Cuthbertson BH, Rattray J, Campbell MK, et al. PRaCTICaL Study Group The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: A pragmatic randomised controlled trial. BMJ. 339:b3723

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
BMJ (online) (Impact Factor: 17.45). 10/2009; 339(oct16 1):b3723. DOI: 10.1136/bmj.b3723
Source: PubMed


To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care.
A pragmatic, non-blinded, multicentre, randomised controlled trial.
Three UK hospitals (two teaching hospitals and one district general hospital).
286 patients aged >or=18 years were recruited after discharge from intensive care between September 2006 and October 2007.
Nurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed.
286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI -1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (-3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective.
A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.
ISRCTN 24294750.

Download full-text


Available from: John Norrie
    • "The return visit appeared to be significant in the quest for meaning, and 'feeling' the room and the experiences of the ICU stay again could be integrated into life in a true way (Storli and Lind, 2009). Written information concerning recovery is not enough to reduce after-care appointments or to improve HRQoL (Jones et al., 2004), and not even multidisciplinary ICU follow-up services are able to measure any increase in HRQoL (Cuthbertson et al., 2009), even though they were started during hospital stay and continued for 3 months. Not all patients were interested in the service, some because of geographical reasons and others because they now felt well (Schandl et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the symptoms seen in patients after discharge from an intensive care unit (ICU) and the follow-up programmes offered to help patients deal with the problems that arise after an ICU stay. An increasing number of people are discharged from an ICU to continued treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. A prolonged stay in an ICU is associated with stressful memories that have long-term physical, mental and social consequences for health-related quality of life. We therefore conducted a data search to identify the programmes that have attempted to cope with these consequences. Searches of six online databases were conducted in December 2013. Qualitative or quantitative, original, empirical studies on symptoms and consequences associated with ICU stay and the follow-up programmes offered were reviewed. Excluded were studies in ICU patients younger than 18 years published in languages other than Scandinavian or English. We analysed original empirical studies according to symptoms, consequences and follow-up programmes and added a category ‘new ideas’. This was done to identify any possible evolution in the programmes offered to patients after ICU care. The review of the literature and the critical analysis were summarized in a figure in order to join the different parts together into a logical, coherent whole. Patients discharged from an ICU are heterogeneous, with a wide array of physical, mental and social problems. They and their close relatives can benefit from returning together to the ICU or participating in follow-up programmes. Little is known about the specific effects of the different types of follow-up. ICU staff as well as other professionals should prepare patients and relatives for the fact that they may need various types of help for many months after discharge from the ICU, and an overview of national and local opportunities for help should be offered.
    No preview · Article · Feb 2015 · Nursing in Critical Care
  • Source
    • "These clinics were usually nurse-led with or without multi-professional input and with the broad aims of screening survivors for complications and providing or referring them to specialist services as necessary (Griffiths et al. 2006, Modrykamien 2012, Egerod et al. 2013). However, this model has not demonstrated tangible benefits (Cuthbertson et al. 2009) despite being well received by survivors and their families (Engstrom et al. 2008, Peterssen et al. 2011). The standardised provision of rehabilitation initiatives which address psychological and physical domains with the intention of improving longterm outcomes for survivors are still required (Rubenfeld 2007, Jackson et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims and objectivesTo critically appraise the available literature and summarise the evidence related to the use, prevalence, purpose and potential therapeutic benefits of intensive care unit diaries following survivors' discharge from hospital and identify areas for future exploration. Background Intensive care unit survivorship is increasing as are associated physical and psychological complications. These complications can impact on the quality of life of survivors and their families. Rehabilitation services for survivors have been sporadically implemented and lack an evidence base. Patient diaries in intensive care have been implemented in Scandinavia and Europe with the intention of filling memory gaps, enable survivors to set realistic recovery goals and cement their experiences in reality. DesignA review of original research articles. Methods The review used key terms and Boolean operators across a 34-year time frame in: CIHAHL, Medline, Scopus, Proquest, Informit and Google Scholar for research reports pertaining to the area of enquiry. Twenty-two original research articles met the inclusion criteria for this review. ResultsThe review concluded that diaries are prevalent in Scandinavia and parts of Europe but not elsewhere. The implementation and ongoing use of diaries is disparate and international guidelines to clarify this have been proposed. Evidence which demonstrates the potential of diaries in the reduction of the psychological complications following intensive care has recently emerged. Results from this review will inform future research in this area. Conclusions Further investigation is warranted to explore the potential benefits of diaries for survivors and improve the evidence base which is currently insufficient to inform practice. The exploration of prospective diarising in the recovery period for survivors is also justified. Relevance to clinical practiceIntensive care diaries are a cost effective intervention which may yield significant benefits to survivors.
    Full-text · Article · Dec 2014 · Journal of Clinical Nursing
  • Source
    • "It is also unclear what components should be included in post-hospital discharge rehabilitation. At the time of concept of this trial, studies evaluating post-hospital discharge rehabilitation following critical illness showed discordant results [11-14]. Jones and colleagues [11] conducted a randomised controlled trial comparing a rehabilitation manual, which included advice on psychological, psychosocial and physical problems and a self-directed exercise programme, to standard care. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Following discharge home from the ICU, patients often suffer from reduced physical function, exercise capacity, health-related quality of life and social functioning. There is usually no support to address these longer term problems, and there has been limited research carried out into interventions which could improve patient outcomes. The aim of this study is to investigate the effectiveness and cost-effectiveness of a 6-week programme of exercise on physical function in patients discharged from hospital following critical illness compared to standard care. The study design is a multicentre prospective phase II, allocation-concealed, assessor-blinded, randomised controlled clinical trial. Participants randomised to the intervention group will complete three exercise sessions per week (two sessions of supervised exercise and one unsupervised session) for 6 weeks. Supervised sessions will take place in a hospital gymnasium or, if this is not possible, in the participants home and the unsupervised session will take place at home. Blinded outcome assessment will be conducted at baseline after hospital discharge, following the exercise intervention, and at 6 months following baseline assessment (or equivalent time points for the standard care group). The primary outcome measure is physical function as measured by the physical functioning subscale of the Short-Form-36 health survey following the exercise programme. Secondary outcomes are health-related quality of life, exercise capacity, anxiety and depression, self efficacy to exercise and healthcare resource use. In addition, semi-structured interviews will be conducted to explore participants' perceptions of the exercise programme, and the feasibility (safety, practicality and acceptability) of providing the exercise programme will be assessed. A within-trial cost-utility analysis to assess the cost-effectiveness of the intervention compared to standard care will also be conducted. If the exercise programme is found to be effective, this study will improve outcomes that are meaningful to patients and their families. It will inform the design of a future multicentre phase III clinical trial of exercise following recovery from critical illness. It will provide useful information which will help the development of services for patients after critical illness.Trial registration: NCT01463579.
    Full-text · Article · Apr 2014 · Trials
Show more