ABSTRACT
Introduction: Admission to intensive care is a life changing event for people which can result in long term detriments to health, function and quality of life.1 Extensive literature exists and guidelines have been written supporting rehabilitation for these patients.2 More qualitative data is also being carried out on patients' perspectives of rehabilitation in intensive care. This has highlighted 'the noxious cycle of ICU' where patients describe fatigue, boredom and lack of concentration.3 Family presence in intensive care can improve a patient's recovery.4 The COVID-19 pandemic has led to more isolation for patients due to visiting restrictions. Partaking in creative activities is known to have many benefits for long stay hospital patients and can have positive impacts on their recovery.5 This led us to the development of a leisure activity trolley with the focus on enhancing well-being in long stay patients. Objectives: The aim of this project is to enhance wellbeing in intensive care patients. This was done by supporting patients to engage with leisure activities. Methods: A mixed methods questionnaire was used to collect data from four long stay patients. This data was used to gauge patients' interests in participating in leisure actives and identify what equipment would be enjoyed. An application to the hospital patient amenities fund was made and funding was secured to purchase a variety of items based on the results of this questionnaire. All long stay patients throughout the hospital including ITU and step down who were awake and medically stable were invited to participate. Patients were given a preactivity questionnaire to gather information on their usual interests and rate their current mood using a Likert scale. This informed us to make suggestions on what they may enjoy. We also provided them with our 'mindfulness menu' to select what they'd like to do. Patients were then set up with their selected activities and given the option to engage alone or in the company of a therapist (see Image 1). A post-activity questionnaire was completed to explore if patients enjoyed the activity. Patient mood following activity was also re-collected using a Likert scale. Patients could continue to partake in the activities chosen, try new ones, or cease to partake all together. Post activity questionnaires were completed after each session. Results: 37 different patients were approached on 96 occasions. They chose to engage in activities on 87/96 (90%) of occasions (see Table 1 for activities). On average, patients' moods improved from a Likhert score of 4.6/10 to 7.2/10, a 36% increase, following participation in a leisure activity. Patient satisfaction with activities offered on initial assessment and on discharge also improved. From this small sample size, patient's well-being was enhanced by participation in leisure activities. Conclusion: Overall, we have found this project to be successful thus far in improving well-being for intensive care patients. We plan to continue to offer these activities for our patients and hope it continues to improve patient wellbeing and recovery.
ABSTRACT
Introduction: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been responsible for one of the largest global viral outbreaks in recent years.1 Admissions to intensive care units (ICU) have increased. A common consequence of prolonged ICU admission is ICUacquired weakness (ICUAW).2 Rehabilitation in ICU is well established to be beneficial in combating ICUAW and should be started as early as clinically possible.3 Objectives: This study aimed to explore the haemodynamic effects of initial active rehabilitation in this complex patient population. Methods: During April to June 2020, continuous, prospective cardiovascular and respiratory data (heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO2) were measured for fifteen minutes before, during and for 30 minutes after the initial active rehabilitation session. Active rehabilitation was defined as a sit over the edge of the bed with assistance from therapists as theminimumachieved in the session. The length of the active rehabilitation session, the type of rehabilitation and reason for stopping the session were recorded. Inclusion and exclusion criteria were established a priori. Data were analysed via non-parametric ANOVA. Results: Initial active physiotherapy rehabilitation was observed in 23 patients (17 male, median age 45 years (IQR 36,51)). Median length of mechanical ventilation prior to starting active rehabilitation was 34 days (IQR 26,40). Four patients were receiving extra-corporeal membrane oxygenation (ECMO) and three patients had been extubated prior to rehabilitation. All patients achieved a sit over the edge of the bed with one patient progressing to a stand. Median length of treatment time was 11 minutes (IQR 8,14). Group analysis did not identify any statistically significant changes in HR (p=0.975), SBP (p=0.907), DBP (p=0.783), MAP (p=0.625) or SpO2 (p=0.666) across the four study periods. There was no clinically significant change across the variables (range -0.5% reduction to 5.9% increase) with minimal changes in cardiovascular changes. No medical intervention such as titration of medication or additional ventilatory support was required during the sessions or as reason for stopping. Conclusion: This service evaluation suggests that initial active rehabilitation in a group of critically ill adults with COVID-19 at a specialist centre can be performed safely without detrimental cardiovascular changes.
ABSTRACT
Introduction: The United States Centers for Disease Control and Prevention (CDC) issued behavioral recommendations to limit the spread of the novel coronavirus disease-2019 (COVID-19). No studies have examined the influence of various factors on adherence to COVID-19 preventive measures. Among individuals with co-morbidities, such as cardiovascular disease (CVD) and residing in rural communities, adherence is essential as they are at an increased risk of COVID-19 infection and increased disease severity. Objective: This study aims to explore factors influencing adherence to evidence-based recommendations for preventing COVID-19 among patients/family caregivers with CVD in rural Central Appalachia. Methods: During March-April 2020, 102 CVD Stakeholders-patients/family caregivers, community leaders, and providers from six states across Appalachia participated in a survey administered through RED Cap. This study used a subsample (n=73) that excluded providers. Adherence score was defined as the rate of compliance with health authorities' guidelines, including hand washing, physical distancing, staying home if sick, wearing a face mask, disinfecting and cleaning daily, and cough and sneezing etiquette. Simple and multiple linear regressions were performed to examine associations between adherence scores and variables of interest. Results: Over half (53.42%) of participants complied with all guidelines. Gender, employmentstatus, hypertension, smoking, no insurance, getting information about COVID-19 from Government/CDC website, and getting information about COVID-19 from worship place/club were significantly associated with adherence to CDC recommendations (p<0.05). Compared to lowpersonal perception of threat (PPT), having no and high PPT were associated with lower and higheradherence scores, respectively (β=-2.32, 1.42;p=0.001). Compared to low perception of COVID-19threat towards family/friends, having moderate or high perception of COVID-19 threat to wardfamily/friends was associated with improved adherence (β= 1.3, 1.57;p<0.05 for both), whereashaving no perception was negatively associated with adherence (β=-2.08, p=0.003). Moderate and high perception of COVID-19 threat toward one's community (β= 2.14, 2.06;p<0.001) were like wiseassociated with higher adherence. R squared for the model= 0.459. Conclusion: Moderate and high perceptions of COVID-19 threats are associated with higheradherence, whereas no perception was associated with lower adherence with health authority recommendations for COVID-19 prevention. These factors should be considered in order to developeffective adherence interventions for CVD stakeholders in rural communities. Results should beconfirmed in a larger study.