Abstract:
Introduction: Numerous primary studies and several review
papers have highlighted delayed physical and psychological
recovery for survivors of critical illness, often beyond 6 months
after discharge. This randomized controlled trial with blinded
assessment aims to test the effects of an 8-week, home-based,
individually tailored physical rehabilitation programme on
physical and psychological recovery for survivors of a critical
illness after discharge from hospital.
Method: Participants are survivors of a critical illness discharged
from nine intensive care units (ICUs) in Australia, who are aged
18 years or older, in an ICU longer than 48 hours, discharged
home to self-care or carer (non-institutional care), able to
participate in physical rehabilitation, and within the hospitals'
local geographical areas for home visits. The study is based in
participants' home environments. Blinded assessments at
weeks 1, 8 and 26 after hospital discharge examine physical
functioning, exercise capacity, health-related quality of life and
psychological well being. The intervention is graded,
individualized endurance and strength training prescribed by a
pulmonary rehabilitation physiotherapist over an 8-week period,
with three home visits, five follow-up phone calls, and a printed
exercise manual supporting the training. Initial focus is on lower
limb exercises and walking, with warm-up stretches, and
progresses to the addition of core stabilization and upper limb
exercises.
Results: The burden of a critical illness is well documented. This
novel study will determine whether a home-based physical
rehabilitation programme improves the recovery trajectory for
survivors of critical illness. The projected sample size of 200
patients aims to detect a clinically important 10% improvement
in physical functioning. The study will also examine whether
other important physical and psychological measures are
improved.
Conclusion This multicentre, randomized controlled trial will
examine outcomes that are meaningful to patients, their family
and society, namely functional ability and well being. The study
will also target a health problem that is likely to increase as the
population ages. If the programme is effective, it will provide a
model that can be easily adapted and adopted by existing
primary care or community services to improve the recovery of
individuals following critical illness.
