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N. Green1, B. O'Neill2, B. Blackwood1, D. McAuley1, F. Moran2, L. Gilfeather3, P. Johnston4, J. McNamee5, C. Shevlin6, J. Trinder7, J. Bradley1
1Queens' University, Belfast, United Kingdom, 2Ulster University, Sch Health Sciences, Newtownabbey, United Kingdom, 3Altnagelvin Hospital, WHSCT, Londonderry, United Kingdom, 4Antrim Hospital, NHSCT, Antrim, United Kingdom, 5Royal Victoria Hospital, BHSCT, Belfast, United Kingdom, 6Craigavon Hospital, SHSCT, Craigavon, United Kingdom, 7Ulster Hospital, SEHSCT, Belfast, United Kingdom
Background: Patients’ views about recovery after critical illness could inform the components and timing of specific rehabilitation interventions.
Purpose: To explore patient views following discharge from an intensive care unit (ICU) about factors that facilitated or were barriers to their physical and cognitive recovery. To determine additional services that patients felt would be useful to their recovery.
Methods: Longitudinal qualitative study involving individual face-to-face semi-structured interviews at 6 months (n=11) and 12 months (n=10). Written, informed consent was obtained. [Ethics approval 17/NI/0115]. Interviews were audiotaped, transcribed and analysed using template analysis (King et al 1998).
Results: Three core themes were identified.
(1) Physical activity and function recovery was hindered by pain and weakness affecting patients’ ability to walk, engage in hobbies, and daily activities. Patients suggested that help from family, specific healthcare services, motivation and goal setting, exercise and technology facilitated their physical recovery. Improvement was evident between 6 and 12 months, but this was an ongoing process: “Still progressing. Sill not 100 per cent”.
(2) Cognitive function was described as exhausting through trying to remember words, spell, or think clearly. Suggestions to facilitate improvement included giving tasks more time, talking, music, and making notes. Additionally, a better diet, exercise, using technology to improve concentration, and cognitive behaviour therapy. By 12 months, patients described feeling mentally better than at 6 months.
(3) Reflections on general recovery were mainly negative including feeling traumatised, experiencing bad dreams and unclear reality, although some patients described positive memories. Factors that facilitated their general recovery included support from family, internet information, setting positive goals, and receiving help from healthcare professionals e.g. dietician, occupational therapist, physiotherapist, general practitioner. The health service gaps identified by patients included follow-up from healthcare professionals e.g. a clinical psychologist, information on accessing services, personal feedback, and support from others that had been through a similar experience. There was considerable agreement about the gap and need for exercise rehabilitation.
(1) Physical activity and function recovery was hindered by pain and weakness affecting patients’ ability to walk, engage in hobbies, and daily activities. Patients suggested that help from family, specific healthcare services, motivation and goal setting, exercise and technology facilitated their physical recovery. Improvement was evident between 6 and 12 months, but this was an ongoing process: “Still progressing. Sill not 100 per cent”.
(2) Cognitive function was described as exhausting through trying to remember words, spell, or think clearly. Suggestions to facilitate improvement included giving tasks more time, talking, music, and making notes. Additionally, a better diet, exercise, using technology to improve concentration, and cognitive behaviour therapy. By 12 months, patients described feeling mentally better than at 6 months.
(3) Reflections on general recovery were mainly negative including feeling traumatised, experiencing bad dreams and unclear reality, although some patients described positive memories. Factors that facilitated their general recovery included support from family, internet information, setting positive goals, and receiving help from healthcare professionals e.g. dietician, occupational therapist, physiotherapist, general practitioner. The health service gaps identified by patients included follow-up from healthcare professionals e.g. a clinical psychologist, information on accessing services, personal feedback, and support from others that had been through a similar experience. There was considerable agreement about the gap and need for exercise rehabilitation.
Conclusion(s): Patients described physical, cognitive, psychological and emotional problems up to 12 months after ICU discharge. Some patients independently implemented strategies to help their recovery, but it was clear that not all patients were able to do this themselves. Access to specific health care services was fragmented and where healthcare services were not available this was described as contributing to slower or poorer quality of recovery.
Implications: ICU patient recovery could be facilitated by a comprehensive rehabilitation intervention that includes patient-directed strategies and health care services. Rehabilitation components should be individualised and accessible for at least 12 months after ICU discharge.
Funding, acknowledgements: Department of the Economy PhD studentship
Northern Ireland Clinical Research Facility
Northern Ireland Clinical Research Facility
Keywords: Recovery after ICU, ICU survivor, qualitative research
Topic: Critical care
Did this work require ethics approval? Yes
Institution: Office for Research Ethics Committee Northern Ireland
Committee: HSC Research Ethics Committee A
Ethics number: Reference: 17/NI/0115
All authors, affiliations and abstracts have been published as submitted.
