TY - JOUR
T1 - Clinician and patient perspectives on the barriers and facilitators to physical rehabilitation in intensive care
T2 - a qualitative interview study
AU - Woodbridge, Huw R
AU - Norton, Christine
AU - Jones, Mandy
AU - Brett, Stephen J
AU - Alexander, Caroline M
AU - Gordon, Anthony C
N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Funding Information:
This report is independent research arising from a Clinical Doctoral Research Fellowship, awarded to HRW, (ICA-CDRF-2015-01-026), supported by the National Institute for Health Research (NIHR) and Health Education England. We acknowledge the support of the NIHR Clinical Research Network and infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC). HRW is supported by the NIHR Imperial BRC.
Funding Information:
HRW reports personal lecture fees from Brunel University and the University of East London. CN reports personal lecture fees from Janssen Pharmaceuticals and Web MD. CMA is a National Institute of Health Research PhD fellowship committee member, although not at the time that funding was awarded for this study. ACG reports salary support from an NIHR Research Professorship (RP-2015-06-018) and research support from the NIHR Imperial BRC.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/11/8
Y1 - 2023/11/8
N2 - OBJECTIVES: The objective of this study is to explore patient, relative/carer and clinician perceptions of barriers to early physical rehabilitation in intensive care units (ICUs) within an associated group of hospitals in the UK and how they can be overcome.DESIGN: Qualitative study using semi-structured interviews and thematic framework analysis.SETTING: Four ICUs over three hospital sites in London, UK.PARTICIPANTS: Former ICU patients or their relatives/carers with personal experience of ICU rehabilitation. ICU clinicians, including doctors, nurses, physiotherapists and occupational therapists, involved in the delivery of physical rehabilitation or decisions over its initiation.PRIMARY AND SECONDARY OUTCOMES MEASURES: Views and experiences on the barriers and facilitators to ICU physical rehabilitation.RESULTS: Interviews were carried out with 11 former patients, 3 family members and 16 clinicians. The themes generated related to: safety and physiological concerns, patient participation and engagement, clinician experience and knowledge, teamwork, equipment and environment and risks and benefits of rehabilitation in intensive care. The overarching theme for overcoming barriers was a change in working model from ICU clinicians having separate responsibilities (a multidisciplinary approach) to one where all parties have a shared aim of providing patient-centred ICU physical rehabilitation (an interdisciplinary approach).CONCLUSIONS: The results have revealed barriers that can be modified to improve rehabilitation delivery in an ICU. Interdisciplinary working could overcome many of these barriers to optimise recovery from critical illness.
AB - OBJECTIVES: The objective of this study is to explore patient, relative/carer and clinician perceptions of barriers to early physical rehabilitation in intensive care units (ICUs) within an associated group of hospitals in the UK and how they can be overcome.DESIGN: Qualitative study using semi-structured interviews and thematic framework analysis.SETTING: Four ICUs over three hospital sites in London, UK.PARTICIPANTS: Former ICU patients or their relatives/carers with personal experience of ICU rehabilitation. ICU clinicians, including doctors, nurses, physiotherapists and occupational therapists, involved in the delivery of physical rehabilitation or decisions over its initiation.PRIMARY AND SECONDARY OUTCOMES MEASURES: Views and experiences on the barriers and facilitators to ICU physical rehabilitation.RESULTS: Interviews were carried out with 11 former patients, 3 family members and 16 clinicians. The themes generated related to: safety and physiological concerns, patient participation and engagement, clinician experience and knowledge, teamwork, equipment and environment and risks and benefits of rehabilitation in intensive care. The overarching theme for overcoming barriers was a change in working model from ICU clinicians having separate responsibilities (a multidisciplinary approach) to one where all parties have a shared aim of providing patient-centred ICU physical rehabilitation (an interdisciplinary approach).CONCLUSIONS: The results have revealed barriers that can be modified to improve rehabilitation delivery in an ICU. Interdisciplinary working could overcome many of these barriers to optimise recovery from critical illness.
KW - Humans
KW - Critical Care
KW - Qualitative Research
KW - Intensive Care Units
KW - Occupational Therapists
KW - Physical Therapists
UR - http://www.scopus.com/inward/record.url?scp=85176382899&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2023-073061
DO - 10.1136/bmjopen-2023-073061
M3 - Article
C2 - 37940149
SN - 2044-6055
VL - 13
SP - e073061
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e073061
ER -