Abstract
BackgroundRehabilitation interventions, including novel technologies such as in-bed cycling, could reduce critical illness-associated morbidity. Frontline intensive care unit (ICU) therapists often implement these interventions; however, little is known about their perceptions of engaging in clinical research evaluating these technologies.ObjectiveTo understand frontline therapist perceptions of barriers and facilitators to implementing a pilot randomized controlled trial (RCT) of early in-bed cycling with mechanically ventilated patients in the ICU and outcome measures (CYCLE Pilot RCT; NCT02377830).MethodsWe developed a 115-item, self-administered, electronic survey informed by 2 complementary knowledge translation (KT) models: the Capability-Opportunity-Motivation-Behaviour (COM-B) system and the Theoretical Domains Framework (TDF). We included demographics and 3 sections: Rehabilitation Practice and Research, Cycling, and Physical Outcome Measures. Each section contained items related to the COM-B system and TDF domains. Item formats included 7-point Likert-type scale questions (1 = strongly disagree, 7 = strongly agree) and free-text responses. We invited therapists (physiotherapists, occupational therapists, and therapy assistants) who participated in the international, multi-center, CYCLE Pilot RCT to complete this cross-sectional survey. We descriptively analyzed results by survey section, COM-B attribute, TDF domain, and individual question within and across sections. We identified barriers based on items with median scores < 4/7.ResultsOur response rate was 85% (45/53). Respondents were from Canada (67%), the USA (21%), and Australia (11%). The majority had a physiotherapy background (87%) and previous research experience (87%). By section, Rehabilitation Practice and Research (85%; 95% confidence interval (CI) [82%, 87%]) was higher than Cycling (77%; 95% CI [73%, 80%]) and Outcome Measures (78%; 95% CI [75%, 82%]). Across the 3 sections, Motivation was lower than Capability and Opportunity. The most common Motivation barrier was the emotion TDF domain, related to the time required to conduct cycling and outcome measures (median [1st, 3rd quartiles] 3/7 [2, 6]).ConclusionsFrontline ICU therapists had positive perceptions of research engagement. However, we identified barriers related to Motivation, and concerns regarding time to implement the research protocol. Our results can inform specific KT strategies to engage frontline ICU therapists and optimize protocol implementation in critical care rehabilitation research.
Highlights
With advancements in medical technology, more people are surviving critical illness [1]
We identified barriers related to Motivation, and concerns regarding time to implement the research protocol
Given the widespread interest in improving patient outcomes and intensive care unit (ICU) rehabilitation research, it is imperative to consider the implications of involving frontline providers in clinical research
Summary
With advancements in medical technology, more people are surviving critical illness [1]. Survivors of an intensive care unit (ICU) stay often experience substantial physical disability [2, 3]. Because of this disability, there has been a great focus on minimizing critical illness-associated morbidity through rehabilitation interventions started early in ICU [4, 5]. While frontline ICU therapists are often responsible for providing these interventions, we have limited knowledge of their perceptions of implementation as part of a research study. Frontline intensive care unit (ICU) therapists often implement these interventions; little is known about their perceptions of engaging in clinical research evaluating these technologies
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