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Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial

Walsh, Timothy S.; Salisbury, Lisa G.; Merriweather, Judith L.; Boyd, Julia A.; Griffith, David M.; Kean, Susanne; Mackenzie, Simon J.; Lewis, Stephanie C.; Murray, Gordon D.; Forbes, John F.; Rattray, Janice E.; Hull, Alastair M.; Walsh, Timothy S; Salisbury, Lisa G; Merriweather, Judith l; Boyd, Julia A; Griffith, David M; Huby, Guro; Kean, Suzanne; MacKenzie, Simon J; Krishan, Ashma; Lewis, Stephanie C; Murray, Gordon D; Forbes, John F; Smith, Joel; Rattray, Janice E; Hull, Alastair M; Ramsay, Pamela

Authors

Timothy S. Walsh

Lisa G. Salisbury

Judith L. Merriweather

Julia A. Boyd

David M. Griffith

Susanne Kean

Simon J. Mackenzie

Stephanie C. Lewis

Gordon D. Murray

John F. Forbes

Janice E. Rattray

Alastair M. Hull

Timothy S Walsh

Lisa G Salisbury

Judith l Merriweather

Julia A Boyd

David M Griffith

Guro Huby

Suzanne Kean

Simon J MacKenzie

Ashma Krishan

Stephanie C Lewis

Gordon D Murray

John F Forbes

Joel Smith

Janice E Rattray

Alastair M Hull

Pamela Ramsay



Abstract

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain.
Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities.
Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014.
Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner.
Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014).
Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision.
Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

Journal Article Type Article
Acceptance Date Jan 26, 2015
Publication Date Jun 1, 2015
Deposit Date Jun 28, 2016
Publicly Available Date Jul 2, 2017
Print ISSN 2168-6106
Electronic ISSN 2168-6114
Publisher American Medical Association
Peer Reviewed Peer Reviewed
Volume 175
Issue 6
Pages 901
DOI https://doi.org/10.1001/jamainternmed.2015.0822
Keywords Intensive care; RECOVER; physical rehabilitation; clinical trial;
Public URL http://researchrepository.napier.ac.uk/id/eprint/10388
Publisher URL http://dx.doi.org/10.1001/jamainternmed.2015.0822
Contract Date Jun 28, 2016