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Critical Care
Published in: Critical Care 3/2006

Open Access 01-06-2006 | Research

Study protocol: Home-based physical rehabilitation for survivors of a critical illness [ACTRN12605000166673]

Authors: Doug Elliott, Sharon McKinley, Jennifer A Alison, Leanne M Aitken, Madeleine T King

Published in: Critical Care | Issue 3/2006

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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.
Appendix
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Literature
1.
Black NA, Jenkinson C, Hayes JA, Young D, Vella K, Rowan KM, Daly K, Ridley S: Review of outcome measures used in adult critical care. Crit Care Med 2001, 29: 2119-2124. 10.1097/00003246-200111000-00012CrossRefPubMed
2.
Needham DM, Dowdy DW, Mendez-Tellez PA, Herridge MS, Pronovost P: Studying outcomes of intensive care unit survivors: measuring exposures and outcomes. Intensive Care Med 2005, 31: 1153-1160. 10.1007/s00134-005-2656-7CrossRefPubMed
3.
Angus DC, Carlet J: Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 2003, 29: 368-377.PubMed
4.
Ball C, Kirkby M, Williams S: Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003, 327: 1014. 10.1136/bmj.327.7422.1014PubMedCentralCrossRefPubMed
5.
Endacott R, Chaboyer W: The nursing role in ICU outreach: an international exploratory study. Nurs Crit Care 2006, 11: 94-102. 10.1111/j.1362-1017.2006.00160.xCrossRefPubMed
6.
Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleston J, Waldmann C, Gager M: Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 2003, 31: 2456-2461. 10.1097/01.CCM.0000089938.56725.33CrossRefPubMed
7.
Higlett T, Bishop N, Hart GK, Hicks P: Review of Intensive Care Resources & Activity 2002/2003. Melbourne: Australian and New Zealand Intensive Care Society; 2005.
8.
Adamson H, Elliott D: Quality of life after a critical illness: a review of general ICU studies 1998–2005. Aust Crit Care 2005, 18: 50-60.CrossRef
9.
Elliott D: Measuring the health outcomes of general ICU patients: a systematic review of methods and findings. Aust Crit Care 1999, 12: 132-140.CrossRefPubMed
10.
Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM: Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 2005, 31: 611-620. 10.1007/s00134-005-2592-6CrossRefPubMed
11.
Herridge MS: Long-term outcomes after critical illness. Curr Opin Crit Care 2002, 8: 331-336. 10.1097/00075198-200208000-00010CrossRefPubMed
12.
Cuthbertson BH, Hull A, Strachan M, Scott J: Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004, 30: 450-455. 10.1007/s00134-003-2004-8CrossRefPubMed
13.
Jackson JC, Gordon MW, Ely EW, Burger C, Hopkins RO: Research issues in the evaluation of cognitive impairment in intensive care unit survivors. Intensive Care Med 2004, 30: 2009-2016. 10.1007/s00134-004-2422-2CrossRefPubMed
14.
Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A: Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 1998, 26: 591-598. 10.1097/00003246-199803000-00037CrossRefPubMed
15.
Rubenfeld GD, Curtis JR: Health status after critical illness: Beyond descriptive studies. Intensive Care Med 2003, 29: 1626-1628. 10.1007/s00134-003-1855-3CrossRefPubMed
16.
Martin UJ, Hincapie L, Numchuk M, Gaughan J, Criner GJ: Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med 2005, 33: 2259-2265. 10.1097/01.CCM.0000181730.02238.9BCrossRefPubMed
17.
Oh EG: The effects of home-based pulmonary rehabilitation in patients with chronic lung disease. Int J Nurs Stud 2003, 40: 873-879.CrossRefPubMed
18.
Boxall A, Barclay L, Sayers A, Caplan G: A randomised controlled trial of home-based pulmonary rehabilitation for COPD patients aged over 60 years. Thorax 2003, 58: Siii76.
19.
Ware JE, Snow KK, Kosinski M: SF-36 Version 2 Health Survey: Manual and Interpretation Guide. Lincoln: Quality Metric Incorporated; 2000.
20.
American Thoracic Society: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002, 166: 111-117.CrossRef
21.
Lovibond P, Lovibond S: The structure of negative emotional states: comparison of the Depression Anxiety Stress Scale (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995, 33: 335-343. 10.1016/0005-7967(94)00075-UCrossRefPubMed
22.
Horowitz M, Wilner N, Alvarez W: Impact of events scale: a measure of subjective stress. Psychosom Med 1979, 41: 209-218.CrossRefPubMed
23.
Kelly M, McKinley S: Patients' physical problems in early recovery after intensive care. Aust Crit Care 2003, 16: 29-30.CrossRef
24.
Boyle M, Murgo M, Adamson H, Gill J, Elliott D, Crawford M: The effect of chronic pain on health related quality of life amongst intensive care survivors. Aust Crit Care 2004, 17: 104-113.CrossRefPubMed
25.
Schelling G, Richter M, Roozendaal B, Rothenhausler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M, Kapfhammer HP: Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med 2003, 31: 1971-1980. 10.1097/01.CCM.0000069512.10544.40CrossRefPubMed
26.
Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, et al.: Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 1998, 26: 651-659. 10.1097/00003246-199804000-00011CrossRefPubMed
27.
Needham DM, Dennison CR, Dowdy DW, Mendez-Tellez PA, Ciesla N, Desai SV, Sevransky J, Shanholtz C, Scharfstein D, Herridge MS, et al.: Study protocol: The improving care of acute lung injury patients (ICAP) study. Crit Care 2005, 10: R9. 10.1186/cc3948PubMedCentralCrossRef
28.
Chelluri L, Im KA, Belle SH, Schulz R, Rotondi AJ, Donahoe MP, Sirio CA, Mendelsohn AB, Pinsky MR: Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 2004, 32: 61-69. 10.1097/01.CCM.0000098029.65347.F9CrossRefPubMed
29.
30.
Moher D, Schulz KF, Altman DG, for the CONSORT Group: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001, 357: 1191-1194. 10.1016/S0140-6736(00)04337-3CrossRefPubMed
31.
Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA: Short form 36 in the intensive care unit: assessment of acceptability, reliabilty and validity of the questionnaire. Anaesthesia 1997, 52: 15-23. 10.1111/j.1365-2044.1997.015-az014.xCrossRefPubMed
32.
Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982, 14: 377-381.PubMed
33.
Barker-Whittle Z, Alison J, Bye P: Arm and leg exercise capacity in subjects with severe CAL compared with healthy control subjects. Respirology 2002, 7s: A33.
34.
Alison J, Spencer L: Effects of pulmonary rehabilitation on 12 minute walk distance in lung volume reduction surgery patients. Respirology 2000, 5S: A44.
35.
DAMOCLES Study Group: A proposed charter for clinical trial data monitoring committees: helping them do their job well. Lancet 2005, 365: 711-722.CrossRef
Metadata
Title
Study protocol: Home-based physical rehabilitation for survivors of a critical illness [ACTRN12605000166673]
Authors
Doug Elliott
Sharon McKinley
Jennifer A Alison
Leanne M Aitken
Madeleine T King
Publication date
01-06-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4949

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