Early mobilisation and rehabilitation in the PICU: a UK survey
Early mobilisation and rehabilitation in the PICU: a UK survey
Objective: To understand the context and professional perspectives of delivering early rehabilitation and mobilisation (ERM) within UK paediatric intensive care units (PICUs).
Design: A web-based survey administered from May 2019 to August 2019.
Setting: UK PICUs.
Participants: A total of 124 staff from 26 PICUs participated, including 22 (18%) doctors, 34 (27%) nurses, 28 (23%) physiotherapists, 19 (15%) occupational therapists and 21 (17%) were other professionals.
Results: Key components of participants' definitions of ERM included tailored, multidisciplinary rehabilitation packages focused on promoting recovery. Multidisciplinary involvement in initiating ERM was commonly reported. Over half of respondents favoured delivering ERM after achieving physiological stability (n=69, 56%). All age groups were considered for ERM by relevant health professionals. However, responses differed concerning the timing of initiation. Interventions considered for ERM were more likely to be delivered to patients when PICU length of stay exceeded 28 days and among patients with acquired brain injury or severe developmental delay. The most commonly identified barriers were physiological instability (81%), limited staffing (79%), sedation requirement (73%), insufficient resources and equipment (69%), lack of recognition of patient readiness (67%), patient suitability (63%), inadequate training (61%) and inadequate funding (60%). Respondents ranked reduction in PICU length of stay (74%) and improvement in psychological outcomes (73%) as the most important benefits of ERM.
Conclusion: ERM is gaining familiarity and endorsement in UK PICUs, but significant barriers to implementation due to limited resources and variation in content and delivery of ERM persist. A standardised protocol that sets out defined ERM interventions, along with implementation support to tackle modifiable barriers, is required to ensure the delivery of high-quality ERM.
epidemiology, rehabilitation
Thompson, Jacqueline Y.
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Menzies, Julie C.
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Manning, Joseph C.
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McAnuff, Jennifer
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Brush, Emily Clare
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Ryde, Francesca
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Rapley, Tim
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Pathan, Nazima
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Brett, Stephen
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Moore, David J.
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Geary, Michelle
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Colville, Gillian A.
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Morris, Kevin P.
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Parslow, Roger Charles
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Feltbower, Richard G.
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Lockley, Sophie
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Kirkham, Fenella J.
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Forsyth, Rob J.
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Scholefield, Barnaby R.
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9 June 2022
Thompson, Jacqueline Y.
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Menzies, Julie C.
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Manning, Joseph C.
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McAnuff, Jennifer
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Brush, Emily Clare
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Ryde, Francesca
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Rapley, Tim
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Pathan, Nazima
4d1ef72a-afc0-4082-b6e0-41fb84c64154
Brett, Stephen
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Moore, David J.
eb27de78-dc20-4820-b1fc-b24906459119
Geary, Michelle
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Colville, Gillian A.
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Morris, Kevin P.
b158d18a-c8a0-4a4b-bf0c-7aff965a2c20
Parslow, Roger Charles
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Feltbower, Richard G.
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Lockley, Sophie
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Kirkham, Fenella J.
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Forsyth, Rob J.
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Scholefield, Barnaby R.
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Thompson, Jacqueline Y., Menzies, Julie C., Manning, Joseph C., McAnuff, Jennifer, Brush, Emily Clare, Ryde, Francesca, Rapley, Tim, Pathan, Nazima, Brett, Stephen, Moore, David J., Geary, Michelle, Colville, Gillian A., Morris, Kevin P., Parslow, Roger Charles, Feltbower, Richard G., Lockley, Sophie, Kirkham, Fenella J., Forsyth, Rob J. and Scholefield, Barnaby R.
(2022)
Early mobilisation and rehabilitation in the PICU: a UK survey.
BMJ Paediatrics Open, 6 (1), [e001300].
(doi:10.1136/bmjpo-2021-001300).
Abstract
Objective: To understand the context and professional perspectives of delivering early rehabilitation and mobilisation (ERM) within UK paediatric intensive care units (PICUs).
Design: A web-based survey administered from May 2019 to August 2019.
Setting: UK PICUs.
Participants: A total of 124 staff from 26 PICUs participated, including 22 (18%) doctors, 34 (27%) nurses, 28 (23%) physiotherapists, 19 (15%) occupational therapists and 21 (17%) were other professionals.
Results: Key components of participants' definitions of ERM included tailored, multidisciplinary rehabilitation packages focused on promoting recovery. Multidisciplinary involvement in initiating ERM was commonly reported. Over half of respondents favoured delivering ERM after achieving physiological stability (n=69, 56%). All age groups were considered for ERM by relevant health professionals. However, responses differed concerning the timing of initiation. Interventions considered for ERM were more likely to be delivered to patients when PICU length of stay exceeded 28 days and among patients with acquired brain injury or severe developmental delay. The most commonly identified barriers were physiological instability (81%), limited staffing (79%), sedation requirement (73%), insufficient resources and equipment (69%), lack of recognition of patient readiness (67%), patient suitability (63%), inadequate training (61%) and inadequate funding (60%). Respondents ranked reduction in PICU length of stay (74%) and improvement in psychological outcomes (73%) as the most important benefits of ERM.
Conclusion: ERM is gaining familiarity and endorsement in UK PICUs, but significant barriers to implementation due to limited resources and variation in content and delivery of ERM persist. A standardised protocol that sets out defined ERM interventions, along with implementation support to tackle modifiable barriers, is required to ensure the delivery of high-quality ERM.
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Accepted/In Press date: 25 February 2022
Published date: 9 June 2022
Additional Information:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Keywords:
epidemiology, rehabilitation
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Local EPrints ID: 470173
URI: http://eprints.soton.ac.uk/id/eprint/470173
PURE UUID: 2175d8a6-0426-4fe1-8db2-191888b6f3a5
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Date deposited: 04 Oct 2022 16:39
Last modified: 17 Mar 2024 02:53
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Contributors
Author:
Jacqueline Y. Thompson
Author:
Julie C. Menzies
Author:
Joseph C. Manning
Author:
Jennifer McAnuff
Author:
Emily Clare Brush
Author:
Francesca Ryde
Author:
Tim Rapley
Author:
Nazima Pathan
Author:
Stephen Brett
Author:
David J. Moore
Author:
Michelle Geary
Author:
Gillian A. Colville
Author:
Kevin P. Morris
Author:
Roger Charles Parslow
Author:
Richard G. Feltbower
Author:
Sophie Lockley
Author:
Rob J. Forsyth
Author:
Barnaby R. Scholefield
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