Background
Physical rehabilitation of patients in intensive care units (ICUs) can reduce ICU stay. However, uncertainties exist limiting rehabilitation delivery, with limited in-depth understanding about barriers to
implement rehabilitation; and there is a need for an adverse event tool to standardise evaluation of rehabilitation safety. An important safety consideration is when administering vasoactive drugs,
therefore, agreement is required on when to implement rehabilitation in this scenario.
Methods
Views of ICU clinicians and patients on barriers to physical rehabilitation were explored using semistructured qualitative interviews. A Delphi process, recruiting ICU clinicians and former patients, sought consensus on the content of an adverse event tool. Clinician consensus on risk assessment of rehabilitation for patients receiving vasoactive drugs was sought. Finally, an observational study
measured standard care and described outcomes related to feasibility of a future trial of rehabilitation whilst receiving vasoactive drugs.
Results
30 ICU clinicians and patients/caregivers described barriers including safety concerns, patient participation, clinician knowledge and team working. 24 clinicians from 10 countries, plus six former ICU
patients/caregivers reached consensus on an adverse event tool. Clinicians agreed upon a risk assessment tool for implementing physical rehabilitation with patients receiving vasoactive drugs.
Finally, a retrospective study of 78 patients receiving vasoactive drugs revealed a lack of physical rehabilitation. A prospective study of 40 patients, with 50 ICU clinicians, gave preliminary indication of
feasible recruitment to a future trial.
Conclusion
This thesis has improved understanding of barriers to physical ICU rehabilitation and how to overcome them. Furthermore, the adverse event tool can ensure more consistent measurement in future studies.
Additionally, clinical decision-making can be informed by the risk assessment tool for rehabilitation for ICU patients receiving vasoactive drugs. Finally, standard care, an understanding of recruitment and use
of outcome measurement gives an indication of feasibility for a clinical trial.