Can in-reach multidisciplinary rehabilitation in the acute ward improve outcomes for critical care survivors? A pilot randomized controlled trial

Abstract

Objectives: To assess the feasibility of in-reach rehabilitation for critical care survivors following discharge from the intensive care unit. To determine whether additional in-reach rehabilitation reduces hospital length-of-stay and improves outcomes in critical care survivors, compared with usual therapy. Participants: A total of 66 consecutively-admitted critical care survivors with an intensive care unit stay ≥5 days were enrolled in the study. Of these, 62 were included in the analyses. Methods: Pilot randomized control trial with blinded assessment at 6 and 12 months. The intervention group (n=29) received in-reach rehabilitation in addition to usual ward therapy. The usual-care group (n=33) received usual ward therapy. The primary outcome assessed was length-of-stay. Secondary outcomes included mobility, functional independence, psychological status and quality-of-life. Results: The intervention group received more physiotherapy and occupational therapy sessions per week than the usual-care group (median=8.2 vs 4.9, p<0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 vs 41 days), this was not significant and the pilot study was not adequately powered (p=0.57). No significant differences were observed in the secondary outcomes at hospital discharge, 6- or 12-month follow-ups. Conclusion: Provision of intensive early rehabilitation to intensive care unit survivors on the acute ward is feasible. A further trial is needed to draw conclusions on how this intervention affects length-of-stay and functional outcomes.