Rehabilitation practices in ICU patient care – a Scandinavian survey study. Oral presentation

Purpose of the project: To explore and describe current early rehabilitation practices among Scandinavian ICU healthcare professionals

Clinical significance/ or scientific background for the project: Patients admitted to the intensive care unit (ICU) often experience physical, psychological, and cognitive challenges related to their critical illness1,2. Rehabilitation is important to prevent and/or reduce the challenges they may experience. Research focusing on early mobilization is well investigated3,4. However, health care personnel’s practices related to cognitive, sensory and socially stimulating activities is less known5.

Methodological approach: An online multicenter survey was conducted from September 2022 to June 2023, using a self-administered questionnaire. Participants from Norwegian, Swedish and Danish ICUs were asked to describe what they perceived as rehabilitation during and after the patient's ICU stay. Moreover, they were asked to quantify the importance and time used within rehabilitation domains such as cognitive, physical, sensory and social stimulation, furthermore participation in personal care. Quantitative data were summarized using descriptive statistics, qualitative data were analysed using the framework method.

Results: A total of 518 participants responded, most were nurses. Rehabilitation began at ICU admission (70%), when the patient was A (airway), B (breathing), C (circulation) stable (19%), or circulatory stable (7%). Participants spent approximately 40% of their working time on rehabilitating activities and estimated that about 90% of all patients would benefit from rehabilitation.
Cognitive stimulation was considered highly important and involved communication activities, activities of daily living, television/radio and delirium prophylaxis. Physical stimulation consisted of physiotherapy, mobilization (sitting on bed, standing), training/activities of daily living, and visiting outdoors in a wheel chair or hospital bed. Rehabilitation activities progressed from passive to active, balancing rest/activities and aimed at strengthening the patient's autonomy, self-management and will to recover. Family members were seen as important to the patient's rehabilitation.

Implication for practice:
Rehabilitation can be initiated very early in the ICU, and should include physical, mental, and social elements of patient care.

A sound balance between rest and activity is important for maintaining the patient’s energy for rehabilitation

References:
1 Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., W einert, C., W unsch, H., Zaw istow ski, C., Bemis-Dougherty, A., Berney, S. C., Bienvenu, O. J., Brady, S. L., Brodsky, M. B., Denehy, L., Elliott, D., Flatley, C., Harabin, A. L., Jones, C., Louis, D., Meltzer, W ., . . . Harvey, M. A. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical Care Medicine, 40(2), 502-509.

2 Inoue, S., Hatakeyama, J., Kondo, Y., Hifumi, T., Sakuramoto, H., Kaw asaki, T., Taito, S., Nakamura, K., Unoki, T., Kaw ai, Y., Kenmotsu, Y., Saito, M., Yamakaw a, K., & Nishida, O. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246.

3 Hodgson, C. L., Bailey, M., Bellomo, R., Brickell, K., Broadley, T., Buhr, H., Gabbe, B. J., Gould, D. W ., Harrold, M., Higgins, A. M., Hurford, S., Iw ashyna, T. J., Serpa Neto, A., Nichol, A. D., Presneill, J. J., Schaller, S. J., Sivasuthan, J., Tipping, C. J., W ebb, S., & Young, P. J. (2022). Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med, 387(19), 1747-1758.

4 Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Paw lik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bow man, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet (London, England), 373(9678), 1874-1882.

5 Collet, M. O., Laerkner, E., Jensen, J., Egerod, I., Christensen, J., Jørgensen, N. K., Kjaergaard, R. S., Olausson, S., W øien, H., Lange, T., Nielsen, A. H., Kjaer, M. N., Bruun, C. R. L., & Perner, A. (2023). Functional and cognitive rehabilitation interventions during intensive care admission: A protocol for a systematic integrative review. Acta Anaesthesiol Scand, 67(5), 670-674.