Intensive care discharge facilitation using the REhabilitation after Critical illness Assisted discharge Pack (RECAP) model: A pilot randomized controlled trial
Affiliations: [a] St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
| [b] Centre for Health and Rehabilitation Technologies (CHaRT), School of Health Sciences, Ulster University, Jordanstown Campus, Newtownabbey, Co. Antrim, Northern Ireland | [c] CSTAR and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
Correspondence:
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Corresponding author: Máire Gilmartin, Physiotherapy Department, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. E-mail: [email protected].
Abstract: PURPOSE:There is limited evidence to guide the delivery of rehabilitation during ward-based recovery post intensive care (ICU). The aim of this study was to explore the feasibility of augmenting usual care physiotherapy with the REhabilitation after Critical illness Assisted discharge Pack (RECAP) in the initial 3 weeks after ICU discharge and to explore the feasibility of conducting a fully powered RECAP trial. METHODS:Twenty patients with an ICU stay greater than 4 days and referred to physiotherapy were randomized to receive usual care or usual care plus RECAP. The Functional Independence Measure (FIM) and State Anxiety Inventory (SAI) were used to measure physical and psychological function respectively, with blinded assessments completed at weeks 1 and 3 after ICU discharge. Patient satisfaction with rehabilitation was explored with a short questionnaire. RESULTS:A recruitment rate of 72% (21/29 eligible patients) was observed. The intervention was successfully delivered to n = 8 patients with a median of 4.0 (IRQ 2.0–4.0) sessions. 45% of study participants were discharged before the study endpoint. The intervention group reported higher satisfaction scores (44.5/50 +/–5.9 vs 42.8/50 +/–7.6). No adverse events were reported. Intervention delivery appeared feasible and aspects to further enhance the intervention were identified. CONCLUSION:RECAP is a short, safe intervention to deliver in combination with ward-based rehabilitation after ICU discharge. Further research is required to optimise RECAP before exploring any effects on physical or psychological function. Methods to overcome challenges to conducting future trials, including defining standards of usual care and choice of appropriate outcome measure could be further explored.
