Abstract
BackgroundSurvivors 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.MethodsA 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.Results43 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.ConclusionsThis 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.
Highlights
Survivors of critical illness experience long-term functional challenges, which are complex, hetero‐ geneous, and multifactorial in nature
In total, 74 survivors of critical illness were referred for participation in the study, of which 16 were excluded because they were transferred to a long-term rehabilitation facility before home discharge, leaving 58 eligible participants
This study shows that it is safe and feasible to provide an early, home-based, rehabilitation intervention within the organization of an interdisciplinary professional network, for patients with symptoms related to Post-Intensive Care Syndrome (PICS)
Summary
Survivors of critical illness experience long-term functional challenges, which are complex, hetero‐ geneous, and multifactorial in nature. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home. Whilst more patients survive critical illness because of improvements in medical care, a growing number of patients leaves the hospital needing rehabilitation interventions for multifactorial problems associated with long-term disability as part of the Post-Intensive Care Syndrome (PICS) [1,2,3,4,5,6]. If primary care rehabilitation specialists such as physical therapists (PTs), occupational therapists (OTs) and dietitians (DTs) can provide early home-based interventions for patients with functional impairments related to PICS, this might increase adherence and satisfaction, decrease the chance of hospital readmissions, and cut healthcare costs [12, 23, 25,26,27]. Care provided within an interprofessional network has shown to increase professional expertise and improve the quality of care [28, 29]
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