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

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02209935.

Figure 1.

Services included in existing PICU-based rehabilitation guidelines. BH = behavioral health; OT = occupational therapy; PT = physical therapy; RT = respiratory therapy; SLT = speech/language therapy

Figure 2.

PICU-based rehabilitation services consultation and timing of initiation in case examples

Figure 3.

Services respondents believed should ideally make up an PICU-based rehabilitation team. AM = alternative medicine; BH = behavioral health; NP/PA = nurse practitioner/physician assistant; OT = occupational therapy; PM&R = physical medicine & rehabilitation physician; PT = physical therapy; RT = respiratory therapy; SLT = speech/language therapy; SP = supportive/palliative service

Figure 4.

Factors impeding provision of PICU-based rehabilitation services.

Figure 5.

Disciplines that participate in PICU Follow-up Clinics. BH = behavioral health; DP = developmental pediatrics; GP = general pediatrics; GS = general surgery; OT = occupational therapy; PICU = pediatric intensive care unit; PM&R = physical medicine & rehabilitation physician; PT = physical therapy; RT = respiratory therapy; SLT = speech/language therapy; SW = social work

Figure 6.

Health domains that respondents rated as first, second, or third importance that should be universally assessed and treated to optimize recovery from critical illness, assuming patient survival.