Patient and family experience of physical rehabilitation on the intensive care unit: a qualitative exploration

Willigen, Zoe van; Ostler, Chantel; Thackray, Debbie; Cusack, Rebecca

doi:10.1016/j.physio.2020.01.003

Cited by 25 publications

(28 citation statements)

References 34 publications

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“…Qualitative studies illustrate how setting rehabilitation goals, early in ICU, may not be a priority for patients or families who could only focus on survival. They described initially needing a paternalistic approach to goal setting [52] , [53] . Critical care survivors described a lost sense of self which rehabilitation began to rebuild: therapy staff were perceived as trusted advocates who could provide motivation and person-centred approaches to help reconstruct a new future [53] .…”

Section: Resultsmentioning

confidence: 99%

Rehabilitation to enable recovery from COVID-19: a rapid systematic review

et al. 2021

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Objectives To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19. Methods The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools. Results Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence. Conclusions Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y

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Section: Resultsmentioning

confidence: 99%

Rehabilitation to enable recovery from COVID-19: a rapid systematic review

et al. 2021

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“…The physical, psychological, and cognitive impairments in survivors of critical illness are highly associated and share risk factors that originate in the ICU setting. 4,8,42 Early mobility during the ICU hospitalization can impact the ICU experience [43][44][45] and patients' short-term physical outcomes. 46 Given the connections between physical health, mental health, and cognitive status in healthy and chronically ill individuals, patient mobilization can potentially impact outcomes in multiple health domains.…”

Section: Discussionmentioning

confidence: 99%

A Step Forward for Intensive Care Unit Patients: Early Mobility Interventions and Associated Outcome Measures

Bach

Hetland

2022

Critical Care Nurse

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Background Critical illness survivors have impairments across physical, psychological, and cognitive health domains known as post–intensive care syndrome. Although physical activity can improve outcomes across all health domains, most intensive care unit early mobility studies focus solely on physical outcomes. Objective To explore the role of early mobility for adult patients in the intensive care unit by analyzing early mobility intervention studies with physical, psychological, or cognitive outcome measures. Methods This integrative review used Whittemore and Knafl’s methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched for primary research articles published from 2005 through 2021 on adult intensive care unit early mobility interventions evaluated by physical, cognitive, or psychological outcome measures during or after intervention delivery. Interventions comprising only passive mobility were excluded. Results Of 1009 articles screened, 20 were included. Variations in outcome measures, measurement timing, instruments, and control groups made synthesis difficult. No study evaluated an intervention using outcome measures from all 3 health domains. Five studies measured physical and cognitive outcomes; 6 studies measured physical and psychological outcomes. Conclusion Early mobility is primarily addressed objectively and unidimensionally, limiting understanding of the implications of early mobility for patients. Post–intensive care syndrome prevention begins in the intensive care unit; early mobility is a promising intervention for targeting multiple risk factors. Studies that measure outcomes in all health domains during or after early mobility are needed to better evaluate the comprehensive effects of early mobility.

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“…In fact, therapeutic relationships could vary depending on patient’s and therapist’s expected outcomes, on their interpersonal affective bonding, on their reactions to difficulties [ 29 ], and it could even vary over time [ 29 ]. This relationship may also depend on the patient’s trust in the therapist’s abilities, a factor that may improve active participation in therapy [ 30 ], impacting the attitudes and expectations of patients’ familiars and caregivers, and on the eventual presence of psychological support [ 31 ]. Diffusion of the PRPS, validated in different languages across the world, could provide a deeper insight in these aspects for improving therapeutic alliance among stakeholders, and hence rehabilitation outcomes.…”

Section: Discussionmentioning

confidence: 99%

Italian Version of the Pittsburgh Rehabilitation Participation Scale: Psychometric Analysis of Validity and Reliability

et al. 2021

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Patient’s active participation in therapy is a key component of successful rehabilitation. In fact, low participation has been shown to be a prognostic factor of poor outcome; however, participation is rarely assessed in clinical settings. The Pittsburgh Rehabilitation Participation Scale (PRPS) is a validated, quick, and accurate measure of participation, relying on clinicians’ observation, and not requiring any self-report by patients. The aim of this study was to validate an Italian version of the PRPS. Following forward and back-translation of PRPS into Italian, the translated version was validated in a total of 640 therapy sessions, related to a cohort of 32 patients admitted to an Italian hospital. It was tested for concurrent validity, finding significant correlations with Barthel Index (R > 0.58, p < 0.001) and SF-36 Physical and Mental Health (R > 0.4, p < 0.02), for predictive validity, finding significant correlation with the effectiveness of rehabilitation (R = 0.358, p = 0.045), and for inter-rater and intra-rater reliability, computing an Intra-class correlation coefficient (ICC = 0.926 and 0.756, respectively). These psychometric properties results were similar to those of the original version of this scale. The proposed PRPS can be helpful for Italian clinicians in the assessment of patient’s participation during rehabilitation.

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Patient and family experience of physical rehabilitation on the intensive care unit: a qualitative exploration

Cited by 25 publications

References 34 publications

Rehabilitation to enable recovery from COVID-19: a rapid systematic review

Rehabilitation to enable recovery from COVID-19: a rapid systematic review

A Step Forward for Intensive Care Unit Patients: Early Mobility Interventions and Associated Outcome Measures

Italian Version of the Pittsburgh Rehabilitation Participation Scale: Psychometric Analysis of Validity and Reliability

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