Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

M E Major, R Kwakman, M E Kho, B Connolly, D McWilliams, L Denehy, S Hanekom, S Patman, R Gosselink, C Jones, F Nollet, D M Needham, R H H Engelbert, M van der Schaaf, M E Major, R Kwakman, M E Kho, B Connolly, D McWilliams, L Denehy, S Hanekom, S Patman, R Gosselink, C Jones, F Nollet, D M Needham, R H H Engelbert, M van der Schaaf

Abstract

Background: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?

Methods: A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5.

Results: Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed.

Conclusions: A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.

Keywords: Consensus statement; Critical illness; Intensive care; Physical therapy; Post-intensive care syndrome; Rehabilitation.

Figures

Fig. 1
Fig. 1
Delphi Consensus Process.COMET Core Outcome Measures in Effectiveness Trials
Fig. 2
Fig. 2
Physical therapy after critical illness: a consensus-based framework

References

    1. Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil. 2015;29(11):1051–1063. doi: 10.1177/0269215514567156.
    1. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658. doi: 10.1186/s13054-014-0658-y.
    1. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. doi: 10.1056/NEJMoa1011802.
    1. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31(5):611–620. doi: 10.1007/s00134-005-2592-6.
    1. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30(5):421–434. doi: 10.1016/j.genhosppsych.2008.05.006.
    1. Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, et al. Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study. Am J Respir Crit Care Med. 2012;185(5):517–524. doi: 10.1164/rccm.201103-0503OC.
    1. van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Functional status after intensive care: a challenge for rehabilitation professionals to improve outcome. J Rehabil Med. 2009;41(5):360–366. doi: 10.2340/16501977-0333.
    1. van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Poor functional recovery after a critical illness: a longitudinal study. J Rehabil Med. 2009;41(13):1041–1048. doi: 10.2340/16501977-0443.
    1. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–509. doi: 10.1097/CCM.0b013e318232da75.
    1. Elliott D, Davidson JE, Harvey MA, Bemis-Dougherty A, Hopkins RO, Iwashyna TJ, et al. Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Crit Care Med. 2014;42(12):2518–2526. doi: 10.1097/CCM.0000000000000525.
    1. Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MW, et al. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Neth Heart J. 2015;23(1):6–17. doi: 10.1007/s12471-014-0612-2.
    1. Griffith DM, Lewis S, Rossi AG, Rennie J, Salisbury L, Merriweather JL, et al. Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms. Thorax. 2016;71(9):820–829. doi: 10.1136/thoraxjnl-2015-208114.
    1. Connolly B, Salisbury L, O’Neill B, Geneen L, Douiri A, Grocott MP, et al. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Library. 2015;(6). doi:10.1002/14651858.CD008632.pub2.
    1. Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, et al. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med. 2015;41(5):744–762. doi: 10.1007/s00134-015-3672-x.
    1. Needham DM. Understanding and improving clinical trial outcome measures in acute respiratory failure. Am J Respir Crit Care Med. 2014;189(8):875–877. doi: 10.1164/rccm.201402-0362ED.
    1. Turnbull AE, Rabiee A, Davis WE, Nasser MF, Venna VR, Lolitha R, et al. Outcome Measurement in ICU survivorship research from 1970 to 2013: a scoping review of 425 publications. Crit Care Med. 2016;44(7):1267–1277. doi: 10.1097/CCM.0000000000001651.
    1. Williamson PR, Altman DG, Blazeby JM, Clarke M, Devane D, Gargon E, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13(1):1. doi: 10.1186/1745-6215-13-132.
    1. The COMET initiative. . Accessed 31 Aug 2016.
    1. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89(2):125–135. doi: 10.2522/ptj.20080234.
    1. Colquhoun HL, Lamontagne ME, Duncan EA, Fiander M, Champagne C, Grimshaw JM. A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals. Clin Rehabil. 2016. [Epub ahead of print]
    1. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67(4):401–409. doi: 10.1016/j.jclinepi.2013.12.002.
    1. Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6(6):e20476. doi: 10.1371/journal.pone.0020476.
    1. Hanekom S, Gosselink R, Dean E, van Aswegen H, Roos R, Ambrosino N, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil. 2011;25(9):771–787. doi: 10.1177/0269215510397677.
    1. von der Gracht HA. Consensus measurement in Delphi studies: review and implications for future quality assurance. J Tech Fore. 2012;79(8):1525–1536. doi: 10.1016/j.techfore.2012.04.013.
    1. The COMET initiative. Delphi consensus project ‘Physical rehabilitation after critical illness’. . Accessed 31 Aug 2016.
    1. Arnardottir RH, Emtner M, Hedenstrom H, Larsson K, Boman G. Peak exercise capacity estimated from incremental shuttle walking test in patients with COPD: a methodological study. Respir Res. 2006;7:127. doi: 10.1186/1465-9921-7-127.
    1. Luxton N, Alison JA, Wu J, Mackey MG. Relationship between field walking tests and incremental cycle ergometry in COPD. Respirology. 2008;13(6):856–862. doi: 10.1111/j.1440-1843.2008.01355.x.
    1. Tan T, Brett SJ, Stokes T. Guidelines: Rehabilitation after critical illness: summary of NICE guidance. BMJ. 2009;338(7697):767–769.
    1. Guidelines for provision of intensive care services. Edition 1. The Faculty of Intensive Care Medicine/Intensive Care Society, UK; 2015. . Accessed 31 Aug 2016.
    1. Dettling-Ihnenfeldt DS, De Graaff AE, Nollet F, Van Der Schaaf M. Feasibility of post-intensive care unit clinics: an observational cohort study of two different approaches. Minerva Anestesiol. 2015;81(8):865–875.
    1. Jutte JE, Erb CT, Jackson JC. Physical, cognitive, and psychological disability following critical illness: what is the risk? Semin Respir Crit Care Med. 2015;36(6):943–958. doi: 10.1055/s-0035-1566002.
    1. Schandl A, Bottai M, Holdar U, Hellgren E, Sackey P. Early prediction of new-onset physical disability after intensive care unit stay: a preliminary instrument. Crit Care. 2014;18(4):455. doi: 10.1186/s13054-014-0455-7.
    1. Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, et al. The RECOVER Program: disability risk groups & one year outcome after >/= 7 days of mechanical ventilation. Am J Respir Crit Care Med. 2016;194(7):831-844.
    1. Puthucheary ZA, Denehy L. Exercise interventions in critical illness survivors: understanding inclusion and stratification criteria. Am J Respir Crit Care Med. 2015;191(12):1464–1467. doi: 10.1164/rccm.201410-1907LE.
    1. Weissman GE, Harhay MO, Lugo RM, Fuchs BD, Halpern SD, Mikkelsen ME. Natural language processing to assess documentation of features of critical illness in discharge documents of ARDS survivors. Ann Am Thorac Soc. 2016;13(9):1538–1545. doi: 10.1513/AnnalsATS.201602-131OC.
    1. Jones C, Eddleston J, McCairn A, Dowling S, McWilliams D, Coughlan E, et al. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomized controlled trial. J Crit Care. 2015;30(5):901–907. doi: 10.1016/j.jcrc.2015.05.002.
    1. Alison JA, Kenny P, King MT, McKinley S, Aitken LM, Leslie GD, et al. Repeatability of the six-minute walk test and relation to physical function in survivors of a critical illness. Phys Ther. 2012;92(12):1556–1563. doi: 10.2522/ptj.20110410.
    1. Chan KS, Pfoh ER, Denehy L, Elliott D, Holland AE, Dinglas VD, et al. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest. 2015;147(5):1316–1326. doi: 10.1378/chest.14-1808.
    1. Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness-a systematic review. Physiotherapy. 2012;98(4):277–286. doi: 10.1016/j.physio.2011.11.003.
    1. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–1024. doi: 10.1136/thx.47.12.1019.
    1. Granger CL, Denehy L, Parry SM, Martin J, Dimitriadis T, Sorohan M, et al. Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study. BMC PulmMed. 2015;15:89. doi: 10.1186/s12890-015-0075-2.
    1. Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test. a systematic review. Chest. 2014;145(6):1357–1369. doi: 10.1378/chest.13-2071.
    1. Sommers J, Vredeveld T, Lindeboom R, Nollet F, Engelbert RH, van der Schaaf M. The de Morton Mobility Index is feasible, reliable, and valid in critically ill patients. Phys.Ther. 2016;96(10):1658-1666.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever