The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative
Zudin Puthucheary, Craig Brown, Evelyn Corner, Sarah Wallace, Julie Highfield, Danielle Bear, Nirandeep Rehill, Hugh Montgomery, Leanne Aitken, Lynne Turner-Stokes, Zudin Puthucheary, Craig Brown, Evelyn Corner, Sarah Wallace, Julie Highfield, Danielle Bear, Nirandeep Rehill, Hugh Montgomery, Leanne Aitken, Lynne Turner-Stokes
Abstract
Background: Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result.
Methods: Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour.
Results: No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = -1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted.
Conclusions: The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.
Keywords: COVID-19; Rehabilitation needs; intensive care.
Conflict of interest statement
Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LTS is a full time NHS employee but, as part of her NHS activities, she directs the UK Rehabilitation Outcomes Collaborative (UKROC), She has a specific research interest in outcomes evaluation and, together with colleagues (including author RJS) she has published extensively on the development and use of standardised measures, and neither LTS or RJS has any personal financial interest in any of the material mentioned in this article. Several of the authors have clinical academic posts, and research/development publications of this kind may be used by their employing NHS or University organisation to contribute to departmental returns in evaluations such as the NHS R&D reports or the Research Excellence Framework. ZP has received honoraria for consultancy from GlaxoSmithKline, Lyric Pharmaceuticals, Faraday Pharmaceuticals and Fresenius-Kabi, and speaker fees from Orion, Baxter, Nutricia and Nestle.
© The Intensive Care Society 2021.
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Source: PubMed