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Title: Searching for the Responder, Unpacking the Physical Rehabilitation Needs of Critically Ill Adults: A REVIEW.
Austin Authors: Jones, Jennifer R A ;Puthucheary, Zudin;McDonald, Luke A ;Denehy, Linda;Berney, Susan C 
Affiliation: Physiotherapy Department and Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Institute for Breathing and Sleep
Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, England
William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, England
Issue Date: Nov-2020
Date: 2020-09-15
Publication information: Journal of Cardiopulmonary Rehabilitation and Prevention 2020; 40(6): 359-369
Abstract: Survivors of critical illness can experience persistent deficits in physical function and poor health-related quality of life and utilize significant health care resources. Short-term improvements in these outcomes have been reported following physical rehabilitation. Safety and feasibility of delivering physical rehabilitation are established; however, low physical activity levels are observed throughout the recovery of patients. We provide examples on how physical activity may be increased through interdisciplinary models of service delivery. Recently, however, there has been an emergence of large randomized controlled trials reporting no effect on long-term patient outcomes. In this review, we use a proposed theoretical construct to unpack the findings of 12 randomized controlled trials that delivered physical rehabilitation during the acute hospital stay. We describe the search for the responder according to modifiers of treatment effect for physical function, health-related quality of life, and health care utilization outcomes. In addition, we propose tailoring and timing physical rehabilitation interventions to patient subgroups that may respond differently based on their impairments and perpetuating factors that hinder recovery. We examine in detail the timing, components, and dosage of the trial intervention arms. We also describe facilitators and barriers to physical rehabilitation implementation and factors that are influential in recovery from critical illness. Through this theoretical construct, we anticipate that physical rehabilitation programs can be better tailored to the needs of survivors to deliver appropriate interventions to patients who derive greatest benefit optimally timed in their recovery trajectory.
DOI: 10.1097/HCR.0000000000000549
Journal: Journal of Cardiopulmonary Rehabilitation and Prevention
PubMed URL: 32956134
Type: Journal Article
Appears in Collections:Journal articles

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