Cognitive and physical rehabilitation of intensive care unit survivors

Abstract

Background Millions of patients who survive medical and surgical general ICU care every year suffer from newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multi-faceted, in-home tele-rehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. Methods This was a single-site, feasibility, pilot randomized trial of 21 general medical/surgical ICU survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation) while intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multi-disciplinary treatment. Interventions over 12 weeks included 6 in-person visits for cognitive rehabilitation and 6 televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months) with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. Results Patients tolerated the program with only 1 adverse event (AE) reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower Test (TOWER) (for planning and strategic thinking) versus controls [13.0 (Interquartile Range, IQR 11.5 to14.0) vs. 7.5 (4.0 to 8.5), adjusted p<0.01]. Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently employed measures of functional status [Functional Activities Questionnaire (FAQ)] at 3 months vs. controls [1.0 (0.0 to 3.0) vs. 8.0 (6.0 to 11.8), adjusted p=0.04]. Conclusions A multi-component rehabilitation program for ICU survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot, feasibility program and to confirm these results as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.

Effect of a Primary Care Management Intervention on Mental Health–Related Quality of Life Among Survivors of Sepsis

“…This primary-care based intervention may not have been sufficiently focused in order to address all their diverse medical and psychological needs. 50 Future trials may evaluate interventions in different patient subgroups targeting specific post-sepsis sequelae. Larger samples should be included, in order to address smaller but potentially still clinically relevant effects of primary care interventions.…”

“…However, there is growing evidence that following critical illness, mental health outcomes can be improved through effective psychological interventions targeting specific syndromes. 50,51 …”

Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial

“…38 Patients who recover from delirium have short 5 and long-term 4 impairments in executive function. Jackson and colleagues 18 reported greater benefits for executive function using cognition-focused and physical therapy verses physical therapy only in ICU survivors. Unlike our study, their combined intervention continued for 12 weeks, their subjects were younger, and none had dementia.…”

“…9 In a recent clinical trial, an intervention of combined cognition-focused and physical therapy improved executive function and instrumental activities of daily living in cognitively impaired survivors of critical illness when compared to physical therapy only. 18 …”

Development of an information system for teleoperated physical rehab care service via Internet. Pilot case: patients with mild knee injury who live in geographically vulnerable zones

“…Telemedicine is a health service in which information is remotely exchanged between a medical specialist and a patient for the awareness, prevention, diagnosis, and treatment of and rehabilitation from diseases using information and communication technologies that promote access to and opportunity to receive services by populations facing limited supply of and/or access to such services in their geographical area (i.e., the geographically vulnerable population) [2,3]. Remote clinical care has been performed in both teleassisted [4][5][6][7] and teleoperated manners [8][9][10][11]. The term "teleassisted" refers to a visual or over-the-phone telemonitoring system by which the therapy processes are specified and that works as a guide for treating of the patient [12].…”