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JAMA Intern Med. 2015 Jun;175(6):901-10. doi: 10.1001/jamainternmed.2015.0822.

Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial.

Author information

  • 1Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland2Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edin.
  • 2Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland4Department of Nursing, School of Social Science, University of Edinburgh, Edinburgh, Scotland.
  • 3Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland3Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland4Department o.
  • 4Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland.
  • 5Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland3Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland.
  • 6Interdisciplinary Social Sciences in Health, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland7Faculty of Health and Social Studies, University College Østfold, Østfold, Norway.
  • 7Department of Nursing, School of Social Science, University of Edinburgh, Edinburgh, Scotland.
  • 8Edinburgh Royal Infirmary, NHS (National Health Service) Lothian, Edinburgh, Scotland.
  • 9Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland8Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland.
  • 10Health Research Institute, University of Limerick, Limerick, Ireland.
  • 11School of Nursing and Midwifery, University of Dundee, Dundee, Scotland.
  • 12Perth Royal Infirmary, NHS Tayside, Dundee, Scotland12Department of Psychiatry, University of Dundee, Dundee, Scotland.

Abstract

IMPORTANCE:

Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain.

OBJECTIVE:

To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities.

DESIGN, SETTING, AND PARTICIPANTS:

A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014.

INTERVENTIONS:

During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner.

MAIN OUTCOMES AND MEASURES:

The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014).

RESULTS:

Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision.

CONCLUSIONS AND RELEVANCE:

Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

TRIAL REGISTRATION:

isrctn.com Identifier: ISRCTN09412438.

PMID:
25867659
[PubMed - indexed for MEDLINE]
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