TY - JOUR
T1 - Barriers and Facilitators to Early Rehabilitation in the ICU
T2 - A Theory Driven Delphi Study
AU - Cuthbertson, Brian H.
AU - Goddard, Shannon L.
AU - Lorencatto, Fabiana
AU - Koo, Ellen
AU - Rose, Louise
AU - Fan, Eddy
AU - Kho, Michelle E.
AU - Needham, Dale M.
AU - Rubenfeld, Gordon D.
AU - Francis, Jill J.
N1 - Funding Information:
Dr. Goddard’s institution received funding from the Canadian Institutes of Health Research. Dr. Lorencatto’s institution received funding from Sunnybrook Health Sciences Centre. Dr. Kho disclosed that she holds a Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation and leads a research program in critical care rehabilitation. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Objectives: There is conflicting evidence for the effectiveness of early rehabilitation in the intensive care and marked variation in rates of implementation in practice. We aimed to identify barriers and facilitators to early rehabilitation in mechanically ventilated patients and their relevance to practice, as perceived by key ICU clinicians across North America. Design: A Delphi study using the Theoretical Domains Framework, consisting of an initial qualitative round and subsequent quantitative rounds, was conducted to gather clinician agreement and perceived importance of barriers and facilitators to early rehabilitation. The survey included questions on the range of individual, sociocultural, and broader organizational influence on behaviors. Setting: Clinical practice in North America. Subjects: Four clinician groups (intensive care physicians, nurses, therapists, and respiratory therapists). Interventions: A three-round Delphi study. Measurements and Main Results: Fifty of 74 (67%) of invited clinicians completed the study. Agreement and consensus with Delphi survey items were high in both rounds within and between professional groups. Agreement was highest for items related to the domain "Beliefs about Consequences"(e.g., mortality reduction) and lowest for items related to the domain "Behavioral Regulation"(e.g., team discussion of barriers). Beliefs expressed about improved mortality and improvements in a variety of other long-term outcomes were not consistent with the current evidence base. Individual agreement scores changed very little from Round 2 to Round 3 of the Delphi, suggesting stability of beliefs and existing consensus. Conclusions: This study identified a wide range of beliefs about early rehabilitation that may influence provider behavior and the success and appropriateness of further implementation. The apparent inconsistency between the optimism of stakeholders regarding mortality reductions and a low level of implementation reported elsewhere represent the most major challenge to future implementation success. Other foci for future implementation work include planning, barriers, feedback, and education of staff.
AB - Objectives: There is conflicting evidence for the effectiveness of early rehabilitation in the intensive care and marked variation in rates of implementation in practice. We aimed to identify barriers and facilitators to early rehabilitation in mechanically ventilated patients and their relevance to practice, as perceived by key ICU clinicians across North America. Design: A Delphi study using the Theoretical Domains Framework, consisting of an initial qualitative round and subsequent quantitative rounds, was conducted to gather clinician agreement and perceived importance of barriers and facilitators to early rehabilitation. The survey included questions on the range of individual, sociocultural, and broader organizational influence on behaviors. Setting: Clinical practice in North America. Subjects: Four clinician groups (intensive care physicians, nurses, therapists, and respiratory therapists). Interventions: A three-round Delphi study. Measurements and Main Results: Fifty of 74 (67%) of invited clinicians completed the study. Agreement and consensus with Delphi survey items were high in both rounds within and between professional groups. Agreement was highest for items related to the domain "Beliefs about Consequences"(e.g., mortality reduction) and lowest for items related to the domain "Behavioral Regulation"(e.g., team discussion of barriers). Beliefs expressed about improved mortality and improvements in a variety of other long-term outcomes were not consistent with the current evidence base. Individual agreement scores changed very little from Round 2 to Round 3 of the Delphi, suggesting stability of beliefs and existing consensus. Conclusions: This study identified a wide range of beliefs about early rehabilitation that may influence provider behavior and the success and appropriateness of further implementation. The apparent inconsistency between the optimism of stakeholders regarding mortality reductions and a low level of implementation reported elsewhere represent the most major challenge to future implementation success. Other foci for future implementation work include planning, barriers, feedback, and education of staff.
KW - critical illness
KW - health personnel
KW - intensive care
KW - qualitative research
KW - quality improvement
KW - rehabilitation
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UR - http://www.scopus.com/inward/citedby.url?scp=85097003110&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000004580
DO - 10.1097/CCM.0000000000004580
M3 - Article
C2 - 33003076
AN - SCOPUS:85097003110
SN - 0090-3493
VL - 48
SP - E1171-E1178
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -