The role of rehabilitation in improving short and long term outcomes for survivors of critical illness

McWilliams, David Joseph (2018) The role of rehabilitation in improving short and long term outcomes for survivors of critical illness. Doctoral thesis (PhD), Manchester Metropolitan University.

Preview

Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (1MB) | Preview

Abstract

This thesis aims to evaluate the role of rehabilitation in improving outcomes for patients admitted to critical care. Patients admitted to critical care experience significant muscle weakness, which when present is associated with prolonged stays in both ICU and hospital and higher mortality levels. Although overall survival rates from critical illness are improving, survivors are often left with significant and ongoing physical, functional and psychological dysfunction. Preventing the physical consequences of critical illness and supporting recovery from intensive care therefore remains a high priority area for critical care practice and research. This thesis presents and critiques 11 peer reviewed publications and 2 national guidelines to demonstrate the role of rehabilitation in improving outcomes. The first 5 papers presented investigate the impact of a novel post ICU rehabilitation programme to improve long term outcomes. This begins with the initial feasibility testing of the programme and demonstrates development of the analysis into a more robust multi-centre trial. The impact of exercise based rehabilitation is evaluated with regards to physical, psychological and quality of life measures. The next 6 papers presented investigate the potential for early rehabilitation which commences in ICU to reduce the negative impact of critical illness and improve patient outcomes. Specifically they evaluate the impact of a structured approach to rehabilitation within critical care, identifying the key components required and potential barriers to implementation. The findings of the papers included in this thesis provide valuable insights to inform future research opportunities and challenges in order to continue to develop the evidence for critical illness rehabilitation and recovery.