Physiotherapy treatment approaches for survivors of critical illness: a proposal from a Delphi study

Abstract

Purpose: The aim of this study was to develop practical recommendations for physiotherapy for survivors of critical illness after hospital discharge. Methods: A modified Delphi consensus study was performed. A scoping literature review formed the basis for three Delphi rounds. The first round was used to gather input from the panel to finalize the survey for the next two rounds in which the panel was asked to rank each of the statements on an ordinal scale with the objective to reach consensus. Consensus was defined as a SIQR of ≤ 0.5. Ten Dutch panelists participated in this study: three primary care physiotherapists, four intensive care physiotherapists, one occupational therapist, one ICU-nurse and one former ICU-patient. All involved professionals have treated survivors of critical illness. Our study was performed in parallel with an international Delphi study with hospital-based health-care professionals and researchers. Results: After three Delphi rounds, consensus was reached on 95.5% of the statements. This resulted in practical recommendations for physiotherapy for critical illness survivors in the primary care setting. The panel agreed that the handover should include information on 14 items. Physiotherapy treatment goals should be directed toward improvement of aerobic capacity, physical functioning, activities in daily living, muscle strength, respiratory and pulmonary function, fatigue, pain, and health-related quality of life. Physiotherapy measurements and interventions to improve these outcomes are suggested. Conclusion: This study adds to the knowledge on post-ICU physiotherapy with practical recommendations supporting clinical decision-making in the treatment of survivors of critical illness after hospital discharge.

Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study

“…The greatest improvement in outcome was seen at 3 months follow up (steps, mean [SD], REACH: 82 [27] vs usual care: 94 [28]). At 6 months the improvement was still visible but tapered off (steps, mean [SD], REACH: 87 [31] vs usual care: 99 [28]). When comparing to normative values, mean steps improved to the lower limits of available norm values [48] in both groups, at 3-and at 6-month follow-up (Table 2).…”

“…While expert recommendations for home-based, PTled interventions for survivors of critical illness have been published [26,30,31], feasibility of such interventions within the primary care setting is yet to be investigated. Therefore, the aim of this study was to investigate the feasibility of an interdisciplinary home-based intervention for patients with new or worsened impairments within one of the domains of PICS, initiated immediately after hospital discharge and targeting (physical) recovery and self-management in comparison to patients receiving usual care.…”

Course of recovery of respiratory muscle strength and its associations with exercise capacity and handgrip strength: A prospective cohort study among survivors of critical illness

“…So far, longitudinal studies on the course of recovery of MIP and MEP in survivors of critical illness have not been reported [15,19] and although interventions targeting RMW have become increasingly common within the ICU [20][21][22], they seldom continue after ICU and hospital discharge [23]. If longitudinal data existed on MIP and MEP and potential associations with other functional outcomes in survivors of critical illness, we could determine if, and when, tailored respiratory muscle training could be valuable to include in post-ICU rehabilitation interventions, as is recommended by recent Delphi studies [24,25].…”

Concern with reproducibility of rehabilitation after critical illness and hospital discharge

“…All patients in the intervention group received physical therapy (PT), but after 3 months, one-third of the intervention group had completed PT. The frequency of intervention was higher in UC, which is presumed to be based on the Dutch practical recommendation for PT [ 2 ]. In addition, the intervention rate of occupational therapy (OT) increased 2.5 times in 3–6 months compared to 0–3 months, showing an increase in contrast to PT.…”