Can in-reach multidisciplinary rehabilitation in the acute ward improve outcomes for critical care survivors? A pilot randomized controlled trial

Abstract

This pilot study aimed to assess whether early, structured rehabilitation can be provided to critical care survivors and aid physical and psychological recovery. The study recruited 66 participants who were critically ill and were in intensive care for at least 5 days. The study compared patients receiving early rehabilitation in addition to usual therapy, vs usual therapy on the acute ward. Both participant groups were assessed at hospital discharge and at 6 and 12 months. The outcomes assessed included: length of hospital stay; mobility ability to carry out activities of daily living; psychological symptoms; and quality of life. The results showed that early rehabilitation was feasible, could be provided to critical care survivors, and suggested that these patients may have a shorter length of stay in hospital. While both groups improved in their other outcomes, there were no major differences between the groups. Objectives: To assess the feasibility of in-reach rehabilitation for critical care survivors following discharge from the intensive care unit. To determine whether additional in-reach rehabilitation reduces hospital length-of-stay and improves outcomes in critical care survivors, compared with usual therapy. Participants: A total of 66 consecutively-admitted critical care survivors with an intensive care unit stay ≥ 5 days were enrolled in the study. Of these, 62 were included in the analyses. Methods: Pilot randomized control trial with blinded assessment at 6 and 12 months. The intervention group (n = 29) received in-reach rehabilitation in addition to usual ward therapy. The usual-care group (n = 33) received usual ward therapy. The primary outcome assessed was length-of-stay. Secondary outcomes included mobility, functional independence, psychological status and quality-of-life. Results: The intervention group received more physiotherapy and occupational therapy sessions per week than the usual-care group (median = 8.2 vs 4.9, p < 0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 vs 41 days), this was not significant and the pilot study was not adequately powered (p = 0.57). No significant differences were observed in the secondary outcomes at hospital discharge, 6-or 12-month follow-ups. Conclusion: Provision of intensive early rehabilitation to intensive care unit survivors on the acute ward is feasible. A further trial is needed to draw conclusions on how this intervention affects lengthof-stay and functional outcomes.

Interprofessional collaboration and patient-reported outcomes in inpatient care: a systematic review

“…Studies include between 20 [ 19 ] and 1531 [ 15 ] patients and are conducted in Australia [ 19 , 28 ], Denmark [ 14 , 34 ], France [ 31 ], GB [ 17 , 22 ], Germany [ 21 , 23 , 27 , 29 , 32 , 33 ], Italy [ 24 ], Netherlands [ 35 ], Norway [ 18 ], Switzerland [ 30 ], and the USA [ 15 , 16 , 20 , 25 , 26 ]. Five studies focus on patients with chronic pain [ 21 , 23 , 30 , 32 , 33 ], four studies on patients undergoing palliative care [ 16 , 19 , 20 , 26 ], and two studies on patients with neurological diseases (Parkinson’s disease (PD) [ 24 ], multiple sclerosis [ 14 ]), cancer [ 27 , 31 ], or severe mental illness [ 34 , 35 ].…”

“…Five studies focus on patients with chronic pain [ 21 , 23 , 30 , 32 , 33 ], four studies on patients undergoing palliative care [ 16 , 19 , 20 , 26 ], and two studies on patients with neurological diseases (Parkinson’s disease (PD) [ 24 ], multiple sclerosis [ 14 ]), cancer [ 27 , 31 ], or severe mental illness [ 34 , 35 ]. Cognitive impairment [ 17 ] in old age, fibromyalgia [ 18 ], general medical patients [ 25 ], patients with anorexia nervosa [ 29 ], critical care survivors [ 28 ], homeless patients [ 22 ], and patients in old age [ 15 ] are study subject in one study each. Based on the categorization by Reeves et al [ 9 ] (see above), nine studies describe an intervention that can be categorized as “interprofessional practice” intervention [ 15 , 16 , 19 , 22 , 25 , 26 , 28 – 30 ], and one study [ 24 ] evaluates an “interprofessional organization” intervention.…”

“…Only two studies [ 21 , 27 ] are considered to have a “low,” while twelve studies [ 14 – 17 , 19 , 20 , 22 , 23 , 25 , 26 , 28 , 29 ] had a “high” RoB. Two RCTs [ 18 , 24 ] were rated to have “some concerns” (see Table 3 ).…”

Acciones y beneficios que proporciona la intervención del Terapeuta Ocupacional en la Unidad de Cuidados Intensivos de adultos

“…Estos factores hacen que a nivel financiero exista una disminución de los gastos en el hospital, de los cuales se identificó un ahorro bruto anual de $2.2 millones y neto de $1.5 millones en costos luego de iniciar el proyecto de mejora de rendimiento 33 . En otro estudio se indica que la intervención realizada por el terapeuta físico y ocupacional de forma adicional a la ya obtenida es de beneficio, en este se observa que es factible brindar rehabilitación de forma temprana e intensiva 35 .…”

A atuação do terapeuta ocupacional em Unidade de Terapia Intensiva: uma revisão sistemática

“…Portanto, os cuidados demandados por pacientes graves sob suporte ventilatório mecânico, sedação e mobilidade restrita reforçam a necessidade de formação qualificada e de conhecimento prévio diferenciado para atuação na UTI (Thomas et al, 2017). A especialidade, qualidade e a multidisciplinaridade dos serviços trazem benefícios, como a redução do tempo de permanência na UTI e a duração da internação hospitalar (Wu et al, 2019). Nesse cenário, observa-se a intervenção do terapeuta ocupacional, individualizada (Dinglas et al, 2013), como membro da mobilização precoce/reabilitação (Ratcliffe & Williams, 2019), ou membro da equipe multidisciplinar (Hsu et al, 2020).…”