FAMILY PARTICIPATION IN THE PHYSICAL REHABILITATION OF CRITICALLY ILL PATIENTS: THE DEVELOPMENT OF AN INTERVENTION

L.M.M. van Delft^1,2, K. Valkenet¹, A. Slooter^3,2, C. Veenhof^1,4

Background: Since both early mobilization, exercise and family engagement are part of the ICU Liberation Bundle, an intervention to increase family participation in physical rehabilitation related tasks (PRRTs) in the ICU might be beneficial. It could optimize patients’ physical function by increasing the frequency and thereby impact of physical activity while relatives make themselves useful at the same time. However, detailed information about how relatives can help is still unknown. The first stages of the Design Thinking process for developing an intervention are “empathize” and “define”. In these stages it is of high importance to gain knowledge of the area of concern, and the likely process of change. In addition, you must get an understanding of the prospective users, their context, and determine which values and requirements the different stakeholders deem important to include in the further design. Before further designing an intervention regarding family participation in PRRTs of critically ill patients, there is need to investigate the opinions of ICU patients, relatives and staff members in detail.  

Purpose: Investigating the perspectives of critically ill patients, relatives and ICU staff members regarding family participation in PRRTs of critically ill patients, as first step in the development of an intervention.

Methods: Multicenter study with a descriptive qualitative design. Semi-structured interviews were performed in an academic and general hospital in the Netherlands. Both critically ill patients, relatives and ICU staff members were included. All interviews were conducted by the first author, who was trained in performing qualitative research, until theoretical saturation was reached. The qualitative content method was used for data analyses.

Results: In total 18 interviews were conducted between May 2019 and February 2020; four patients, five family members, and 13 ICU staff members. Six major themes did emerge: prerequisites for family participation (e.g. permission and capability of relatives), practical approach (e.g. communication, form of presenting), eligible candidates (e.g. first degree relatives, weak and long stay patients), suitable PRRTs for family members (e.g. passive movements, active exercises/strength training, breathing exercises), effects (e.g. physical recovery, psychological safety), and barriers and facilitators which might affect the feasibility (e.g. relation between patient and relative, workload staff, patient safety and privacy).  

Conclusion(s): Both patients, relatives and staff members support the idea of an intervention aiming to increase family participation in ICU physical rehabilitation care. However, diverse requirements should be included in the further design and implementation of the intervention.

Implications: This qualitative study presents the perspectives and ideas of ICU patients, relatives and staff members about family participation in PRRTs. These requirements must be included in the further development of an intervention to increase family participation in PRRTs. The following steps of the project group, based on the stages of the Design Thinking process, are to generate all ideas, produce prototype(s) and test these prototypes. After the prototyping phase, the feasibility and acceptability of the intervention will be assessed in a pilot study (January – April 2021). These primary results will also be presented in April 2021, but the focus will be on the themes and requirements conducted from the interviews.

Funding, acknowledgements: None 

Keywords: Critical care, Family participation, Physical rehabilitation

Topic: Critical care

Did this work require ethics approval? Yes

Institution: University Medical Center Utrecht, Utrecht, the Netherlands

Committee: The Local Medical Ethics Committee

Ethics number: protocol number 18-842