Can in-reach multidisciplinary rehabilitation in the acute ward improve outcomes for critical care survivors? A pilot randomized controlled trial
Preview of fully accepted paper, still not published in any volume
Objectives: To assess the feasibility of in-reach rehabilitation for critical care survivors following discharge from the intensive care unit. To determine whether additional in-reach rehabilitation reduces hospital length-of-stay and improves outcomes in critical care survivors, compared with usual
Participants: A total of 66 consecutively-admitted critical care survivors with an intensive care unit stay ≥ 5 days were enrolled in the study. Of these, 62 were included in the analyses.
Methods: Pilot randomized control trial with blinded assessment at 6 and 12 months. The intervention group (n = 29) received in-reach rehabilitation in addition to usual ward therapy. The usual-care group (n = 33) received usual ward therapy. The primary outcome assessed was length-of-stay. Secondary outcomes included mobility, functional independence, psychological status and quality-of-life.
Results: The intervention group received more physiotherapy and occupational therapy sessions per week than the usual-care group (median = 8.2 vs 4.9, p < 0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 vs 41 days), this was not significant and the pilot study was not adequately powered (p = 0.57). No significant differences were observed in the secondary outcomes at hospital discharge, 6- or 12-month follow-ups.
Conclusion: Provision of intensive early rehabilitation to intensive care unit survivors on the acute ward is feasible. A further trial is needed to draw conclusions on how this intervention affects length-of-stay and functional outcomes.
This pilot study aimed to assess whether early, structured rehabilitation can be provided to critical care survivors and aid physical and psychological recovery. The study recruited 66 participants who were critically ill and were in intensive care for at least 5 days. The study compared patients receiving early rehabilitation in addition to usual therapy, vs usual therapy on the acute ward. Both participant groups were assessed at hospital discharge and at 6 and 12 months. The outcomes assessed included: length of hospital stay; mobility ability to carry out activities of daily living; psychological symptoms; and quality of life. The results showed that early rehabilitation was feasible, could be provided to critical care survivors, and suggested that these patients may have a shorter length of stay in hospital. While both groups improved in their other outcomes, there were no major differences between the groups.
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