None listed
Conditions
Brief summary
The aim of the study was to determine whether early, structured rehabilitation is effective in critically ill patients in aiding physical and psychological recovery. The study was conducted as a trial and compared patients receiving early rehabilitation versus usual care. Patients were assessed on commencement on the study, on discharge from hospital, and at 6 and 12 months. The study was conducted at St. Vincent’s Hospital Sydney. Patients were eligible for the study if they were critically ill patients and were in intensive care (ICU) for at least 5 days. The early rehabilitation group received early routine screening by a rehabilitation physician, routine multidisciplinary assessment and provision of individualised, structured rehabilitation programme (up to two 30-minute therapy sessions per day) with formal coordination through case conferencing. This was be provided through the Mobile Rehabilitation Team (MRT). The participants were followed-up by the rehabilitation clinic The key components were daily team communication, higher intensity of therapy than usual care, and weekly case conferencing. In the usual care group, therapy could be provided by usual therapists in the ICU or acute ward. A rehabilitation physician was still able to review the patient at the request of the treating team and the MRT may have been involved if deemed necessary. The 2 groups were followed at hospital discharge and at 6 and 12 months. Outcomes assessed at discharge included their length of hospital day; muscle strength; mobility/endurance; functional independence/ability to carry out activities of daily living; and symptoms of depression, anxiety and stress. The outcomes assessed at 6 and 12 months included: ability to carry out activities of daily living; symptoms of depression, anxiety and stress; and quality of life.
Interventions
The intervention group received additional interventions from an in-reach mobile rehabilitation team, with the aim of delivering higher intensity rehabilitation. This team consisted of a rehabilitation physician (0.2 FTE), a nurse (0.2 FTE), a fulltime physiotherapist and occupational therapist. Participants in the intervention group were all visited by the rehabilitation physician for an initial assessment. Subsequent visits were based on clinical needs, typically once or twice per week. A stru
The intervention group received additional interventions from an in-reach mobile rehabilitation team, with the aim of delivering higher intensity rehabilitation. This team consisted of a rehabilitation physician (0.2 FTE), a nurse (0.2 FTE), a fulltime physiotherapist and occupational therapist. Participants in the intervention group were all visited by the rehabilitation physician for an initial assessment. Subsequent visits were based on clinical needs, typically once or twice per week. A structured multidisciplinary rehabilitation program was devised for each patient. This aimed to address individual patient needs, involved the patient in decision-making, goal setting and was regularly reviewed during the patient journey via weekly multidisciplinary team meetings (case conferencing). The in-reach therapists worked with ward therapists so the therapy intensity delivered was over and above what the patient would normally receive from ward therapists. Up to 2 sessions of therapy of 30 minutes duration were provided. The mobile rehabilitation team had a case load of 6-8 patients at any one time. This team commenced rehabilitation immediately after baseline assessment, soon after ICU discharge to the general ward. The team was available 5 days per week, and rehabilitation interventions were chosen by the therapists according to patient needs. The duration of the study intervention was also determined by clinical need i.e. patients could be discharged from the service once all rehabilitation goals were achieved. For those needing inpatient rehabilitation, the in-reach team remained involved until acute hospital discharge and transfer to rehabilitation.
Sponsors
St Vincent's Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
• Inpatients with an ICU length of stay of 5 or more days. • Baseline functional independence (defined a priori as a Barthel Index score of 70 or higher obtained from a proxy describing patient function 2 weeks before admission) (those who are functionally dependent prior to critical illness may have limited rehabilitation potential)
Exclusion criteria
• Adult patients receiving palliative care or not expected to survive (withdrawing life support and considering comfort measures only) • Irreversible disorders with 6-month mortality estimated at more than 50% • Unable to be followed up e.g. travellers, rural residents, homeless, deaf • Unable to speak English (many of the instruments used do not have translations) • Pre-existing diagnosis of dementia of any aetiology (those who are cognitively impaired may have limited rehabilitation potential) • Severe psychiatric disorders with recent hospitalisation (within 6 months) or an active substance abuse (they may have limited rehabilitation potential) • Living in residential care at baseline (those who are functionally dependent prior to critical illness may have limited rehabilitation potential)
Outcome results
None listed