Beyond survival Optimizing the rehabilitation pathway after critical illness

Patients who are admitted to the intensive care unit (ICU) with a critical illness, frequently require complex medical interventions, which often end up being lifesaving. Survival of critical illness, however, presents new challenges for patients and their relatives: challenges in the physical, mental, and/or cognitive health domain, referred to as Post-Intensive Care Syndrome (PICS). While PICS-related symptoms vary between individuals in type, severity and timing, most survivors require rehabilitation interventions starting within the ICU and continuing after ICU and hospital discharge. Understanding patients’ rehabilitation needs during discharge planning is essential for the provision of aftercare. The general aim of this thesis was to describe, within the context of professional practice, scientific research, and education what characterizes critical illness survivorship and optimal physical therapy interventions during the different stages of the rehabilitation pathway.
Chapter 2 relates to professional competencies of physical therapists (PTs) in the ICU. A mixed-method proof of concept study among undergraduate PT students and ICU physical therapists, investigating the feasibility of the application of e-learning in preparation for a clinical rotation in ICU, is described. Chapter 3 describes a grounded theory study among survivors or critical illness and their relatives, investigating the transition experiences from ICU to the hospital ward and homewards. Chapter 4 presents a prospective cohort study investigating longitudinal changes in respiratory muscle strength and factors associated with recovery, in mechanically ventilated patients. Chapters 5 and 6 present two separate Delphi studies comprising recommendations for a core outcome set and primary care PT interventions for patients with PICS. Chapter 7 describes a mixed-method, non-randomized prospective pilot study investigating the feasibility of an interdisciplinary home-based intervention for patients with PICS. The thesis closes with a general discussion summarizing the main findings and providing recommendations to optimize the rehabilitation pathway after critical illness.