Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Connolly, Bronwen; Salisbury, Lisa; O’Neill, Brenda; Geneen, Louise J; Douiri, Abdel; Grocott, Michael; Hart, Nicholas; Walsh, Timothy; Blackwood, Bronagh

doi:10.1002/14651858.cd008632.pub2

Cited by 121 publications

(131 citation statements)

References 89 publications

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“…Understanding of the pathophysiological processes that result in neuromuscular dysfunction during critical illness is improving,3 4 but there is little evidence that interventions delivered after injury has occurred can improve physical outcomes 5. A systematic review of exercise-based rehabilitation trials initiated after intensive care unit (ICU) discharge,6 and our recently published rehabilitation trial (RECOVER)7 suggest no effect on physical recovery when the intervention is started during the post-ICU period. Reasons for this lack of response are uncertain, but could include an established neuromuscular deficit or persisting pathophysiological processes blocking muscle recovery.…”

Section: Introductionmentioning

confidence: 99%

Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms

Griffith¹,

Lewis

Rossi

et al. 2016

Thorax

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Section: Introductionmentioning

confidence: 99%

Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms

Griffith¹,

Lewis

Rossi

et al. 2016

Thorax

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“…We have presented a framework for assessing intervention fidelity of a complex intervention based on five domains (design, training, delivery, receipt, and enactment) (Bellg et al, 2004;Borrelli, 2011). High dropout rate is a common challenge encountered in other interventions aiming at ICU survivors, such as physical rehabilitation (Connolly et al, 2015). This could result in incomplete outcome data and the failure of the intervention.…”

Section: Discussionmentioning

confidence: 99%

Intervention fidelity in postintensive care follow‐up consultations at ten sites in the RAPIT‐trial: A mixed‐methods evaluation

Jensen

Overgaard

Bestle

et al. 2019

Journal of Advanced Nursing

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Aim The aim of the study was to evaluate intervention fidelity of nurses’ delivery of the RAPIT recovery program for postintensive care patients. Background Interventions addressing patient problems after intensive care lack description of the process of delivery and the evidence of their effectiveness. This is needed to understand how these interventions work. Design Multistage intervention framework in a mixed‐methods design. Intervention fidelity strategies were assessed for intervention design, training, delivery, receipt, and enactment with quantitative and qualitative methods inspired by the Medical Research Council and the National Institutes of Health Fidelity Framework. Methods Data collection was embedded in a multicenter randomized controlled trial to explore intervention fidelity of a recovery program (December 2012–February 2017). Ten Danish intensive care units participated in the RAPIT‐trial including 386 patients and 27 nurses. Quantitative data covered training and delivery. Qualitative data explored design, quality of delivery, receipt, and enactment seen from nurses’ and patients’ perspectives. Data were analysed statistically and by systematic deductive‐inductive thematic analysis. Findings A framework for participatory enactment of a complex intervention was developed and demonstrated delivery with high consistent fidelity across sites. Low delivery doses and variations were related to the program, patient, provider nurses and context. Conclusion Our study provides insight into the process of intervention fidelity of a nurse‐led postintensive care recovery program and potentially enables professionals to understand key factors in cross‐site implementation. Although we demonstrate consistent delivery and variations suggest that some patients may benefit more than others.

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“…Hence[12] the extent of improvements in functional outcomes during hospitalization should be incorporated in hospital discharge planning. However, the evidence is still inconclusive regarding the benefits of exercise-based interventions on functional exercise capacity and health-related quality of life for survivors of critical illness[23]. Further research into the rehabilitation during hospitalization and post hospital discharge are required[24].…”

Section: Discussionmentioning

confidence: 99%

Determination of functional prognosis in hospitalized patients following an intensive care admission

Ferreira¹,

Lopes²,

Ferreira³

et al. 2016

WJCCM

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AIMTo investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODSRetrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality (KATZ Index of Independence in Activities of Daily Living) and muscle strength (MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit (ICU), in the Ward (WARD) and the total time of hospital stay (TOT).RESULTSConsidering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P < 0.05) were the KATZ and MRC on admission, age, sepsis (no), and total length of stay (TLS). Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex (female). The variable age (AUC = 0.664) discriminated the ΔKATZICU. The variables age (AUC = 0.712), KATZ in ICU (AUC = 0.590) and on ward admission (AUC = 0.746), and MRC on ward admission (AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission (AUC = 0.621) and TLS (AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII (AUC = 0.661) and MRC on ICU admission (AUC = 0.653) were discriminative. MRC on ICU (AUC = 0.681) and ward admission (AUC = 0.553) were discriminative for ΔMRCWARD. TLS (AUC = 0.649) and MRC on ward admission (AUC = 0.696) discriminative for the ΔMRCTOT.CONCLUSIONSpecific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

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Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Abstract: Blackwood, B. (2015). Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane database of systematic reviews (Online), (6).

Cited by 121 publications

References 89 publications

Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms

Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms

Intervention fidelity in postintensive care follow‐up consultations at ten sites in the RAPIT‐trial: A mixed‐methods evaluation

Determination of functional prognosis in hospitalized patients following an intensive care admission

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