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document
Cognitive and physical rehabilitation of intensive care unit survivors : results of the RETURN randomized controlled pilot investigation . BACKGROUND Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities . To overcome the current reality in which patients receive inadequate rehabilitation , we devised a multifaceted , in-home , telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes . METHODS This was a single-site , feasibility , pilot , randomized trial of 21 general medical/surgical intensive care unit survivors ( 8 controls and 13 intervention patients ) with either cognitive or functional impairment at hospital discharge . After discharge , study controls received usual care ( sporadic rehabilitation ) , whereas intervention patients received a combination of in-home cognitive , physical , and functional rehabilitation over a 3-month period via a social worker or master 's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment . Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation . Outcomes were measured at the completion of the rehabilitation program ( i.e. , at 3 months ) , with cognitive functioning as the primary outcome . Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores . RESULTS Patients tolerated the program with only one adverse event reported . At baseline both groups were well-matched . At 3-month follow-up , intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test ( for planning and strategic thinking ) vs. controls ( median [ interquartile range ] , 13.0 [ 11.5-14.0 ] vs. 7.5 [ 4.0-8.5 ] ; adjusted p < .01 ) . Intervention group patients also reported better performance ( i.e. , lower score ) on one of the most frequently used measures of functional status ( Functional Activities Questionnaire at 3 months vs. controls , 1.0 [ 0.0 -3.0 ] vs. 8.0 [ 6.0-11.8 ] , adjusted p = .04 ) . CONCLUSIONS A multicomponent rehabilitation program for intensive care unit survivors combining cognitive , physical , and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months . Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results , as well as to elucidate the elements of rehabilitation contributing most to improved outcomes .
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Intervention_Educational
Cognitive
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Intervention_Educational
physical rehabilitation
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Intervention_Educational
usual care ( sporadic rehabilitation )
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Intervention_Educational
in-home cognitive , physical , and functional rehabilitation
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Intervention_Educational
cognitive rehabilitation
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Intervention_Educational
physical/functional rehabilitation
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Intervention_Educational
rehabilitation
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Outcome_Mental
cognitive functioning
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Outcome_Other
tolerated
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Outcome_Other
improved
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Outcome_Mental
cognitive executive functioning
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Outcome_Mental
planning and strategic thinking
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Outcome_Mental
performance
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Outcome_Mental
Functional Activities Questionnaire
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Outcome_Other
feasible and possibly effective in improving
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Outcome_Mental
cognitive performance
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Outcome_Other
and
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Outcome_Mental
functional outcomes
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Participant_Condition
intensive care unit survivors
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Participant_Condition
survive medical and surgical general intensive care unit care
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Participant_Sample-size
21 general
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Participant_Sample-size
8
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Participant_Condition
intensive care unit survivors