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Cited by 318Intensive Care Unit Cognitive DisordersMedical Practices and RehabilitationTraumatic Brain Injury Research

Cognitive and physical rehabilitation of intensive care unit survivors: Results of the RETURN randomized controlled pilot investigation*

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Jackson, James C., Ely, E. Wesley, Morey, Miriam C., Anderson, Venice M., Denne, Laural B., Clune, Jennifer, Siebert, Carol S., Archer, Kristin R. +10 more·2012·Critical Care Medicine
DOI 10.1097/ccm.0b013e3182373115PMC PMC3755871
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Abstract

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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  • Three studies, one RCT and two observational studies, evaluated early post-hospital follow-up in patients with critical illness.

    “Three studies, one RCT (628) and two observational studies (629, 630) evaluated early post-hospital follow-up in patients with critical illness.”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [630]

  • Ethics consultation did not result in a reduction in ICU stay, hospital stay, or life-sustaining treatments in patients who did not survive to discharge.

    “Ethics consultation did not result in a reduction in ICU stay, hospital stay, or life-sustaining treatments in patients who did not survive to discharge.”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [542]

    The Results (Participants; page unavailable) compare ICU hospitalization and ventilation duration between rehabilitation groups, not ethics-consultation groups. Searches for ethics consultation and life-sustaining treatment among patients who did not survive to discharge found no passage addressing the claim. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Neither study demonstrated an effect of interventions on mortality.

    “Neither study demonstrated an effect of interventions on mortality.”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [542]

    The Methods (Outcome Measures; page unavailable) list cognitive, physical, and daily functioning outcomes, while the Results (Participants; page unavailable) report withdrawals and an adverse event, not mortality effects. A search for mortality, deaths, and survival found no intervention–control mortality comparison in this paper; it also does not report the outcomes of two studies on that measure. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • A feasibility pilot RCT in general medical/surgical ICU survivors found improved executive functioning at 3 months with combined in-home cognitive, physical, and functional rehabilitation after discharge.

    “A feasibility, pilot, randomised trial in general medical/surgical ICU survivors comparing usual care to an intervention of combined in-home cognitive, physical, and functional rehabilitation following discharge showed improved executive functioning at 3 months [633].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [633]

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Research works printed but not linked: 5

  1. [11]Lezak MD Neuropsychological Assessment 3 New York Oxford University Press 1995
  2. [20]Rehabiliation after Critical Illness National Institute for Health and Clinical Excellence Guideline 83 2009 20704055
  3. [46]Lezak MD Neuropsychological Assessment 3 New York Oxford University Press 1995
  4. [47]Spreen O Strauss E A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary 2 New York Oxford University Press 1998
  5. [68]Colcombe S Kramer AF Fitness effects on the cognitive function of older adults: a meta-analytic study Psychol Sci 2003 14 125 130 12661673

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Authors
Jackson, J. C., Ely, E. W., Morey, M. C., Anderson, V. M., Denne, L. B., Clune, J., Siebert, C. S., Archer, K. R., Torres, R., Janz, D., Schiro, E., Jones, J., Shintani, A. K., Levine, B., Pun, B. T., Thompson, J., Brummel, N. E., & Hoenig, H.
Affiliations
  • Vanderbilt University Medical Center (US)
  • Duke University (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-04
Volume
40
Issue
4
Pages
1088-1097
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e3182373115
PMC
PMC3755871
OpenAlex
W2022518136
Semantic Scholar
5006c650bfa9cf34e2da5f3148ecd9d0817491bd
Cited by
318
References
71
Citations by year
2026: 22 · 2025: 21 · 2024: 24 · 2023: 14 · 2022: 17 · 2021: 26 · 2020: 23 · 2019: 24 · 2018: 19 · 2017: 24 · 2016: 30 · 2015: 20 · 2014: 16 · 2013: 21 · 2012: 16
FWCI
13.66
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Public Health Service (RRDE3386R)
  • National Institute on Aging (AG028716, K23AG031322, R01AG027472, P30AG028716)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
intensive care unit survivors, cognitive rehabilitation, physical rehabilitation, functional rehabilitation, telerehabilitation, home-based rehabilitation, executive function, cognitive impairment, functional disability, social workers, telemedicine, multidisciplinary care, post-intensive care syndrome, feasibility
MeSH terms
Activities of Daily Living, Adult, Aged, Cognition Disorders, Critical Care, Exercise Therapy, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Occupational Therapy, Pilot Projects, Critical Illness, Treatment Outcome, Telemedicine, Survivors

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