Critical Illness, Delirium
Conditions
Brief summary
An ICU admission is stressful for not only patients but their families as well. Research has shown that involving family members during a loved one's ICU stay can be helpful for them, but there is not clear direction on the best way to do this. For patients, family presence as well as early movement during their ICU stay has been shown to help recovery from things like delirium (a state of confusion) faster, and might prevent the weakness that can happen with a stay in the ICU. In this study, the investigators will explore whether having family help with moving patients through physiotherapy guided exercise can help both patients and families have a better experience and result from their ICU stay. The investigators hypothesize that family involvement in activities as part of an overall physiotherapy treatment plan will provide a tangible means for family members to engage in the care of their critically ill loved one, thus improving outcomes for both critically ill patients and family members.
Interventions
OTHERFamily involvement
Family delivery of mobility activities
Sponsors
St. Joseph's Healthcare Hamilton
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (≥18 years) in the ICU * Anticipated length of stay ≥48 hours for whom a request for physiotherapy has been placed by the treating physician * Appropriateness for physiotherapy confirmed by the unit's physiotherapist. * Families will be eligible if they are able to be present in ICU during physiotherapist or research team work hours until they are cleared to deliver activities independently, then at least three times weekly thereafter.
Exclusion criteria
* Patients who are receiving end of life care * Patients who have high risk injuries including spinal cord injury or spinal fractures, post-operative from spinal surgery, and untreated hip or long bone fractures * Patients at risk of raised intracranial pressure (ICP) (e.g. Malignant middle cerebral artery stroke, large subarachnoid hemorrhage), admitted post trauma activation, post-operative from brain surgery or with external ventricular drain (EVD) in situ. * Patients who are bed-bound or require mechanical lift at baseline who would not otherwise be offered physiotherapy services. *
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility - resources | Study duration - up to one year | Physiotherapist and nurse outcomes will include inability to train families due to physiotherapy or team resources, and number of sessions per week cancelled due to inadequate staffing resources during the patients ICU stay. |
| Feasibility - consent rate | Study duration - up to one year | We define a successful consent rate as \> 70% of SDMs or patients approached to consent, agreeing to take part in the study |
| Feasibility - recruitment rate | Study duration - up to one year | We define a successful recruitment rate as achieving enrolment of four patients per month over the duration of the trial |
| Feasibility - protocol adherence | During ICU stay, censored at 1 month | We define successful adherence as average family involvement in ≥ 3 sessions/week. Furthermore, adherence to documentation of involvement will be successful if documented by family for ≥80% of sessions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Delirium | During ICU stay, censored at 1 month | CAM-ICU |
| Patient & Family PTSD symptoms | 1 & 3 months | IES-R |
| Adverse Events | During ICU stay, censored at 1 month | Falls, hypotension, bradycardia, line removal, unplanned extubation, inappropriate family intervention, unexpected injuries |
| Family satisfaction | 1 & 3 months | 23-item Family Satisfaction in the ICU questionnaire; HADS scale |
Countries
Canada
Outcome results
None listed