Sepsis survivors and caregivers perspectives on post–acute rehabilitation and aftercare in the first year after sepsis in Germany

Abstract

BackgroundSepsis survivors often suffer from new morbidities. Current rehabilitation therapies are not tailored to their specific needs. The perspective of sepsis survivors and their caregivers on rehabilitation and aftercare is insufficiently understood. We aimed to assess how sepsis survivors in Germany rated the suitability, extent and satisfaction with rehabilitation therapies that they underwent in the year following the acute sepsis episode.MethodsProspective mixed-methods, multicenter study among a cohort of adult ICU-treated sepsis survivors and their caregivers. Interviews were conducted 6 and 12 months after ICU discharge by telephone and comprised closed as well as open-ended questions. Primary outcomes were the utilization and patient satisfaction with inpatient and outpatient rehabilitation and post-sepsis aftercare in general. Open-ended questions were analyzed according to the principles of content analysis.ResultsFoun hundred interviews were performed with 287 patients and/or relatives. At 6 months after sepsis, 85.0% of survivors had applied for and 70.0% had undergone rehabilitation. Among these, 97% received physical therapy, but only a minority reported therapies for specific ailments including pain, weaning from mechanical ventilation, cognitive deficits of fatigue. Survivors were moderately satisfied with the suitability, extent, and overall results of received therapies and perceived deficits in the timeliness, accessibility, and specificity of therapies as well as deficits in the structural support frameworks and patient education.ConclusionFrom the perspective of survivors who undergo rehabilitation, therapies should already begin in hospital, be more appropriate for their specific ailments and include better patient and caregiver education. The general aftercare and structural support framework should be improved.

How do sepsis survivors experience life after sepsis? A Danish qualitative study exploring factors of importance

“…This could indicate that mental needs are not necessarily handled after sepsis. Likewise, in a study from Germany, researchers found that sepsis survivors often applied for rehabilitation, but these rehabilitations mostly addressed physical impairments, whereas other impairments (eg, fatigue or psychological problems) were rarely addressed 12…”

“…Most research on long-term consequences related to sepsis has used these tools and have focused on patients admitted to the intensive care unit (ICU), although many patients with sepsis are treated at the hospital ward 10 11. Few studies have focused on the patients’ perspectives without using predefined tools and questionnaires 12–14. In a German study, 15 sepsis survivors discharged from the ICU were interviewed to identify important HRQL.…”

Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis

“…This may be one of the reasons why only a small proportion of sepsis patients (17%) receive rehabilitation after their acute care hospitalization in Germany [ 11 ]. A survey among sepsis survivors also revealed that such rehabilitation often addresses only a small proportion of the sequelae [ 12 ]. Specific rehabilitation concepts for sepsis survivors are lacking, and survivors call for better and more specific follow-up care [ 13 ].…”

Understanding Post-Sepsis Syndrome: How Can Clinicians Help?

“…Early physical rehabilitation could well allow the patient to remobilize after sepsis to maintain an active, healthy lifestyle that is associated with a lower risk of cardiovascular events. Sepsis survivors mention prompt rehabilitation after discharge, physiotherapy and sports as important aspects that should be addressed to improve post-sepsis care, 129 all of which could be stimulated by clinicians.…”

“…Sepsis survivors mention that there is a need for psychological care as one of the unmet needs after hospital discharge. 129 The impact of critical illness can reflect in several mental health-related problems, like symptoms of PTSD, anxiety or depression with or without cognitive impairment, as described in several studies in survivors of critical illness, independent of sepsis admission status. 134 , 135 Risk factors like treatment-related stressors may leave patients vulnerable to develop long-term mental and cognitive health problems which can last for years.…”