Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

Joanne McPeake; Martin Shaw; Theodore J Iwashyna; Malcolm Daniel; Helen Devine; Lyndsey Jarvie; John Kinsella; Pamela MacTavish; Tara Quasim

doi:10.1371/journal.pone.0188028

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

PLoS One. 2017 Nov 29;12(11):e0188028. doi: 10.1371/journal.pone.0188028. eCollection 2017.

Authors

Joanne McPeake^{1

2}, Martin Shaw^{1

3}, Theodore J Iwashyna^{4

5}, Malcolm Daniel², Helen Devine², Lyndsey Jarvie², John Kinsella^{1

2}, Pamela MacTavish¹, Tara Quasim^{1

2}

Affiliations

¹ University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom.
² NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom.
³ NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Clinical Physics Department, Glasgow, Scotland, United Kingdom.
⁴ Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan, United States of America.
⁵ Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America.

Abstract

Background: Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors.

Methods: Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008-2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID.

Results: 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07-0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15).

Conclusions and relevance: This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.

MeSH terms

Adult
Critical Care*
Employment*
Female
Humans
Male
Middle Aged
Patient Discharge
Quality of Life
Return to Work*
Self Efficacy

Grants and funding

JMcP is supported by a CNO Scotland Fellowship and the Health Foundation. TJI's work was supported, in part, by US Department of Veterans Affairs, Health Services Research & Development, IIR 13-079. MD, HD, PMacT, JK and TQ are supported by the Health Foundation. This study does not necessarily represent the official views of the US Government or Department of Veterans Affairs. The Health Foundation is a charitable organisation. They had no role in the design, collection, analysis, interpretation of data or in the writing of this manuscript. They had no role in the decision to submit the manuscript for publication.