Occupational therapy is emerging as one of the components of early rehabilitation for patients in intensive care units (ICUs).
Purpose:
This study aimed to explore the lived experience of mechanically ventilated patients participating in an occupation-based intervention, delivered in an ICU by occupational therapists.
Method:
Interpretative description methodology guided a qualitative study of participants in the intervention group of a single site randomised controlled feasibility trial (EFFORT-ICU). Semi-structured interviews were completed with 11 participants at 90-day post-randomisation. Data were analysed using reflexive thematic analysis.
Results:
Three themes emerged from the data including (1) relationships with health professionals, (2) mastery of self through participation in daily occupations and (3) the journey of recovery. Participants perceived early engagement in therapy as positive.
Conclusion:
Participation in early occupation-based therapy, incorporating activities such as grooming and selfcare, was considered beneficial by patients who perceived it had a positive impact on their recovery and the experience of an ICU admission. The results support the contribution of the occupational therapist in ICUs in contributing to humanising care and enhancing longer-term outcomes of patients and highlight the importance of collaboration with families.
ÁlvarezEAGarridoMATobarEA, et al. (2017) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. Journal of Critical Care37: 85–90.
Bani HaniDAAlshraidehJAAlshraidehB (2022) Patients’ experiences in the intensive care unit in Jordan: A cross-sectional study. Nursing Forum57: 49–55.
4.
BohartSLamprechtCAndreasenAS, et al. (2023) Perspectives and wishes for patient and family centred care as expressed by adult intensive care survivors and family-members: A qualitative interview study. Intensive and Critical Care Nursing75: 103346.
5.
BoykoYJennumPNikolicM, et al. (2017, February) Sleep in intensive care unit: The role of environment. Journal of Critical Care37: 99–105.
6.
BraunVClarkeV (2012) Thematic analysis. In: CooperH (ed.) APA Handbook of Research Methods in Psychology, vol. 2. Washington: American Psychological Association, pp.57–71.
7.
CorcoranJRHerbsmanJMBushnikT, et al. (2017) Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: An interprofessional performance improvement project. Physical Medicine and Rehabilitation9: 113–119.
8.
CornerEJMurrayEJBrettSJ (2019) Qualitative, grounded theory exploration of patients’ experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open9: e026348.
9.
HodgsonCLBaileyMBellomoR, et al. (2016, June) A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Critical Care Medicine44: 1145–1152.
10.
JubranAGrantBJBDuffnerLA, et al. (2019) Long-term outcome after prolonged mechanical ventilation. A long-term acute-care hospital study. American Journal of Respiratory and Critical Care Medicine199: 1508–1516.
11.
LaerknerEEgerodIOlesenF, et al. (2019, June) Negotiated mobilisation: An ethnographic exploration of nurse-patient interactions in an intensive care unit. Journal of Clinical Nursing28: 2329–2339.
12.
LordRKMayhewCRKorupoluR, et al. (2013, March) ICU early physical rehabilitation programs: financial modeling of cost savings. Critical Care Medicine41: 717–724.
13.
MeriläinenMKyngäsHAla-KokkoT (2010) 24-hour intensive care: An observational study of an environment and events. Intensive and Critical Care Nursing26: 246–253.
14.
OlsenKDNesterMHansenBS (2017, December) Evaluating the past to improve the future – A qualitative study of ICU patients’ experiences. Intensive and Critical Care Nursing43: 61–67.
15.
RamnarainDAupersEden OudstenB, et al. (2021) Post intensive care syndrome (PICS): An overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Review of Neurotherapeutics21: 1159–1177.
16.
Rapolthy-BeckAFlemingJTurpinM, et al. (2021, February18) A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: Study protocol for a single site feasibility trial (EFFORT-ICU). Pilot and Feasibility Studies7: 51.
17.
Rapolthy-BeckAFlemingJTurpinM, et al. (2023) Efficacy of Early Enhanced Occupational Therapy in an Intensive Care Unit (EFFORT-ICU): A single-site feasibility trial. The American Journal of Occupational Therapy77: 7706205110.
18.
RattrayJCrockerCJonesM, et al. (2010) Patients’ perceptions of and emotional outcome after intensive care: results from a multicentre study. Nursing in Critical Care15: 86–93.
19.
RengelKFHayhurstCJPandharipandePP, et al. (2019) Long-term cognitive and functional impairments after critical illness. Anesthesia & Analgesia128: 772–780.
20.
RyanRMDeciEL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist55: 68–78.
Schofield-RobinsonOJLewisSRSmithAF, et al. (2018) Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database of Systematic Reviews11: CD012701.
23.
SottilePDNordon-CraftAMaloneD, et al. (2015, October) Patient and family perceptions of physical therapy in the medical intensive care unit. Journal of Critical Care30: 891–895.
24.
ThorneS (2016) Interpretive Description: Qualitative Research for Applied Practice (2nd ed.). Routledge.
25.
TongASainsburyPCraigJ (2007, December) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal of Quality in Health Care19: 349–357.
26.
TronstadOFlawsDLyeI, et al. (2021) Doing time in an Australian ICU; the experience and environment from the perspective of patients and family members. Australian Critical Care34: 254–262.
27.
TurnerBFlemingJOwnsworthT, et al. (2011) Perceptions of recovery during the early transition phase from hospital to home following acquired brain injury: A journey of discovery. Neuropsychology Rehabilitation21: 64–91.
28.
van WilligenZOstlerCThackrayD, et al. (2020) Patient and family experience of physical rehabilitation on the intensive care unit: A qualitative exploration. Physiotherapy109: 102–110.
29.
WilliamsTAHoKMDobbGJ, et al. (2010) Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. British Journal of Anaesthesia104: 459–464.
