Abstract
Survivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home.
Methods
A mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline.
Results
43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions.
Conclusions
This study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy.
Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792, registered 7-06-2019.
| Original language | English |
|---|---|
| Article number | 279 |
| Number of pages | 15 |
| Journal | Critical Care |
| Volume | 25 |
| DOIs | |
| Publication status | Published - 2021 |
Funding
MM receives a research grant by the Dutch Research Council (NWO doctoral grant for teachers, 023.007.006). The funder does not intervene nor has a role in content related matters of the research projects. The development of the REACH professional network was funded by Taskforce for Applied Research (SIA, RAAK.PUB04.037). The authors would like to extend acknowledgements to members of the REACH project group: Dr. Hinke Kruizenga, Benno van Tol (MSc), Sanne Pellegrom (MSc), Marjolein Siebel, to all REACH professionals for their devotion to improvement of quality of care for patients with PICS, and to all participants to this study. MM is PhD candidate in the field of physiotherapeutic rehabilitation after critical illness and works as senior lecturer at the European School of Physiotherapy. DD is PT/PhD researcher at Amsterdam UMC. Her expertise lies in the area of rehabilitation during and after critical illness, PICS and aftercare. SR is associate professor clinical reasoning and shared decision making. His research focus is on the development of clinical reasoning competency, in particular in interprofessional teams. RE is professor in Physiotherapy, combining patient care, research and education. His research focus is transition of care in complex patients. He supervises PhD candidates performing clinical and research tasks on complex patients during and after their ICU and hospital stay. MvdS is PT/researcher and associate professor in rehabilitation in acute care. She supervises PhD candidates in the area of rehabilitation in critically ill and frail patients during and after hospital discharge.