Critical illness can lead to profound physical morbidity that persists for years post-intensive care unit (ICU) discharge. Rehabilitation started in ICU can mitigate morbidity and improve outcomes, however, there are gaps in existing research. This thesis includes manuscripts addressing three areas: primary research reporting, patient-reported outcome measures (PROM), and research intervention implementation.
The first manuscript was a scoping review of ICU rehabilitation interventions. Previous systematic reviews assessed the effectiveness of ICU rehabilitation to improve functional outcomes, and identified conflicting results and deficiencies in study reporting. I conducted a scoping review to describe the types, amounts, and reporting of rehabilitation interventions in ICU studies. I identified 117 prospective ICU rehabilitation studies from database inception to 2016 and assessed the completeness of study and intervention reporting using standardized reporting guidelines. Results identified adequate overall study reporting, however important reporting deficiencies in intervention and control groups, limiting future trial development and clinical implementation.
The second manuscript evaluated the psychometrics of the Patient-Reported Functional Scale-ICU (PRFS-ICU) – a new PROM for ICU survivors in acute care. I demonstrated the PRFS-ICU was feasible, reliable, responsive, and valid in medical-surgical ICU patients able to follow commands. Results suggest the PRFS-ICU warrants future research and may be useful to assess and monitor patient perceptions of their functioning over time.
The final manuscript was a self-administered electronic survey of frontline therapists, assessing barriers and facilitators to implementing a novel rehabilitation intervention in the context of research. Respondents implementing CYCLE, a trial of in-bed cycling with mechanically ventilated patients, identified two primary barriers to implementing the protocol: time required to conduct the protocol and concerns for provision of equitable service to all patients on their caseload.
Together these manuscripts provide an important foundation to guide development, implementation, and evaluation of future ICU rehabilitation trials. / Thesis / Doctor of Philosophy (PhD) / Critical illness requiring intensive care unit (ICU) admission can lead to physical disability lasting years post-ICU. Exercises started in ICU can reduce disability. However there are important gaps in the research addressed by my thesis: 1) Summaries of studies found different results on the effects of exercise on disability, and details of exercises were sparse. I reviewed over 3 decades of exercise research for ICU patients and determined reporting must improve; 2) ICU patients had no standard way to report their own level of movement in hospital. I evaluated a measure, which may be useful to assess how patients think they are functioning; 3) ICU therapists reported challenges delivering exercises to patients in research studies. I conducted a survey and learned therapists needed more time to provide these exercises. My findings can inform future ICU exercise studies, assess how patients feel they are functioning, and optimize exercise delivery.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24803 |
| Date | January 2019 |
| Creators | Reid, Julie |
| Contributors | Kho, Michelle, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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