icucycle.com
Alex Molloy: (289) 808 6947

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Research Coordinator

Research Coordinator

Click any of the following numbers corresponding to the schema to jump directly to that section of documents on this page.

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Study Protocol (Aug-03-2022)

Delegation of Authority Form

Operations Manual

CRF Bundle (Mar-31-2023)

Click here to access all background articles.

1 - Screening

(ICU Admission)

Case Report Forms

Form 1 Screening (PDF)

Note: Include patients who meet all eligiblility criteria on the screening logs and enter all eligible non-randomized patients into iDatafax.

Study Materials

Screening Log Manual (PDF)

Paper Screening Log (PDF)

Electronic Screening Log (Excel)

Revised Monthly Screening Log - January 2021 (Word)

Revised Monthly Screening Log - February 2021 (Word)

Revised Monthly Screening Log - March 2021 (Word)

Revised Monthly Screening Log - April 2021 (Word)

Revised Monthly Screening Log - May 2021 (Word)

Revised Monthly Screening Log - June 2021 (Word)

Revised Monthly Screening Log - July 2021 (Word)

Revised Monthly Screening Log - August 2021 (Word)

Revised Monthly Screening Log - September 2021 (Word)

Revised Monthly Screening Log - October 2021 (Word)

Revised Monthly Screening Log - November 2021 (Word)

Revised Monthly Screening Log - December 2021 (Word)

Revised Monthly Screening Log - January 2022 (Word)

Revised Monthly Screening Log - February 2022 (Word)

Revised Monthly Screening Log - March 2022 (Word)

Revised Monthly Screening Log - April 2022 (Word)

Revised Monthly Screening Log - May 2022 (Word)

Revised Monthly Screening Log - June 2022 (Word)

Revised Monthly Screening Log - July 2022 (Word)

Revised Monthly Screening Log - August 2022 (Word)

Revised Monthly Screening Log - September 2022 (Word)

Revised Monthly Screening Log - October 2022 (Word)

Revised Monthly Screening Log - November 2022 (Word)

Revised Monthly Screening Log - December 2022 (Word)

Revised Monthly Screening Log - January 2023 (Word)

Revised Monthly Screening Log - February 2023 (Word)

Revised Monthly Screening Log - March 2023 (Word)

Revised Monthly Screening Log - April 2023 (Word)

2 - Consent

(ICU Admission)

Case Report Forms

Form 3 Baseline (PDF)

Form 3 Baseline - French (PDF)

Note: Coordinate with PT regarding patient randomization. Please complete Form 3 at the time of consent.

Study Materials

St. Joe's Example Consent Form (PDF)

Please use your site specific consent form.

Consent Discussion Form (PDF)

Telephone Consent Script (PDF)

Participant Contact Information Form (PDF)

Participant Contact Information Form (fillable PDF)

Participant Contact Information Form (Word)

Top 10 Talking Points for CYCLE (PDF)

APACHE II

APACHE II Calculation Worksheet (PDF)

APACHE III Admitting Diagnoses (PDF)

APACHE SOP (PDF)

Click here to download all "Consent" Documents from above.

3 - Randomization

(Randomized / Study Entry ≤4 d MV)

Case Report Forms

Form 2 Randomization (PDF)

Study Materials

Randomize.net Information - Contact Methods Centre for details

Clinical Note

Sample Clinical Note (Word)

St. Joseph's Clinical Note Example (PDF)

Bedside Handout

Bedside Handout - All Sites (PDF)

6-slide Overview - SJH (PDF)

6-slide Overview - Customizable by site (PPT)

Chart Stickers

Chart Stickers (Word)

Click here to download all "Randomization" Documents from above.

4 - Daily ICU Responsibilites

(30 min cycling + Routine PT OR Routine PT)

Case Report Forms

Form 4 Daily Data (PDF)

*Form 4A Daily Data (PDF)

*If a patient is discharged from ICU and readmitted within 72 hours, complete this form in place of DAILY DATA (Form 4) for each complete study day outside ICU prior to readmission.

Study Materials

CRF Checklist

CRF Checklist - CYCLE RCT (PDF)

CRF Checklist - CYCLE RCT (fillable PDF)

CRF Checklist - CYCLE RCT (Word)

Nutrition

Please refer to CRF Manual for relevant documents.

Patient Tracking Sheet

Patient Tracking Sheet (PDF)

Patient Tracking Sheet (fillable PDF)

Patient Tracking Sheet (Word)

Click here to download all "Daily ICU Responsibilities" Documents from above.

5 - ICU Awakening

(Awake)

Test #1

Case Report Forms

Form RC1 IPAT (ICU Awakening) (PDF)

Form RC1 IPAT (ICU Awakening) - French (PDF)

Form RC1 IPAT (ICU Awakening) - French (Word)

Note: Coordinate with PT. Complete IPAT after ICU Awakening PT Strength and Function (Form SF1).

Study Materials

IPAT Administration Guidelines (PDF)

IPAT Educational Tool Handout (PDF)

IPAT Source document: Wade - IPAT Design - Critical Care (2014) (PDF)

Click here to download all "ICU Awakening" Documents from above.

6 - ICU Discharge

(ICU Discharge)

Test #2

Case Report Forms

Form RC2 ICU Discharge Ax (PDF)

Form RC2 ICU Dicharge Ax - French (PDF)

Form RC2 ICU Discharge Ax - French (Word)

Form 6 PT Post-last Study Day (PDF)

Note: Coordinate with PT.

Study Materials

N/A

7 - 3 Days Post-ICU Discharge

(3 d Post-ICU Discharge)

Case Report Forms

N/A

Note: Contact PT for blinded outcomes assessment.

Study Materials

N/A

8 - Hospital Discharge, Death or Withdrawal

(Hospital Discharge)

Test #4

Case Report Forms

Form RC3 Hospital Discharge Ax (PDF)

Form RC3 Hospital Discharge Ax - French (PDF)

Form RC3 Hospital Discharge Ax - French (Word)

Form 7 Final Status (PDF)

Study Materials

N/A

9 - 90 Days Post Randomization

(90 Day After Enrollment)

Test #5

Case Report Forms

Form RC4 90 Day (Post-randomization) Follow-up Questionnaire (PDF)

Form RC4 90 Day (Post-randomization) Follow-up Questionnaire - French (PDF)

Form RC4 90 Day (Post-randomization) Follow-up Questionnaire - French (Word)

Study Materials

90 Day Questionnaire Follow-Up Patient Log (PDF)

90 Day Questionnaire Follow Up Call Log (PDF)

90 Day Questionnaire Follow Up Call Log (fillable PDF)

90 Day Questionnaire Follow Up Call Log (Word)

90 Day Questionnaire Participant Contact Information Form (PDF)

90 Day Questionnaire Participant Contact Information Form (fillable PDF)

90 Day Questionnaire Participant Contact Information Form (Word)