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E. King1, J. Grant1, O. Gustafson1
1Oxford University Hospitals NHS Foundation Trust, Oxford Allied Health Professions Research & Innovation Unit, Oxford, United Kingdom
Background: Approximately 260,000 adults require treatment in an intensive care unit (ICU) annually in the UK. Despite high survival rates, prolonged recovery and poor health related quality of life are common. The UK National Institute of Clinical Excellence recommends patients receive a functional assessment of health and social needs at two-three months after discharge from critical care. However, in the UK only 14.6% of follow-up clinics have a physiotherapist, with no common method to describe physical impairments.
In June 2022, a critical care physiotherapist was introduced into the ICU follow-up clinic of a UK, university teaching hospital. Prior to instigating physiotherapy interventions to improve patient outcomes, it is essential to clearly understand the patients’ presentation and consistently record their problems.
In June 2022, a critical care physiotherapist was introduced into the ICU follow-up clinic of a UK, university teaching hospital. Prior to instigating physiotherapy interventions to improve patient outcomes, it is essential to clearly understand the patients’ presentation and consistently record their problems.
Purpose: To describe patient presentations at ICU follow-up clinic through the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF).
Methods: A prospective service evaluation of all patients assessed by a physiotherapist in ICU follow-up clinic between June and September 2022. Patient presentation was categorised using the ICF codes by the ICU follow-up physiotherapist. All data was analysed and presented using descriptive statistics.
Results: In the evaluation period, 47patients attended 13 face to face clinics. Patient's median (IQR) ICU length of stay was 12.5 (6 -28) days and attended clinic 171 (124.25-230.25) days from ICU discharge. 81% of patients (n=38) received a physiotherapy review in clinic, with 36 reporting a new or an exacerbation of an existing problem following critical care that were categorised using the ICF codes.
100% of patients (n=36) had a body structure and function problem across 13 different domains. The four most common problems included: “structure related to movement (unspecified)”, which we defined as global deconditioning (42%, n= 15); “structure of the shoulder” (39%, n=14); and “structure of the lower extremity” (33%, n=12) and exercise tolerance (33%, n=12). More than half of patients had more than one structure and function problem (53%, n=19).
72% (n=26) of patients had problems relating to environmental/personal factors across 11 different domains. The three most common were: “health service, systems and policies” (42%, n=16); “natural environment” (25%, n=9); and “attitudes” (11%, n=4). 31% (n=11) had more than one problem relating to environmental/personal factors.
100% (n=36) of patients had an activity/participation problem across 12 different domains. The three most common were: “recreation and leisure” (50%, n=18); “walking and moving” (44%, n=16); and “work and employment” (19%, n=7). 69% (n=25) had more than one activity/participation problem.
100% of patients (n=36) had a body structure and function problem across 13 different domains. The four most common problems included: “structure related to movement (unspecified)”, which we defined as global deconditioning (42%, n= 15); “structure of the shoulder” (39%, n=14); and “structure of the lower extremity” (33%, n=12) and exercise tolerance (33%, n=12). More than half of patients had more than one structure and function problem (53%, n=19).
72% (n=26) of patients had problems relating to environmental/personal factors across 11 different domains. The three most common were: “health service, systems and policies” (42%, n=16); “natural environment” (25%, n=9); and “attitudes” (11%, n=4). 31% (n=11) had more than one problem relating to environmental/personal factors.
100% (n=36) of patients had an activity/participation problem across 12 different domains. The three most common were: “recreation and leisure” (50%, n=18); “walking and moving” (44%, n=16); and “work and employment” (19%, n=7). 69% (n=25) had more than one activity/participation problem.
Conclusions: Through application of the ICF model, description of patient's physical presentation to ICU follow-up clinic post ICU discharge is diverse and complex, with impairments impacting across the biopsychosocial sphere. Future work should use the ICF model to evaluate the requirement for other healthcare professionals in the ICU follow-up clinic.
Implications: The ICF codes empower objectivity; and as endorsed by the WHO can be translated internationally. Despite different health systems, a holistic approach to patient assessments should guide bespoke treatments. Clinicians and researchers can use the ICF model to develop service delivery for multi-morbid patients within ICU follow-up clinic.
Funding acknowledgements: This is an unfunded project.
Keywords:
ICU follow-up clinic
ICF
function
ICU follow-up clinic
ICF
function
Topics:
Critical care
Disability & rehabilitation
Critical care
Disability & rehabilitation
Did this work require ethics approval? No
Reason: This project consisted of evaluating routinely collected data, included no intervention or change in care provision, and is not intended to be generalisable. Therefore, this project has been classified as a service evaluation by the HRA research classification tool and local classification committees, and subsequently followed all local governance processes (including registration on the local quality improvement and audit system - Ulysses number: 7815).
All authors, affiliations and abstracts have been published as submitted.
