Kwakman R1,2, Major M2,3, Dettling-Ihnenfeldt D1, Nollet F1, Engelbert R1,2, van der Schaaf M1,2
1Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands, 2ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands, 3European School of Physiotherapy / Amsterdam University of Applied Sciences, Amsterdam, Netherlands
Background: Over the last decade, the number of critically ill patients who survive admittance to an intensive care unit (ICU) has significantly increased through improvements in medical care. However, after discharge from the ICU many patients still suffer from long-term limitations in physical and mental health as part of the Post Intensive Care Syndrome (PICS). Confronted with severe muscle weakness and deconditioning, 80% of the patients will eventually seek help of a primary care physiotherapist. However, survivors of critical illness are likely to receive a suboptimal physiotherapeutic intervention, as there are no guidelines on physical rehabilitation after critical illness and primary care physiotherapists lack specific knowledge regarding PICS.
Purpose: The aim of this study was to develop practical recommendations for physiotherapy for survivors of critical illness after hospital discharge in the Netherlands, the following questions were addressed:
1) Which handover information is recommended,
2) what are recommended physiotherapy goals,
3) what are feasible measurement instruments and
4) what constitutes an optimal physiotherapy intervention for critical illness survivors after hospital discharge?
Methods: A modified Delphi consensus study was performed. A scoping literature review formed the basis for three Delphi rounds. The first round was used to gather input from the panel to finalize the survey for the next two rounds in which the panel was asked to rank each of the statements on an ordinal scale with the objective to reach consensus. Consensus was defined as a SIQR of ≤0.5. Ten Dutch panelists participated in this study; three primary care physiotherapists, four intensive care physiotherapists, one occupational therapist, one ICU-nurse and one former ICU-patient. All involved professionals have treated survivors of critical illness. Our study was performed in parallel with an international Delphi study with hospital based healthcare professionals and researchers.
Results: After 3 Delphi rounds, consensus was reached on 95.5% of the statements. This resulted in practical recommendations for physiotherapy for critical illness survivors in the primary care setting. The panel agreed that the handover should include information on 14 items. Physiotherapy treatment goals should be directed towards improvement of aerobic capacity, physical functioning, activities in daily living, muscle strength, respiratory and pulmonary function, fatigue, pain and health related quality of life. Physiotherapy measurements and interventions to improve these outcomes are suggested.
Conclusion(s): This study adds to the knowledge on post-ICU physiotherapy with practical recommendations supporting clinical decision-making in the treatment of survivors of critical illness after hospital discharge in the Netherlands.
Implications: This framework assists in implementing evidence-based physiotherapy interventions and improves quality and continuity of care for survivors of critical illness after hospital discharge.
Keywords: PICS, critical illness, physiotherapy
Funding acknowledgements: R. Kwakman is funded by the Amsterdam UMC, M. Major receives funding from the Dutch Organisation for Scientific Research (NWO).
Purpose: The aim of this study was to develop practical recommendations for physiotherapy for survivors of critical illness after hospital discharge in the Netherlands, the following questions were addressed:
1) Which handover information is recommended,
2) what are recommended physiotherapy goals,
3) what are feasible measurement instruments and
4) what constitutes an optimal physiotherapy intervention for critical illness survivors after hospital discharge?
Methods: A modified Delphi consensus study was performed. A scoping literature review formed the basis for three Delphi rounds. The first round was used to gather input from the panel to finalize the survey for the next two rounds in which the panel was asked to rank each of the statements on an ordinal scale with the objective to reach consensus. Consensus was defined as a SIQR of ≤0.5. Ten Dutch panelists participated in this study; three primary care physiotherapists, four intensive care physiotherapists, one occupational therapist, one ICU-nurse and one former ICU-patient. All involved professionals have treated survivors of critical illness. Our study was performed in parallel with an international Delphi study with hospital based healthcare professionals and researchers.
Results: After 3 Delphi rounds, consensus was reached on 95.5% of the statements. This resulted in practical recommendations for physiotherapy for critical illness survivors in the primary care setting. The panel agreed that the handover should include information on 14 items. Physiotherapy treatment goals should be directed towards improvement of aerobic capacity, physical functioning, activities in daily living, muscle strength, respiratory and pulmonary function, fatigue, pain and health related quality of life. Physiotherapy measurements and interventions to improve these outcomes are suggested.
Conclusion(s): This study adds to the knowledge on post-ICU physiotherapy with practical recommendations supporting clinical decision-making in the treatment of survivors of critical illness after hospital discharge in the Netherlands.
Implications: This framework assists in implementing evidence-based physiotherapy interventions and improves quality and continuity of care for survivors of critical illness after hospital discharge.
Keywords: PICS, critical illness, physiotherapy
Funding acknowledgements: R. Kwakman is funded by the Amsterdam UMC, M. Major receives funding from the Dutch Organisation for Scientific Research (NWO).
Topic: Critical care
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This is a Delphi expert consensus study in which no patients were involved.
All authors, affiliations and abstracts have been published as submitted.
