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Can in-reach multidisciplinary rehabilitation in the acute ward improve outcomes for critical care survivors? A pilot randomized controlled trial [with consumer summary]
Wu J, Vratsistas-Curto A, Shiner CT, Faux SG, Harris I, Poulos CJ
Journal of Rehabilitation Medicine 2019 Sep;51(8):598-606
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 versus 4.9, p < 0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 versus 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.

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