Clinical decision making in intensive care units for starting early rehabilitation.

Determining the factors that influence clinical decision making of when to commence early rehabilitation in intensive care units

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12616000963426

Enrollment

1450

Registered

2016-07-21

Start date

2013-11-27

Completion date

2015-02-25

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Survivors of the intensive care unit (ICU) can suffer long standing impairments in physical function. Rehabilitation provided in the ICU has been shown to improve physical function outcomes at both hospital discharge and 12-months. Early rehabilitation has been shown to be safe and feasible and may help prevent the long term sequelae. However, early rehabilitation is not routinely implemented in ICU due to cultural barriers and a lack of well-defined safety parameters, it currently relies on the discretion of the clinicians caring for the patient. Clinician's decisions can be influenced by conventional wisdom, personal experience, intuition and knowledge. The factors that clinicians consider to be important in the decision to provide rehabilitation, particularly out of bed functional activities in the ICU, are currently unknown. Therefore we aim to identify the factors that influence the initiation of early rehabilitation and develop a decision making support tree that includes safety parameters to assist clinicians in the provision of early rehabilitation for patients in ICU.

Interventions

Prospective evaluation of clinical decision making in critically ill patients. Prospectively evaluate all the factors that influence clinical decision making of when to commence early rehabilitation in intensive care units. These factors will be identified through an extensive literature review and consultation with international experts who have published in the area of early rehabilitation in critically ill patients. Doctors, Nurses and Physiotherapists will be asked if the patient in front of them is ready to complete early mobilisation. If the therapist responds "No" they will then be asked to rank the factors that have influenced their decision. The duration of clinician involvement will be the time it takes to come to their decision each day. The participant who the decision is being made about will remain in the study for duration of their ICU stay or until 3 consecutive days of rehab occur.

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

Observed Patient inclusion criteria Predicted to be mechanically ventilated for greater 48 hours. Predicted intensive care unit length of stay greater than or equal to 48 hours (as per ICU consultant prediction) Medical, Nursing and Physiotherapist inclusion criteria Any healthcare provider involved in decision making must hold tertiary degree (or equivalent) in area of practice.

Exclusion criteria

Observed Patient exclusion criteria Known primary systemic neuromuscular disease or intracranial process on admission (as this limits the patient's ability to complete early rehabilitation and alters the clinican's decision making process). Doctors, Nurses and Physiotherapists exclusion criteria. Nil.

Outcome results