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

The aim of this study was to test the utility and efficiency of the theory of planned behaviour (TPB) and the health belief model (HBM) in predicting testicular self-examination (TSE) behaviour. A questionnaire was administered to an opportunistic sample of 195 undergraduates aged 18-39 years. Structural equation modelling indicated that, on the basis of all the fit indices, the TPB model was the better model, however, the quality of the models was very similar. The TPB explained 50% of the variance in intention and 22% in behaviour while the HBM (with self-efficacy) accounted for 56 and 21%, respectively. Self-efficacy was the most important predictor of TSE behavioural intention across both models. These findings contribute to the growing literature on the testing of multiple models in the health psychology domain.

Background Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors’ transition from the intensive care unit to home, their support needs develop and change. Methods In this scoping review, we categorised patients’ support needs using House’s Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient’s transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors’ experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. Results From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe ( n = 17, 53%), Canada and the USA ( n = 6, 19%), Australasia ( n = 6, 19%), Hong Kong ( n = 1, 3%), Jordan ( n = 1, 3%) and multi-country ( n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. Conclusions This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors. Electronic supplementary material The online version of this article (10.1186/s13054-019-2441-6) contains supplementary material, which is available to authorized users.

NCT01463579. (results), https://clinicaltrials.gov/.

BackgroundPhysical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery.MethodsSix electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence.ResultsFive eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge.ConclusionsPatients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for design of future interventional trials and SR.Trial registration numberCRD42015001068.