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Major-Helsloot M.1, Kwakman R.2, Kho M.3, Connolly B.4, McWilliams D.5, Denehy L.6, Hanekom S.7, Patman S.8, Gosselink R.9, Jones C.10, Nollet F.11, Needham D.12,13, Engelbert R.11,14, Van der Schaaf M.11,15
1ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, European School of Physiotherapy, Amsterdam, Netherlands, 2Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands, 3McMaster University, School of Rehabilitation Sciences, Hamilton, Canada, 4Guy’s and St.Thomas’ NHS Foundation Trust, Lane Fox Clinical Respiratory Physiology Research Unit, London, United Kingdom, 5University Hospitals Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom, 6The University of Melbourne, Department of Physiotherapy, Melbourne, Australia, 7Stellenbosch University, Faculty of Medicine & Health Sciences, Physiotherapy Division, Department of Interdisciplinary Health Sciences, Cape Town, South Africa, 8The University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia, 9University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium, 10University of Liverpool, Musculoskeletal Biology, Institute of Ageing & Chronic Disease, Liverpool, United Kingdom, 11Academic Medical Center, University of Amsterdam, Rehabilitation, Amsterdam, Netherlands, 12Johns Hopkins University, Outcomes after Critical Illness and Surgery Group, Baltimore, United States, 13Johns Hopkins University, Division of Pulmonary and Critical Care Medicine / Department of Physical Medicine and Rehabilitation, Baltimore, United States, 14ACHIEVE – Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands, 15ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
Background: Long-term recovery problems after survival of critical illness, in the physical, cognitive and mental domain have been defined as Post-Intensive Care Syndrome (PICS) by the Society of Critical Care Medicine in 2012. Little is known about optimal physical therapy interventions for survivors, as evidence on effectiveness as well as valid measurement tools is scarce. In absence of robust scientific research, a Delphi consensus process can be an alternative way to move forward. In Delphi projects a panel of experts, representative to the specific scientific field, is asked to rank statements with the aim to reach consensus on the importance of each of the topics. If such a consensus statement were to exist for physical therapy after ICU- and hospital discharge a framework could be set up for the organization of physical therapy and feasibility could be tested through further research projects.
Purpose: The aim of this study was to develop, through the use of Delphi methodology, a consensus statement including recommendations for PT practice for survivors of critical illness after hospital discharge. Leading research questions were: what are physical therapy goals, recommended measurement tools, and what constitutes an optimal physical therapy intervention for survivors of critical illness?
Methods: Panelists were included based on relevant fields of expertise, years of clinical experience and publication record. A literature review determined five themes, forming the basis for Delphi round one, aimed at generating ideas. Statements were drafted and ranked in two additional rounds with the objective to reach consensus. Results were expressed in median and semi-interquartile range (SIQR), with the consensus threshold set at ≤ 0.5.
Results: 10 internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80%, 100% and 100% across 3 Delphi rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes (COS) should test exercise capacity, skeletal muscle strength, ADL function, mobility, quality of life and pain. PT interventions could include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery and should include a nutritional component. A set of screening tools is proposed to identify impairments in other health domains for PT referral to specialist health providers.
Conclusion(s): This consensus-based framework contributes to optimal PT after hospital discharge. Testing the feasibility of this framework, developing risk stratification tools and validating core measurement tools for ICU survivors should be the focus of future research.
Implications: This paper contributes to raising awareness among physical therapists providing interventions to survivors of critical illness after they have been discharged from hospital. Signs of PICS-related complications might be recognized quicker and clinical-decision making with regards to choice of outcome measure and intervention is guided by our proposed framework. With these results, we can study feasibility of the proposed physical therapy intervention in clinical practice and set up (cost)effectiveness studies to optimize the physical rehabilitation for patients who survived critical illness.
Funding acknowledgements: Mel Major received a research grant by the Netherlands Organization for Scientific Research (NWO)
Topic: Critical care
Ethics approval: Approval by an ethical committee was not required for this Delphi study.
All authors, affiliations and abstracts have been published as submitted.
