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01-04-2017 | Systematic Review

Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies

Authors: Selina M. Parry, Laura D. Knight, Bronwen Connolly, Claire Baldwin, Zudin Puthucheary, Peter Morris, Jessica Mortimore, Nicholas Hart, Linda Denehy, Catherine L. Granger

Published in: Intensive Care Medicine | Issue 4/2017

Abstract

Purpose

To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers.

Methods

Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454.

Results

Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment.

Conclusions

The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.

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Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E (2016) Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 42(5):725–738CrossRefPubMed

Kayambu G, Boots R, Paratz J (2013) Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 41(6):1543–1554CrossRefPubMed

Hashem M, Nelliot A, Needham D (2016) Early mobilization and rehabilitation in the ICU: moving back to the future. Respir Care 61(7):971–979CrossRefPubMed

Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100(2):126–131PubMedPubMedCentral

National Institute for Health and Clinical Excellence (2009) Rehabilitation after critical illness. NICE clinical guideline, vol 83. National Institute for Health and Clinical Excellence, Manchester

Berry A, Beattie K, Bennett J, Cross , Cushway S, Hassan A, Longhurst E, Moore R, Phillips D, Plowman E, Scott J, Thomas L, Elliott D (2014) Physical activity and movement: a guideline for critically ill adults, in SHPN. Agency for Clinical Innovation, Chatswood

Berney SC, Rose JW, Bernhardt J, Denehy L (2015) Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care 30(4):658–663CrossRefPubMed

Berney S, Harrold M, Webb S, Seppelt I, Patman S, Thomas P, Denehy L (2013) Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc 15(4):260–265PubMed

Nydahl P, Ruhl A, Bartoszek G, Dubb R, Filipovic S, Flohr H-J, Kaltwasser A, Mende H, Rothaug O, Schuchhardt D, Schwabbauer N, Needham D (2014) Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 42(5):1178–1186CrossRefPubMed

10.

Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker Kaltwasser A, Needham D (2016) Barriers and strategies for early mobilization in intensive care units. Ann Am Thorac Soc 36:2238–2243

11.

Honiden S, Connors G (2015) Barriers and challenges to the successful implementation of an intensive care unit mobility program: understanding systems and human factors in search for practical solutions. Clin Chest Med 36(3):431–440CrossRefPubMed

12.

Parry SM et al (2016) What are the factors that impact on physical activity and rehabilitation for survivors of critical illness: A systematic review of quantitative and qualitative studies. Intensive Care Med Exp 4 (Suppl 1): A40

13.

Moher D, Liberati A, Tetzlaff J, Altman D, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. doi:10.1371/journal.pmed.1000097

14.

Tong A, Flemming K, McInnes E, Oliver S, Craig J (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 12(181):1–8

15.

Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357CrossRefPubMed

16.

Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8:45

17.

Harrold M, Salisbury L, Webb S, Allison G (2015) Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care 19(1):336CrossRefPubMedPubMedCentral

18.

Pohlman M, Schweickert W, Pohlman A, Nigos C, Pawlik A, Esbrook C, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt G, Bowman A, Barr R, McCallister K, Hall J, Kress J (2010) Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med 38(11):2089–2094CrossRefPubMed

19.

Castro E, Turcinovic M, Platz J, Law I (2015) Early mobilization: changing the mindset. Criti Care Nurs 35(4):e1–e5CrossRef

20.

TEAM Study Investigators, Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L, Harrold M, Higgins A, Presneill J, Saxena M, Skinner E, Young P, Webb S (2015) Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 19:81

21.

Needham D, Korupolu R (2010) Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Topic Stroke Rehabil 17(4):271–281CrossRef

22.

Morris P, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite R, Haponik E (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36(8):2238–2243CrossRefPubMed

23.

Berney S, Haines K, Skinner E, Denehy L (2012) Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther 92(12):1524–1535CrossRefPubMed

24.

Knott A, Stevenson M, Harlow S (2015) Benchmarking rehabilitation practice in the intensive care unit. J Intensive Care Soc 16(1):24–30CrossRef

25.

Dammeyer J, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, Strachan C, Iwashyna J (2013) Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Quart 36(1):109–119CrossRef

26.

Appleton R, MacKinnon M, Booth M, Wells J, Quasim T (2011) Rehabilitation within Scottish intensive care units: a national survey. J Intensive Care Soc 12(3):221–227CrossRef

27.

Winkelman C, Peereboom K (2010) Staff-perceived barriers and facilitators. Crit Care Nurse 30(2):S13–S16CrossRefPubMed

28.

Mendez-Tellez P, Dinglas V, Colantuoni E, Ciesla N, Sevransky J, Shanholtz C, Pronovost P, Needham D (2013) Factors associated with timing of initiation of physical therapy in patients with acute lung injury. J Crit Care 28(6):980–984CrossRefPubMed

29.

McWilliams D, Pantelides K (2008) Does physiotherapy led early mobilisation affect length of stay in ICU? Assoc Chart Physiother Respir Care J 40:5–10

30.

Dinglas V, Colantuoni E, Ciesla N, Mendez-Tellez P, Shanholtz C, Needham D (2013) Occupational therapy for patients with acute lung injury: factors associated with time to first intervention in the intensive care unit. Am J Occup Ther 67(3):355–362CrossRefPubMedPubMedCentral

31.

Harris C, Shahid S (2014) Physical therapy-driven quality improvement to promote early mobility in the intensive care unit. Bayl Univ Med Cent Proc 27(3):203–207

32.

Zanni J, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer J, Brower R, Needham D (2010) Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care 25(2):254–262CrossRefPubMed

33.

Engel H, Tatebe S, Alonzo P, Mustille R, Rivera M (2013) Physical therapist-established intensive care unit early mobilization program: quality improvement project for critical care at the University of California San Francisco Medical Center. Phys Ther 93:975–985CrossRefPubMed

34.

Bassett R, McCutcheon Adams K, Danesh V, Groat P, Haugen A, Kiewel A, Small C, Van-Leuven M, Venus S, Ely E (2015) Rethinking critical care: decreasing sedation, increasing delirium monitoring, and increasing patient mobility. Jt Comm J Qual Patient Saf 41(2):62–74CrossRefPubMedPubMedCentral

35.

Jolley S, Caldwell E, Hough C (2014) Factors associated with receipt of physical therapy consultation in patients requiring prolonged mechanical ventilation. Dimens Criti Care Nurs 33(3):160–167CrossRef

36.

Jolley S, Dale C, Hough C (2015) Hospital-level factors associated with report of physical activity in patients on mechanical ventilation across Washington State. Ann Am Thorac Soc 12(2):209–215CrossRefPubMedPubMedCentral

37.

Jolley S, Regan-Baggs J, Dickson R, Hough C (2014) Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study. BMC Anaesthesiol 14:84

38.

Tadyanemhandu C, Manie S (2015) Profile of patients and physiotherapy patterns in intensive care units in public hospitals in Zimbabwe: a descriptive cross-sectional study. BMC Anaesthesiol 15:136CrossRef

39.

Davis J, Crawford K, Wierman H, Osgood W, Cavanaugh J, Smith K, Mette S, Orff S (2013) Mobilization of ventilated older adults. J Geriatr Phys Ther 36(4):162–168CrossRefPubMed

40.

Malone D, Ridgeway K, Nordon-Craft A, Moss P, Schenkman M, Moss M (2015) Physical therapist practice in the intensive care unit: results of a national survey. Phys Ther 95(10):1335–1344CrossRefPubMedPubMedCentral

41.

Barber E, Everard T, Holland A, Tipping C, Bradley S, Hodgson C (2015) Barriers and facilitators to early mobilisation in intensive care: a qualitative study. Aust Crit Care 28(4):177–182CrossRefPubMed

42.

Leditschke A, Green M, Irvine J, Bissett B, Mitchell I (2012) What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther 23(1):26–29

43.

Williams N, Flynn M (2013) An exploratory study of physiotherapist’s views of early rehabilitation in critically ill patients. Physiother Practi Res 34(2):93–102

44.

Bakhru R, Wiebe D, McWilliams D, Spuhler V, Schweickert W (2015) An environmental scan for early mobilization practices in US ICUs. Crit Care Med 43(11):2360–2369CrossRefPubMed

45.

Eakin M, Ugbah L, Arnautovic T, Parker A, Needham D (2015) Implementing and sustaining an early rehabilitation program in a medical intensive care unit: a qualitative analysis. J Crit Care 30(4):698–704CrossRefPubMed

46.

Hopkins R, Spuhler V, Thomsen G (2007) Transforming ICU culture to facilitate early mobility. Crit Care Clin 23(1):81–96CrossRefPubMed

47.

Miller M, Govindan S, Watson S, Hyzy R, Iwashyna T (2015) ABCDE, but in that order? A cross-sectional survey of Michigan intensive care unit sedation, delirium, and early mobility practices. Ann Am Thorac Soc 12(7):1066–1071CrossRefPubMedPubMedCentral

48.

Hopkins R, Spuhler V (2009) Strategies for promoting early activity in critically ill mechanically ventilated patients. AACN Adv Crit Care 20(3):277–289PubMed

49.

Bailey P, Thomsen G, Spuhler V, Blair R, Jewkes J, Bezdijian L, Veale K, Rodriguez L, Hopkins R (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35(1):139–145CrossRefPubMed

50.

Brummel N, Girard T, Ely E, Pandharipande P, Morandi A, Hughes C, Graves A, Shintani A, Murphy E, Work B, Pun B, Boehm Gill L, Dittus R, Jackson J (2014) Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med 40(3):370–379CrossRefPubMed

51.

Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner E, Chipman D, Schmidt U, Kasotakis G, Benjamin J, Zafonte R, Eikermann M (2011) Early mobilization in critically ill patients: patient’s mobilization level depends on health care provider’s profession. Phys Med Rehabil 3(4):307–313

52.

Holdsworth C, Haines K, Francis J, Marshall A, O’Connor D, Skinner E (2015) Mobilization of ventilated patients in the intensive care unit: an elicitation study using the theory of planned behavior. J Crit Care 30(6):1243–1250CrossRefPubMed

53.

King J, Crowe J (1998) Mobilization practices in Canadian critical care units. Physiotherapy 50(3):206–211

54.

Perme C, Lettvin C, Throckmorton T, Mitchell K, Masud F (2011) Early mobility and walking for patients with femoral arterial catheters in intensive care unit: a case series. J Acute Care Phys Ther 2(1):30–34CrossRef

55.

Perme C, Nalty T, Winkelman C, Nawa R, Masud F (2013) Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther 24(2):12–17

56.

Dalmuji A, Zanni J, Mantheiy E, Colantuoni E, Kho M, Needham D (2013) Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit. J Crit Care 28(4):535.e9–535.e15CrossRef

57.

Wang Y, Haines T, Ritchie P, Walker C, Ansell T, Ryan D, Lim P, Vij S, Acs R, Fealy N, Skinner E (2014) Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care 18(4):R161CrossRefPubMedPubMedCentral

58.

Toonstra A, Zanni J, Sperati J, Nelliot A, Mantheiy E, Skinner E, Needham D (2016) Feasibility and safety of physical therapy during continuous renal replacement therapy in the intensive care unit. Ann Am Thorac Soc 13(5):699–704CrossRefPubMed

59.

Bassett R, Vollman K, Brandwene L, Murray T (2012) Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit Care Nurs 28(2):88–97CrossRefPubMed

60.

Carrothers K, Barr J, Spurlock B, Ridgely M, Damberg C, Ely E (2013) Contextual issues influencing implementation and outcomes associated with an integrated approach to managing pain, agitation, and delirium in adult ICUs. Crit Care Med 41(9 Suppl 1):S128–S135CrossRefPubMed

61.

Reames C, Price D, King E, Dickinson S (2016) Mobilizing patients along the continuum of critical care. Dimens Crit Care Nurs 35(1):10–15CrossRefPubMed

62.

Balas M, Burke W, Gannon D, Cohen M, Colburn L, Bevil C, Franz D, Olsen K, Ely E, Vasilevskis E (2013) Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU pain, agitation, and delirium guidelines. Crit Care Med 41(9 Suppl 1):S116–S127CrossRefPubMedPubMedCentral

63.

Messer A, Corner L, Forst S (2015) Implementation of a progressive mobilization program in a medical-surgical intensive care unit. Crit Care Nurse 35(5):28–42CrossRefPubMed

64.

Walker W, Wright J, Danjoux G, Howell S, Martin D, Bonner S (2015) Project post intensive care exercise (PIX): a qualitative exploration of intensive care unit survivors’ perceptions of quality of life post-discharge and experience of exercise rehabilitation. J Intensive Care Soc 16(1):37–44CrossRef

65.

Deacon K (2012) Re-building life after ICU: a qualitative study of the patient’s perspective. Intensive Crit Care Nurs 28(2):114–122CrossRefPubMed

66.

Czerwonka A, Herridge M, Chan L, Chu L, Matte A, Cameron J (2015) Changing support needs of survivors of complex critical illness and their family caregivers across the care continuum: a qualitative pilot study of towards RECOVER. J Crit Care 30(2):242–249CrossRefPubMed

67.

Connolly B, Thompson A, Douiri A, Moxham J, Hart N (2015) Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit–acquired weakness: a pilot feasibility trial. J Crit Care 30(3):589–598CrossRefPubMedPubMedCentral

68.

Sottile P, Nordon-Craft A, Malone D, Schenkman M, Moss M (2015) Patient and family perceptions of physical therapy in the medical intensive care unit. J Crit Care 30(5):891–895CrossRefPubMedPubMedCentral

69.

Needham D, Korupolu R, Zanni J, Pradhan P, Colantuoni E, Palmer J, Brower R, Fan E (2010) Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 91(4):536–542CrossRefPubMed

70.

Connolly B, Douiri A, Steier J, Moxham J, Denehy L, Hart N (2014) A UK survey of rehabilitation following critical illness: implementation of NICE clinical guidance 83 (CG83) following hospital discharge. BMJ Open 4:e004963CrossRefPubMed

71.

Hodgin K, Nordon-Craft A, McFann K, Mealer M, Moss M (2009) Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med 37(2):561–568CrossRefPubMedPubMedCentral

72.

Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373(9678):1874–1882CrossRefPubMed

73.

Dafoe S, Stiller K, Chapman M (2015) Staff perceptions of the barriers to mobilizing ICU patients. Internet J Allied Health Sci Pract 13(2):1–13

74.

Dafoe S, Chapman M, Edwards S, Stiller K (2016) Overcoming barriers to the mobilisation of patients in an intensive care unit. Anaesth Intensive Care 44(2):185–324

75.

Dinglas V, Parker A, Reddy D, Colantuoni E, Zanni J, Turnbull A, Nelliot A, Ciesla N, Needham D (2014) A quality improvement project sustainably decreased time to onset of active physical therapy intervention in patients with acute lung injury. Ann Am Thorac Soc 11(8):1230–1238CrossRefPubMed

76.

Fraser D, Spiva L, Forman W, Hallen C (2015) Original research: implementation of an early mobility program in an ICU. Am J Nurs 115(12):49–58CrossRefPubMed

77.

Wahab R, Yip N, Chandra S, Nguyen M, Pavlovich K, Benson T, Vilotijevic D, Rodier D, Patel K, Rychcik P, Perez-Mir E, Boyle S, Berlin D, Needham D, Brodie D (2016) The implementation of an early rehabilitation program is associated with reduced length of stay: a multi-ICU study. J Intensive Care Soc 17(1):2–11CrossRef

78.

Hanekom S, Louw Q, Coetzee A (2013) Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units. Physiotherapy 99(2):139–145CrossRefPubMed

79.

Lee C, Herridge M, Matte A, Cameron J (2009) Education and support needs during recovery in acute respiratory distress syndrome survivors. Crit Care 13:R153CrossRefPubMedPubMedCentral

80.

Michie S, van Stralen M, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 23(6):42CrossRef

81.

Tabak M, Vollenbroek-Hutten M, van der Valk P, van der Pale J, Hermens H (2014) A telerehabilitation intervention for patients with chronic obstructive pulmonary disease: a randomized controlled pilot trial. Clin Rehabil 28(6):582–591CrossRefPubMed

Title: Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies
Authors: Selina M. Parry
Laura D. Knight
Bronwen Connolly
Claire Baldwin
Zudin Puthucheary
Peter Morris
Jessica Mortimore
Nicholas Hart
Linda Denehy
Catherine L. Granger
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 4/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4685-4

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Springer Medicine

Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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