EMPOWER: A pilot project of outpatient rehabilitation classes to address the symptoms of Post Intensive Care Syndrome (PICS)

ABSTRACT

Introduction: The EMPOWER (Early Mobilisation PrOject With Extended Rehabilitation) classes at University Hospital Southampton (UHS) originated in direct response to patient voice. During an interview study exploring patient and family experience of rehabilitation on ICU,1 the wife of an ICU patient stated There was no point in spending all of that money on keeping him alive if you're not gonna get him better. He's alive, but he's not functioning Objective: To explore if post ICU outpatient rehabilitation classes can be effective in addressing symptoms of PICS, for patients previously admitted to critical care at UHS. Methods: Funding was obtained to trial a pilot project of 8 classes over 8 weeks, starting in September 2019. Due to time constraints, original inclusion criteria were abolished and instead a convenience sample of 8 patients were selected, along with a relative if desired. Design was a 3-hour class, once a week, in a small gym venue within an acute hospital setting. Patient transport costs were covered, as had previously been highlighted as an incentive to participation in other studies.2 During the first hour of the class, former ICU patients completed an exercise circuit, while their relatives attended a separate peer support session, facilitated by experienced ICU volunteers. The second hour was an education session, provided by an ICU healthcare professional (e.g., dietitian, occupational therapist). The final hour was for peer support and goal setting. One participant withdrew from the pilot following the first week and was signposted elsewhere. The demographic details for the remaining 7 participants represent are included in Table 1. In addition, four female relatives also participated and evaluated the pilot. Results: Outcome measures reflected the physical, cognitive and psychological domains of PICS. These were collected from assessments at week 1 and week 8, and the mean results are presented in Table 2. In addition, qualitative data was collected before and after the 8-week course. Examples of quotes from participants at the start of the pilot include I have reduced my working hours to spend more time at home with her I feel dreadful. I'm not getting better. I lose words midsentence, and have memory problems Feedback following the pilot was very positive. One participant reported It's been a safe space for me, as a 'carer', to express my fears and concerns and to get help, advice and support from people who really understand the issues of post-ICU recovery. Our GP practice really doesn't seem to provide any after-care/ follow up care for this. Conclusion: In this small pilot project of post ICU outpatient rehabilitation classes, all outcome measures improved despite participant heterogeneity. Patient/ relative satisfaction for the classes was high. Wehave since managed to secure £30k through the Q Exchange to continue the work of EMPOWER following the COVID-19 pandemic.