TY - JOUR
T1 - Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge
T2 - Mixed methods process evaluation of the RECOVER randomised clinical trial
AU - RECOVER collaborators
AU - Ramsay, Pam
AU - Huby, Guro
AU - Merriweather, Judith
AU - Salisbury, Lisa
AU - Rattray, Janice
AU - Griffith, David
AU - Walsh, Timothy
AU - Boyd, Julia A.
AU - Mackenzie, Simon J.
AU - Krishan, Ashma
AU - Lewis, Stephanie C.
AU - Murray, Gordon D.
AU - Forbes, John F.
AU - Smith, Joel
AU - Hull, Alastair M.
AU - Wallis, Charles
AU - Stewart, Joyce
AU - Bateman, Anthony
AU - Wilson, Elizabeth
AU - Gillies, Mike
AU - Kean, Susanne
AU - Hope, David
AU - Dawson, Heidi
AU - McCulloch, Corrienne
AU - Antonelli, Jean
AU - Boardman, Louise
AU - Dow, Leanne
AU - Williams, Winchell
AU - McCann, Audrey
AU - Alexander, Sarah
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Objectives: To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design: Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting: Two university-affiliated hospitals in Scotland. Participants: 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions: A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results: The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated greater access to physiotherapy, nutritional care and information that cut across disciplinary boundaries and staffing constraints. Patients highly valued its individualisation according to their needs, abilities and preferences. Conclusions: Case management by dedicated RAs improves patients' experiences of post-ICU hospital-based rehabilitation and increases perceived quality of care.
AB - Objectives: To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design: Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting: Two university-affiliated hospitals in Scotland. Participants: 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions: A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results: The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated greater access to physiotherapy, nutritional care and information that cut across disciplinary boundaries and staffing constraints. Patients highly valued its individualisation according to their needs, abilities and preferences. Conclusions: Case management by dedicated RAs improves patients' experiences of post-ICU hospital-based rehabilitation and increases perceived quality of care.
KW - QUALITATIVE RESEARCH
KW - REHABILITATION MEDICINE
UR - http://www.scopus.com/inward/record.url?scp=84982856550&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2016-012041
DO - 10.1136/bmjopen-2016-012041
M3 - Article
C2 - 27481624
AN - SCOPUS:84982856550
SN - 2044-6055
VL - 6
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e012041
ER -