Qualitative, grounded theory exploration of patients’ experience of early mobilisation, rehabilitation and recovery after critical illness

Abstract

RationalePhysical rehabilitation (encompassing early mobilisation) of the critically ill patient is recognised best practice; however, further work is needed to explore the patients’ experience of rehabilitation qualitatively; a better understanding may facilitate implementation of early rehabilitation and elucidate the journey of survivorship.ObjectivesTo explore patient experience of physical rehabilitation from critical illness during and after a stay on intensive care unit (ICU).DesignExploratory grounded theory study using semistructured interviews.SettingAdult medical/surgical ICU of a London teaching hospital.ParticipantsA purposive sample of ICU survivors with intensive care unit acquired weakness (ICUAW) and an ICU length of stay of >72 hours.AnalysisData analysis followed a four-stage constant comparison technique: open coding, axial coding, selective coding and model development, with the aim of reaching thematic saturation. Peer debriefing and triangulation through a patient support group were carried out to ensure credibility.Main resultsFifteen people were interviewed (with four relatives in attendance). The early rehabilitation period was characterised by episodic memory loss, hallucinations, weakness and fatigue, making early rehabilitation arduous and difficult to recall. Participants craved a paternalised approach to care in the early days of ICU.The central idea that emerged from this study was recalibration of the self. This is driven by a lost sense of self, with loss of autonomy and competence; dehumanised elements of care may contribute to this. Participants described a fractured life narrative due to episodic memory loss, meaning that patients were shocked on awakening from sedation by the discrepancy between their physical form and cognitive representation of themselves.ConclusionsRecovery from ICUAW is a complex process that often begins with survivors exploring and adapting to a new body, followed by a period of recovering autonomy. Rehabilitation plays a key role in this recalibration period, helping survivors to reconstruct a desirable future.

Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta‐synthesis and meta‐summary

“…However, the review included studies published up to 2012 (Baumgarten & Poulsen, 2015) and no other published or ongoing reviews have emerged more recently on this topic to the best of our knowledge, while several primary qualitative studies have been conducted (e.g., Corner, Murray, & Brett, 2019; Kisorio & Langley, 2019). Therefore, recent improvements in the field of mechanical ventilation and sedative medications in ICU (Moreira & Neto, 2016) as experienced by patients that can inform nursing care decisions have not been summarised to date.…”

Lessons from a review of physiotherapy and psychological rehabilitation received during ICU stay and beyond to inform the development of an ICU follow clinic

“…Overall, the results recognise known factors such as difficulties around transitions 20 and echoes research on ICU survivorship and self-identity. 21 Feedback was from ICU survivors with different experiences at different time points to generate a range of data, however common themes exist, suggesting a process of transition from a sense of self prior to and following critical illness which is harder for some than others. It has long been known that survivors can become increasingly dependent and modify life habits beyond medical indications.…”

Does enhanced physical rehabilitation following intensive care unit discharge improve outcomes in patients who received mechanical ventilation? A systematic review and meta-analysis

“…While our findings indicate a lack of benefit of enhanced post-ICU rehabilitation in the evaluated population, highly self-motivated individuals might have derived benefit from such therapies. Further studies should collect data on motivation and engagement, which are crucial in maximising the benefits of rehabilitation 37. Lastly, the patient characteristics, follow-up timing and types of outcomes reported might exhibit substantial heterogeneity across trials and within each individual trial, an aspect we did not examine in the present analysis.…”