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PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians*

Treble-Barna, Amery PhD1; Beers, Sue R. PhD2; Houtrow, Amy J. MD, PhD, MPH1; Ortiz-Aguayo, Roberto MD3; Valenta, Cynthia MSN, CNRN4; Stanger, Meg PT, PCS5; Chrisman, Maddie PT, DPT5; Orringer, Maxine MA, CCC–SLP6; Smith, Craig M. MD7; Pollon, Dorothy MBA, JD8; Duffett, Mark PhD9; Choong, Karen MB, BCh, MSc9,10; Watson, R. Scott MD, MPH11,12; Kochanek, Patrick M. MD, MCCM13,14; Fink, Ericka L. MD, MS13,14; for the PICU-Rehabilitation Study Group, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and Prevalence of Acute critical Neurological disease in children: A Global Epidemiological Assessment (PANGEA) Investigators

Pediatric Critical Care Medicine: June 2019 - Volume 20 - Issue 6 - p e274-e282
doi: 10.1097/PCC.0000000000001940
Online Clinical Investigations
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Objectives: Characterize current practices for PICU-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings.

Design: International, self-administered, quantitative, cross-sectional survey.

Setting: Online survey distributed from March 2017 to April 2017.

Patients or Subjects: Pediatric critical care physicians who subscribed to email distribution lists of the Pediatric Acute Lung Injury and Sepsis Investigators, the Pediatric Neurocritical Care Research Group, or the Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment study group, and visitors to the World Federation of Pediatric Intensive and Critical Care Societies website.

Interventions: None.

Measurements and Main Results: Of the 170 subjects who began the survey, 148 completed it. Of those who completed the optional respondent information, most reported working in an academic medical setting and were located in the United States. The main findings were 1) a large majority of PICU physicians reported working in institutions with no guidelines for PICU-based rehabilitation, but expressed interest in developing and implementing such guidelines; 2) despite this lack of guidelines, an overwhelming majority of respondents reported that their current practices would involve consultation of multiple rehabilitation services for each case example provided; 3) PICU physicians believed that additional research evidence is needed to determine efficacy and optimal implementation of PICU-based rehabilitation; 4) PICU physicians reported significant barriers to implementation of PICU-based rehabilitation across centers; and 5) low routine assessment of long-term functional outcomes of PICU patients, although some centers have developed multidisciplinary follow-up programs.

Conclusions: Physicians lack PICU-based rehabilitation guidelines despite great interest and current practices involving a high degree of PICU-based rehabilitation consultation. Data are needed to identify best practices and necessary resources in the delivery of ICU-based multidisciplinary rehabilitation and long-term functional outcomes assessment to optimize recovery of children and families affected by critical illness.

1Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA.

2Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.

3Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA.

4Professional Practice and Education Division, Jefferson Hospital, Jefferson Hills, PA.

5Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, PA.

6Department of Audiology and Speech-Language Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.

7Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

8Children's Hospital of Pittsburgh Foundation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.

9Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada.

10Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

11Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.

12Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA.

13Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.

14Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA.

*See also p. 586.

The views presented in this article are solely the responsibility of the author(s) and do not necessarily represent the views of Patient-Centered Outcomes Research Institute, its Board of Governors or Methodology Committee.

PICU-Rehabilitation Study Group Members are listed in Appendix 1.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Patient-Centered Outcomes Research Institute (PCORI) (CER-1310–08343) (to Dr. Fink). Research reported in this article was funded through a PCORI Award (CER-1310–08343); 5T32HD040686-18 (to Dr. Treble-Barna).

Drs. Beers’s, Houtrow’s, Ortiz-Aguayo’s, Chrisman’s, Orringer’s, Smith’s, and Fink’s institutions received funding from Patient-Centered Outcomes Research Institute. Dr. Choong’s institution received funding from Alternate Funding Plan Innovation Grant, and she received funding from McMaster University. Dr. Kochanek receives a stipend from the Society of Critical Care Medicine and World Federation of Pediatric and Intensive Care Societies for his role as editor-in-chief of Pediatric Critical Care Medicine. Dr. Fink’s institution received funding from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This project is registered with clinicaltrials.gov (NCT02209935).

For information regarding this article, E-mail: finkel@ccm.upmc.edu

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies