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Rehabilitation after critical illness: A randomized, controlled trial

Jones, Christina PhD; Skirrow, Paul MPhil; Griffiths, Richard D. MD, FRCP; Humphris, Gerald H. PhD, M Clin Psych; Ingleby, Sarah BSc; Eddleston, Jane FRCA; Waldmann, Carl FRCA; Gager, Melanie RGN

doi: 10.1097/01.CCM.0000089938.56725.33
CLINICAL INVESTIGATIONS
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Objective To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery.

Design Randomized controlled trial, blind at follow-up with final assessment at 6 months.

Setting Two district general hospitals and one teaching hospital.

Patients Patients were 126 consecutively admitted intensive care patients meeting the inclusion criteria.

Interventions Control patients received ward visits, three telephone calls at home, and clinic appointments at 8 wks and 6 months. Intervention patients received the same plus a 6-wk self-help rehabilitation manual.

Measurements and Main Results We measured levels of depression and anxiety (Hospital Anxiety and Depression Scale), phobic symptoms (Fear Index), posttraumatic stress disorder (PTSD)-related symptoms (Impact of Events Scale), and scores on the Short-Form Health Survey physical dimension 8 wks and 6 months after intensive care unit (ICU) treatment. Memory for ICU was assessed at 2 wks post-ICU discharge using the ICU Memory Tool.

The intervention group improved, compared with the control patients, on the Short-Form Health Survey physical function scores at 8 wks and 6 months (p = .006), and there was a trend to a lower rate of depression at 8 wks (12% vs. 25%). However, there were no differences in levels of anxiety and PTSD-related symptoms between the groups. The presence of delusional memories was correlated significantly with both anxiety and Impact of Events Scale scores.

Conclusions A self-help rehabilitation manual is effective in aiding physical recovery and reducing depression. However, in those patients recalling delusional memories from the ICU, further psychological care may be needed to reduce the incidence of anxiety and PTSD-related symptoms.

From the Intensive Care Research Group, Department of Medicine (CJ, PS, RDG), University of Liverpool, and the Intensive Care Unit, Whiston Hospital, Prescot, UK; the Department of Clinical Psychology (GHH), University of Manchester, UK; the Intensive Care Unit (SI, JE), Manchester Royal Infirmary, Manchester, UK; and the Intensive Care Unit (CW, MG), Royal Berkshire Hospital, Reading, UK.

Supported, in part, by the Stanley Thomas Johnson Foundation, Berne, Switzerland, and REMEDI, UK.

Address requests for reprints to Prof. Richard D. Griffiths, MD, FRCP, Intensive Care Research Group, Department of Medicine, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, UK. E-mail: rdg@liverpool.ac.uk

A self-help rehabilitation manual is effective in aiding physical recovery and reducing depression.

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