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Barriers to rehabilitation for intensive care unit survivors
Despite emerging awareness of Post Intensive Care Syndrome (PICS), there is lack of robust evidence on optimal rehabilitation strategies for ICU survivors. The precise timing of initiation, duration, frequency (dose) of early physical rehabilitation remains unclear. Studies that focus on psychological rehabilitation of ICU survivors are sparse and show mixed benefit.
There are multiple modifiable barriers to the ongoing rehabilitation of ICU survivors in acute care hospitals. Some of the barriers to in-hospital rehabilitation include:
A) Patient factors: delirium, weakness, frailty, physiological safety
B) Knowledge and skills: knowledge of PICS; general knowledge and skills around mobilisation; inadequate training and adherence to pain, agitation and delirium guidelines
C) Environment and resources: Inadequate staffing/equipment/space/funding
D) Behavioural: Lack of mobility champions, absence of protocol/medical order for mobilisation, lack of interprofessional communication
Addressing these barriers and investing in future research related to rehabilitation strategies may have benefits for the ongoing care of ICU survivors.