Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

Abstract

Background: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? Methods: A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5. Results: Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed. Conclusions: A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.

Core Domains for Clinical Research in Acute Respiratory Failure Survivors: An International Modified Delphi Consensus Study

“…An even smaller subset of these studies permitted patients or caregivers to participate in the prioritization of outcomes. The public is commonly excluded from Delphi panels because it can be challenging to identify appropriate patient and caregiver representatives, provide them with information tailored to their health literacy level, and incorporate them into the consensus process in a way that effectively utilizes and respects their area of expertise(41–43). We purposefully recruited a sufficient number of patient/caregiver representatives to ensure that if the most patient/caregivers rated a domain as “Not Important” (score ≤3) the domain would not meet our a priori consensus criteria, effectively giving patients and caregivers veto power.…”

Folgen kritischer Erkrankung und mögliche Interventionen

“…Insbesondere bei dieser Komplikation scheinen physisch re-habilitative Übungen im Anschluss an die Intensivbehandlung indiziert. Ein aktuelles Expertenstatement zur physischen Rehabilitation nach kritischer Erkrankung definierte nach einem 3-stufigen Delphi-Konsensus-Prozess u. a. Maßnahmen und primäre Ziele physischer Rehabilitationsmaßnahmen nach überlebter kritischer Erkrankung [39]. In ▶ Abb.…”

Physiotherapy treatment approaches for survivors of critical illness: a proposal from a Delphi study

“…Moreover, the British NICE guidelines contains advices regarding functional assessment 3 months following hospital discharge but do not provide recommendations for physiotherapy practice in primary care (Connolly et al, 2014). Considering the lack of knowledge and clinical expertise among primary care physiotherapists on the relatively new syndrome PICS (Major et al, 2016) and the lack of both national and international clinical guidelines to support physical rehabilitation in primary care after critical illness (McDowell et al, 2017), it is assumed that survivors of critical illness do not receive optimal physiotherapy treatment (Wieske et al, 2015).…”

“…In parallel with our study, a Delphi project on physical rehabilitation for ICU patients after hospitals discharge was performed by Major et al (2016) with an international panel of hospital-based clinicians and researchers with expertise in the field of critical illness. The authors proposed a consensus-based framework for physical rehabilitation for survivors of critical illness, after hospital discharge.…”