Cognitive and physical rehabilitation of intensive care unit survivors (original) (raw)

2012, Critical Care Medicine

Background-Millions of patients who survive medical and surgical general ICU care every year suffer from newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multi-faceted, in-home tele-rehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. Methods-This was a single-site, feasibility, pilot randomized trial of 21 general medical/ surgical ICU survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation) while intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 weeks included 6 in-person visits for cognitive rehabilitation and 6 televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months) with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. Results-Patients tolerated the program with only 1 adverse event (AE) reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower Test (TOWER) (for planning and strategic thinking) versus controls [13.0 (Interquartile Range, IQR 11.5 to14.0) vs. 7.5 (4.0 to 8.5), adjusted p<0.01]. Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently employed measures of functional status [Functional Activities Questionnaire (FAQ)] at 3 months vs. controls [1.0 (0.0 to 3.0) vs. 8.0 (6.0 to 11.8), adjusted p=0.04]. Conclusions-A multi-component rehabilitation program for ICU survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot, feasibility program and to confirm these results as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.