Hogeschool van Amsterdam

Urban Vitality

REACH

Rehabilitation after critical illness and hospital discharge (reach)

Project

Every year, more than 85,000 patients end up in intensive care. Thanks to improvements in the care these patients receive, the survival rate for such life-threatening hospital stays is on the rise. The down side is that an increasing number of patients are discharged from hospital with Post-Intensive Care Syndrome (PICS). PICS is caused by the life-threatening condition as well as by the IC treatment. The REACH study is aimed at developing, testing and implementing a physiotherapy programme for patients with PICS.

A stay in the intensive care unit has a major impact on patients: the majority of those who have been treated in an ICU for more than two days still experience physical complaints one year later. They also suffer from psychological symptoms such as forgetfulness, depression and post-traumatic stress disorder. These problems can lead to significant limitations in these patients’ ability to perform daily activities like walking and returning to work.

IC patients are the most vulnerable and complex group within the field of healthcare. Post-intensive care syndrome has a major impact on those who suffer from it: physical, cognitive and mental health issues can persist for years after a patient has been discharged from hospital. These problems occur on top of the effects of the condition for which the patient was originally admitted to the ICU.

Positive Health

In 2012, research physician Machteld Huber introduced a new definition of health: ‘Health as a person’s ability to adapt and to self-manage, in the face of social, physical and emotional challenges of life.’ This gave rise to Positive Health, a new concept that distinguishes between five aspects of health:

  • physical health;
  • mental health;
  • sense of purpose;
  • quality of life;
  • social participation.

Positive Health helps professionals to provide personalised care that meets the needs of the patient. Positive Health is ideally suited for patients with a long-term and complex health issue, such as PICS.

Physiotherapist’s role

After being discharged from hospital, most patients with PICS receive physiotherapy treatment from a first-line physiotherapist. The physiotherapists do not receive all the necessary information from the hospital about the patient’s hospital stay, and they are not sufficiently familiar with the consequences of PICS. The healthcare field is effectively facing a new syndrome for which no rehabilitation treatment currently exists. These diverse complaints and limitations are incorrectly interpreted and/or not listed in a logical order in the treatment plan. The dimensions of Huber’s concept emerge in the case of PICS, and the care provider – primarily the physiotherapist – must consult with the patient to identify the areas in which support is needed.

PURPOSE

The purpose is to develop and implement a transmural physiotherapy programme for a Community of Practice of professionals, students and patients, in order to provide optimum support to PICS patients after their discharge from hospital.

METHOD

In this research project, a Community of Practice (CoP) made up of 26 researchers, professionals and former IC patients will develop and test a transmural physiotherapy programme for patients with PICS based on the concept of Positive Health. This research project builds upon existing knowledge from previous research by the AUAS Occupational Therapy professorship and the Amsterdam UMC’s Rehabilitation department (AMC location), literature reviews and consultation with professionals and former IC patients.

Follow-up projects will focus on the development of a Randomised Clinical Trial (RCT) and the further development and implementation of an interdisciplinary rehabilitation programme that combines physiotherapy, occupational therapy, dietetics and psychology to treat patients with PICS. This project therefore does not include an impact study, but an initial testing of the intervention that has been developed.

EXPECTED RESULTS

A toolkit with:

  • a form for the physiotherapeutic transfer from the hospital to the first-line care provider, with necessary information about the history of the condition and its effects on the patient;
  • a programme for first-line physiotherapists with a manual for the use and interpretation of measurement tools, clinical reasoning and the associated treatment;
  • a description of screening tools that first-line physiotherapists can use to identify patients’ care needs in the areas of physical functioning, mental health and well-being at the various stages of the treatment process;
  • an animated film, informational material and recommendations to support healthcare professionals in treating patients with PICS (already developed, see above).

WHAT DOES THE STUDY CONTRIBUTE TO THE PROFESSIONAL PRACTICE AND EDUCATION?

The knowledge about the rehabilitation treatment of patients with PICS will be circulated within the first-line physiotherapy community and incorporated into the curriculum at the Faculty of Health and the Faculty of Sports and Nutrition at the AUAS.

Published by  Urban Vitality 23 September 2019

Project Info

Start date 01 Jun 2018
End date 29 May 2020