evaluation to guide treatment progression. Protocols for the delivery of in-bed cycle ergometry are presented according to the Rehabilitation Treatment Specification System. Specifically, the components of in-bed leg cycle ergometry are described, including preparation, equipment, therapist actions (instructions and feedback), progression considerations, and clinical decision-making. Patient selection for in-bed cycle ergometry in the intensive care unit should prioritize physiological stability, with safety criteria for starting and stopping, and defined inclusion and exclusion criteria to support standardized and reproducible delivery. The patient should be in the semi-recumbent position, with the in-bed cycle ergometer secured at the foot of the bed and neutral lower limb alignment maintained. Dosing and progression should consider active or passive modes, frequency, duration, cadence, and resistance. Patient monitoring should include clearly specified physiological and tolerance thresholds, with increases applied systematically. Documentation of treatments following the Rehabilitation Treatment Specification System supports clinical decision-making, standardization, and reproducibility.