Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

Arch Phys Med Rehabil. 2019 Apr;100(4):703-710. doi: 10.1016/j.apmr.2018.11.017. Epub 2018 Dec 19.

Abstract

Objective(s): Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.

Design: Substudy of a data from Wee-Cover, a prospective cohort study.

Setting: Two PICU sites.

Participants: Caregivers (N=168) of children 1-17 years old admitted into a PICU for ≥48 hours.

Main outcome measures: Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child's participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child's participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a preexisting condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.

Results: History of a preexisting condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.

Conclusion(s): Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child's functioning post-PICU. Families of children with a preexisting condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services.

Trial registration: ClinicalTrials.gov NCT02148081.

Keywords: Critical care; Pediatrics; Rehabilitation.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Critical Illness / psychology
  • Critical Illness / rehabilitation*
  • Female
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Parents / psychology*
  • Patient Discharge
  • Patient Participation / methods*
  • Patient Participation / psychology
  • Prospective Studies
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology*
  • Time Factors
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02148081