Anxiety, Critical Care, Intensive Care, Depressive Symptoms, Physical Disability, Post-Intensive Care Syndrome, Posttraumatic Stress Symptom
Conditions
Keywords
Post-intensive care syndrome, Pilot study, Early follow-up intervention
Brief summary
Pilot study of the feasibility and utility of an early, in-hospital multidisciplinary intervention in ICU survivors at risk for psychological and physical problems post-ICU stay
Detailed description
60 adult patients at two hospitals in Region Stockholm (Karolinska University Hospital and Södersjukhuset) with an ICU stay ≥12 hours with increased risk for psychological/physical sequelae will be invited to participate. Intervention: Early re-assessment and multidisciplinary follow-up, led by an ICU follow-up staff (Case Manager, CM). The CM will support the patient and coordinate the rehabilitation efforts from ICU discharge to primary care with a secondary, deepened assessment of symptoms in the ward, recapitulation and information about the time spent in the ICU, followed by a multidisciplinary discussion with concerned specialists and the set-up of an individual rehabilitation plan communicated to the patient and the informal caregivers. The CM will keep track of the patient during hospital stay and ensure that there is a plan for further primary care rehabilitation after hospital discharge. The CM will contact the patient weekly to follow up on wellbeing and planned primary care activities until 12 weeks. At twelve weeks, patients will be assessed with regards to psychological symptoms (HADS, PTSS-14) and physical disability (BI). Outcome: The primary outcome is the feasibility of the intervention. Patients and informal caregivers will be invited to participate in semi-structured interviews that will deepen the knowledge about their views upon the intervention, needs and suggested measures to improve the patients' recovery. Resource utilisation will be documented by the CM and feedback collected from involved ICU staff and hospital clinicians. Secondary outcomes are patients' level of psychological and physical problems and health-related quality of life. The results from the pilot study will inform a subsequent randomized controlled trial of an early follow-up intervention.
Interventions
OTHERCase-manager led multidisciplinary follow-up after intensive care
Early in-hospital follow-up in survivors of intensive care with an increased risk of psychological/physical sequelae. The follow-up is led by a case-manager reassessing the patient after ICU discharge for psychological/physical rehabilitation needs. The CM will discuss patient needs with concerned specialists in a multidisciplinary team, leading to the establishment of a personal rehabilitation plan, communicated to the patient and next-of-kin. The CM will keep track of the patient during hospital stay and ensure primary care rehabilitation (if needed) is established once the patient is discharged from the hospital. The CM will contact the patient weekly to follow up on well-being and primary care activities until 12 weeks after discharge.
Sponsors
Region Stockholm
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Pilot study of the feasibility of the intervention
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- Patients admitted ≥12 hours to the ICU with an increased risk for physical or psychological sequelae (assessed with the PROGRESS-ICU/PREPICS instruments)
Exclusion criteria
* Dementia or other major cognitive problems * Structural brain or spinal cord injury * Multiple limitations of medical treatment * Insufficient language skills (Swedish)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of the intervention | Outcome measured during and after termination of data collection and end of intervention | Evaluation of the method including resource utilization with involved ICU follow-up staff/case managers and patients and their informal caregivers. |
| Utility of the intervention | Outcome measured three-four months after ICU discharge | Patient and caregiver views on the intervention's utility. Views on the intervention from hospital ward staff. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depressive symptoms post-ICU | Outcome measured three months after ICU discharge | Assessment of patients' symptoms of depression post-intervention |
| Anxiety symptoms post-ICU | Outcome measured three months after ICU discharge | Assessment of patients' symptoms of anxiety post-intervention |
| Symptoms of post-traumatic stress post-ICU | Outcome measured three months after ICU discharge | Assessment of patients' symptoms of post-traumatic stress post-intervention |
| Physical disability post-ICU | Outcome measured three months after ICU discharge | Assessment of physical performance post-intervention |
| Health-related quality of life post-ICU | Outcome measured three months after ICU discharge | Health-related quality of life (HRQL) assessed with the RAND-36 questionnaire, scoring 0-100 where a higher score indicates greater HRQL. |
Countries
Sweden
Contacts
PRINCIPAL_INVESTIGATORAnna Milton
Karolinska Institutet/Karolinska University Hospital
Outcome results
None listed