Up to two thirds of patients discharged from ICU have ongoing significant physical, psychological and cognitive morbidity (‘post intensive care syndrome’). As a result, survivors of critical illness are often left with complex rehabilitation needs, adversely impacting return to pre-illness quality of life and function. In the longer-term, a third of working age patients still need help with basic activities (e.g., going to the toilet, getting dressed), 50% have been readmitted to hospital, and less than half have returned to work one year after leaving ICU.
The development and widespread implementation of structured, individualised interventions to support patients on ICU step down has the potential to improve overall recovery and quality of life. The James Lind Alliance Intensive Care Priority Setting Partnership highlighted the need for research on supporting recovery after intensive care as a key research priority. A national service evaluation of twenty-five centres in the UK highlighted that at step down from ICU 98% patient of patients required ongoing physiotherapy and 70% were at risk of malnutrition.
Over three-quarters of UK ICUs provide follow-up teams intended to optimise the care of patients in hospital following an ICU stay. The purpose of follow-up teams is to aid the transition to the ward, support the ward teams with ongoing care such as tracheostomy weaning, improve lines of communication between services, and identify clinical deterioration. These teams were often developed with little evidence to support their practice and the ICU Getting it Right First-Time report and a recent systematic review demonstrated wide variation in provision.
This study is focused on muscle loss resulting in reduced mobility and malnutrition. It is a mixed-methods, two-centre, randomised controlled feasibility study to establish the viability of conducting a larger multicentre RCT to test the effects of the combined physiotherapy and nutritional intervention on days alive and out of hospital in 30 days.