The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation

Lynne Turner-Stokes; Evelyn J. Corner; Richard J. Siegert; Craig Brown; Sarah Wallace; Julie Highfield; Danielle Bear; Leanne M. Aitken; Hugh Montgomery; Zudin Puthucheary

doi:10.1177/1751143720988715

The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation

Lynne Turner-Stokes^*, Evelyn J. Corner, Richard J. Siegert, Craig Brown, Sarah Wallace, Julie Highfield, Danielle Bear, Leanne M. Aitken, Hugh Montgomery, Zudin Puthucheary

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

Abstract

Background: Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and development of rehabilitation services. These issues could be resolved in part by the systematic use of a clinical tool to support decision-making as patients progress from the Intensive Care Unit (ICU), through acute hospital care and onwards into rehabilitation. We describe (i) the development of such a tool (the Post-ICU Presentation Screen (PICUPS)) and (ii) the subsequent preparation of a person-centred Rehabilitation Prescription (RP) to travel with the patient as they continue down the care pathway. Methods: PICUPS development was led by a core group of experienced clinicians representing the various disciplines involved in post-ICU rehabilitation. Key constructs and item-level descriptors were identified by group consensus. Piloting was performed as part of wider clinical engagement in 26 acute hospitals across England. Development and validation of such a tool requires clinimetric analysis, and this was based on classical test theory. Teams also provided feedback about the feasibility and utility of the tool. Results: Initial PICUPS design yielded a 24-item tool. In piloting, a total of 552 records were collated from 314 patients, of which 121 (38.5%) had COVID-19. No obvious floor or ceiling effects were apparent. Exploratory factor analysis provided evidence of uni-dimensionality with strong loading on the first principal component accounting for 51% of the variance and Cronbach’s alpha for the full-scale score 0.95 – although a 3-factor solution accounted for a further 21%. The PICUPS was responsive to change both at full scale- and item-level. In general, positive responses were seen regarding the tool’s ability to describe the patients during their clinical course, engage and flag the relevant professionals needed, and to inform what should be included in an RP. Conclusions: The PICUPS tool has robust scaling properties as a clinical measure and is potentially useful as a tool for identifying rehabilitation needs as patients step down from ICU and acute hospital care.

Original language	English
Journal	Journal of the Intensive Care Society
DOIs	https://doi.org/10.1177/1751143720988715
Publication status	Accepted/In press - 2021

Keywords

COVID-19
intensive care
Rehabilitation needs

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10.1177/1751143720988715

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Turner-Stokes, L., Corner, E. J., Siegert, R. J., Brown, C., Wallace, S., Highfield, J., Bear, D., Aitken, L. M., Montgomery, H., & Puthucheary, Z. (Accepted/In press). The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation. Journal of the Intensive Care Society. https://doi.org/10.1177/1751143720988715

@article{2168ff07ee1f4dd695e4a3f087e4b0bb,

title = "The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation",

abstract = "Background: Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and development of rehabilitation services. These issues could be resolved in part by the systematic use of a clinical tool to support decision-making as patients progress from the Intensive Care Unit (ICU), through acute hospital care and onwards into rehabilitation. We describe (i) the development of such a tool (the Post-ICU Presentation Screen (PICUPS)) and (ii) the subsequent preparation of a person-centred Rehabilitation Prescription (RP) to travel with the patient as they continue down the care pathway. Methods: PICUPS development was led by a core group of experienced clinicians representing the various disciplines involved in post-ICU rehabilitation. Key constructs and item-level descriptors were identified by group consensus. Piloting was performed as part of wider clinical engagement in 26 acute hospitals across England. Development and validation of such a tool requires clinimetric analysis, and this was based on classical test theory. Teams also provided feedback about the feasibility and utility of the tool. Results: Initial PICUPS design yielded a 24-item tool. In piloting, a total of 552 records were collated from 314 patients, of which 121 (38.5%) had COVID-19. No obvious floor or ceiling effects were apparent. Exploratory factor analysis provided evidence of uni-dimensionality with strong loading on the first principal component accounting for 51% of the variance and Cronbach{\textquoteright}s alpha for the full-scale score 0.95 – although a 3-factor solution accounted for a further 21%. The PICUPS was responsive to change both at full scale- and item-level. In general, positive responses were seen regarding the tool{\textquoteright}s ability to describe the patients during their clinical course, engage and flag the relevant professionals needed, and to inform what should be included in an RP. Conclusions: The PICUPS tool has robust scaling properties as a clinical measure and is potentially useful as a tool for identifying rehabilitation needs as patients step down from ICU and acute hospital care.",

keywords = "COVID-19, intensive care, Rehabilitation needs",

author = "Lynne Turner-Stokes and Corner, {Evelyn J.} and Siegert, {Richard J.} and Craig Brown and Sarah Wallace and Julie Highfield and Danielle Bear and Aitken, {Leanne M.} and Hugh Montgomery and Zudin Puthucheary",

note = "Funding Information: Development of UK Rehabilitation Outcomes Collaborative Database was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-0407-10185) and it is now commissioned directly by NHS England. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: Hugh Montgomery is supported by the National Institute for Health Research Biomedical Research Centre at University College London Hospitals. Professor Turner-Stokes receives funding for writing and research time from the London North West Hospitals Healthcare Charity. Publisher Copyright: {\textcopyright} The Intensive Care Society 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

doi = "10.1177/1751143720988715",

language = "English",

journal = "Journal of the Intensive Care Society",

issn = "1751-1437",

publisher = "Stansted News Ltd",

}

Turner-Stokes, L, Corner, EJ, Siegert, RJ, Brown, C, Wallace, S, Highfield, J, Bear, D, Aitken, LM, Montgomery, H & Puthucheary, Z 2021, 'The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation', Journal of the Intensive Care Society. https://doi.org/10.1177/1751143720988715

TY - JOUR

T1 - The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I

T2 - Development and preliminary clinimetric evaluation

AU - Turner-Stokes, Lynne

AU - Corner, Evelyn J.

AU - Siegert, Richard J.

AU - Brown, Craig

AU - Wallace, Sarah

AU - Highfield, Julie

AU - Bear, Danielle

AU - Aitken, Leanne M.

AU - Montgomery, Hugh

AU - Puthucheary, Zudin

N1 - Funding Information: Development of UK Rehabilitation Outcomes Collaborative Database was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-0407-10185) and it is now commissioned directly by NHS England. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: Hugh Montgomery is supported by the National Institute for Health Research Biomedical Research Centre at University College London Hospitals. Professor Turner-Stokes receives funding for writing and research time from the London North West Hospitals Healthcare Charity. Publisher Copyright: © The Intensive Care Society 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - Background: Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and development of rehabilitation services. These issues could be resolved in part by the systematic use of a clinical tool to support decision-making as patients progress from the Intensive Care Unit (ICU), through acute hospital care and onwards into rehabilitation. We describe (i) the development of such a tool (the Post-ICU Presentation Screen (PICUPS)) and (ii) the subsequent preparation of a person-centred Rehabilitation Prescription (RP) to travel with the patient as they continue down the care pathway. Methods: PICUPS development was led by a core group of experienced clinicians representing the various disciplines involved in post-ICU rehabilitation. Key constructs and item-level descriptors were identified by group consensus. Piloting was performed as part of wider clinical engagement in 26 acute hospitals across England. Development and validation of such a tool requires clinimetric analysis, and this was based on classical test theory. Teams also provided feedback about the feasibility and utility of the tool. Results: Initial PICUPS design yielded a 24-item tool. In piloting, a total of 552 records were collated from 314 patients, of which 121 (38.5%) had COVID-19. No obvious floor or ceiling effects were apparent. Exploratory factor analysis provided evidence of uni-dimensionality with strong loading on the first principal component accounting for 51% of the variance and Cronbach’s alpha for the full-scale score 0.95 – although a 3-factor solution accounted for a further 21%. The PICUPS was responsive to change both at full scale- and item-level. In general, positive responses were seen regarding the tool’s ability to describe the patients during their clinical course, engage and flag the relevant professionals needed, and to inform what should be included in an RP. Conclusions: The PICUPS tool has robust scaling properties as a clinical measure and is potentially useful as a tool for identifying rehabilitation needs as patients step down from ICU and acute hospital care.

AB - Background: Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and development of rehabilitation services. These issues could be resolved in part by the systematic use of a clinical tool to support decision-making as patients progress from the Intensive Care Unit (ICU), through acute hospital care and onwards into rehabilitation. We describe (i) the development of such a tool (the Post-ICU Presentation Screen (PICUPS)) and (ii) the subsequent preparation of a person-centred Rehabilitation Prescription (RP) to travel with the patient as they continue down the care pathway. Methods: PICUPS development was led by a core group of experienced clinicians representing the various disciplines involved in post-ICU rehabilitation. Key constructs and item-level descriptors were identified by group consensus. Piloting was performed as part of wider clinical engagement in 26 acute hospitals across England. Development and validation of such a tool requires clinimetric analysis, and this was based on classical test theory. Teams also provided feedback about the feasibility and utility of the tool. Results: Initial PICUPS design yielded a 24-item tool. In piloting, a total of 552 records were collated from 314 patients, of which 121 (38.5%) had COVID-19. No obvious floor or ceiling effects were apparent. Exploratory factor analysis provided evidence of uni-dimensionality with strong loading on the first principal component accounting for 51% of the variance and Cronbach’s alpha for the full-scale score 0.95 – although a 3-factor solution accounted for a further 21%. The PICUPS was responsive to change both at full scale- and item-level. In general, positive responses were seen regarding the tool’s ability to describe the patients during their clinical course, engage and flag the relevant professionals needed, and to inform what should be included in an RP. Conclusions: The PICUPS tool has robust scaling properties as a clinical measure and is potentially useful as a tool for identifying rehabilitation needs as patients step down from ICU and acute hospital care.

KW - COVID-19

KW - intensive care

KW - Rehabilitation needs

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U2 - 10.1177/1751143720988715

DO - 10.1177/1751143720988715

M3 - Article

AN - SCOPUS:85101264756

SN - 1751-1437

JO - Journal of the Intensive Care Society

JF - Journal of the Intensive Care Society

ER -

The post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part I: Development and preliminary clinimetric evaluation

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