Journal of Rehabilitation Medicine 51-8 | Page 62

J Rehabil Med 2019; 51: 598–606 ORIGINAL REPORT CAN IN-REACH MULTIDISCIPLINARY REHABILITATION IN THE ACUTE WARD IMPROVE OUTCOMES FOR CRITICAL CARE SURVIVORS? A PILOT RANDOMIZED CONTROLLED TRIAL Jane WU, MBBS, FAFRM, MPH 1,2 , Angela VRATSISTAS-CURTO, BAppSc (OT) 1 , Christine T. SHINER, BMedSci Hons, PhD 1,2 , Steven G. FAUX, BA, MBBS, FAFRM, FFPM 1,2 , IAN HARRIS, MBBS, MMed (Clin Epi) 3,4 and Christopher J. POULOS, MBBS, FAFRM, PhD 5 From the 1 St Vincent’s Hospital, Sydney, 2 St Vincent’s Clinical School, 3 South Western Sydney Clinical School, University of New South Wales, Wales, 4 Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney and 5 School of Public Health and Community Medicine, University of New South, Wales, Australia Objectives: To assess the feasibility of in-reach re- habilitation for critical care survivors following discharge from the intensive care unit. To deter- mine whether additional in-reach rehabilitation re- duces hospital length-of-stay and improves outco- mes in critical care survivors, compared with usual therapy. 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 ad- dition 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 independen- ce, psychological status and quality-of-life. Results: The intervention group received more phy- siotherapy 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 interven- tion 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 diffe- rences were observed in the secondary outcomes at hospital discharge, 6- or 12-month follow-ups. Conclusion: Provision of intensive early rehabilita- tion 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. Key words: critical illness; rehabilitation; critical care; treat- ment outcome; rehabilitation research; outcomes research Accepted Jun 14, 2019; Epub ahead of print Jul 8, 2019 J Rehabil Med 2019; 51: 598–606 Correspondence address: Jane Wu, St Vincent’s Hospital, Sydney, New South Wales, Australia. E-mail: [email protected] C ritical care survivors experience long-term phy- sical and functional impairments, neurocognitive deficits, impaired mental health, decreased quality of life, and decreased rates of return to work (1). Existing LAY ABSTRACT This pilot study aimed to assess whether early, struc- tured rehabilitation can be provided to critical care sur- vivors 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 ad- dition 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 asses- sed included: length of hospital stay; mobility ability to carry out activities of daily living; psychological symp- toms; 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. guidelines for the rehabilitation management of critical care survivors, such as those developed in the UK (2), encourage the commencement of rehabilitation “as soon as possible” and “as much as possible”. Of the research published to date investigating early re- habilitation of critical care survivors, interventions are primarily delivered within the intensive care setting. This includes a recent trial that found that a combined physiotherapy and occupational therapy programme delivered in the intensive care unit (ICU) resulted in improved functional outcomes at hospital discharge and a shorter duration of delirium (3). Furthermore, the effectiveness of early mobilization of patients in the ICU has been examined in several systematic reviews (4–7) and a meta-analysis (8), where it was also found to improve physical function and reduce the duration of mechanical ventilation. In keeping with Australian guidelines (9), early mobilization in the ICU has been adopted as part of standard care in some hospitals. In Australia, early co-ordinated rehabilitation is routi- nely provided in the following hospital settings: stroke units (10), orthogeriatric services (11) and aged care ser- vices (12). For patients not receiving care in one of these settings, early rehabilitation would typically commence only after a referral was made by the acute medical or surgical treating team to rehabilitation services. Early This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2579 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977