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Table 1 Rehabilitation post-critical illness: overview of programmes post-hospital discharge

From: Exercise rehabilitation following hospital discharge in survivors of critical illness: an integrative review

    Intervention    
Study and status Design (sample) Location/commenced/duration Exercise component description Participant contact Assessments Outcome
Jones et al. 2003 [37]; study complete Multi-centre RCT
(n = 126)
Home-based/in hospital post-ICU discharge/6 weeks Unsupervised, patient-directed home-based Three phone calls during intervention period Baseline, 8/52 and 6/12 post-hospital discharge Significant improvements in SF-36 PF in intervention group compared to control at 8/52 and 6/12 (P = 0.006), with a trend towards lower rates of depression at 8/52 (12% versus 25%)
    Printed rehabilitation manual, focus on exercise and psychosocial function   Assessor and patients blind to randomisation  
      Exercise capacity measured by SF-36 PF domain  
Denehy et al. 2008 [35]a; protocol Single-centre RCT
(n = 150)
Hospital out-patient and home-based/within 2 weeks post-hospital discharge/8 weeks Individualised exercise programmeb with functional, resistance and aerobic components; unsupervised home walking programme Minimum two (of three) supervised sessions/week in-class format Baseline, 3, 6 and 12/12 post-hospital discharge Recruitment complete
    Instruction sheet focusing on HRQL and physical function   Assessor blind to randomisation Results not available
      Exercise capacity measured by 6MWT, TUG, SF-36 PF  
Danjoux et al. [40]; protocol Multi-centre, parallel group RCT
(n = 64)
Location unspecified/8 to 16 weeks post-hospital discharge Supervised exercise sessions/8 weeks duration Two supervised 40-minute exercise sessions and one unsupervised (40 minute brisk walk) session per week Baseline, week 9, week 26 Recruitment complete
      Exercise capacity measured by anaerobic threshold Results not available
Connolly et al. 2009 [39]; protocol Dual-centre RCT
(n = 148)
Hospital out-patient and home-based/within two weeks post-hospital discharge/16 session duration (each session comprises education and exercise) Focus on exercise capacity and HRQL Two supervised 40-minute exercise sessions in class format. Up to three unsupervised sessions per week Baseline and three months Recruitment ongoing
    Individualised exercise programme of cardiovascular and upper and lower limb strength training   Assessor non-blind to randomisation Results not available
    Home exercise diary to accompany exercise advice   Exercise capacity measured by ISWT, 6MWT, SF-36 PF  
McWilliams et al. 2009 [44]; study complete Non- randomised, uncontrolled
(n = 38)
Out-patient and home-based/up to three weeks post-hospital discharge/6 weeks duration Each session comprised exercise and education, with interval approachd One supervised 20-minute session per week. Two unsupervised 20-minute sessions per weeke 1/52 prior and 1/52 post-programme Significant improvements in exercise capacity (ISWT median improvement 160 m, P < 0.001, 6MWT median improvement 160 m, P < 0.001) and anxiety and depression (P = 0.001)
    Home exercise diary accompanied exercise advice, focus on exercise capacity and anxiety/depression   Assessor non-blinded to randomisation  
      Exercise capacity measured by ISWT and 6MWT  
Cuthbertson et al. 2009 [38]; study complete Multi-centre RCT
(n = 286)
In hospital/continuing at home post-hospital discharge/3 months Manual-based physical rehabilitation programme, focus on HRQL Self-directed physical rehabilitation programme Baseline, 6 and 12/12 No significant differences in SF-36 (physical (P = 0.46) or mental function domain (P = 0.83)) at 12/12. Intervention significantly more costly
      Assessor blinded to randomisation  
Griffiths et al. 2010 [42]f; protocol Dual-centre RCT
(n = 180)
Outpatient and home-based/in hospital/3 months Enhanced physiotherapy programme One 1 hour supervised session, and two home exercise sessions per week Baseline, 3/12 post-intensive care discharge Recruitment ongoing
      Outcomes assessor blinded to randomization Results not available
      Exercise capacity measured using 6MWT  
Elliott et al. 2011 [41]; study complete Multi-centre RCT
(n = 183)
Home-based/1 week post-hospital discharge/8 weeks Graded, individualised programme of walking, upper and lower limb strengthening, core stabilisation, flexibility and stretches; up to 5 sessions per week un-supervised, of 20 to 30 minutes duration Three home visits with supervised sessions of 60 to 90 minutesg, and five phone call follow-ups monitoring progress and to revise exercise prescription Baseline, 8/52 and 26/52 Non-significant improvements in 6MWT and SF-36 PF domain at 8/52 and 26/52
    Exercise manual accompanied exercise advice, focus on endurance and strength training   Assessor blind to randomization  
      Exercise capacity measured by 6MWT and SF-36 PF  
O'Neill et al 2011 [45]; protocol. Multi-centre RCT
(n = 68)
Outpatient and home-based/post-hospital discharge, exact time-frame not specified/6 weeks Warm-up, exercise circuit, aerobic exercise, cool down Two supervised and one unsupervised exercise session per week Baseline, 6/52; secondary measures also at 6/12 Recruitment not yet commenced
    Accompanying written exercise manual   Physical function measured using SF-36 PF subscale Results not available
Jackson et al 2012 [43]; study complete Single-centre RCT
(n = 21)
Home-based/post-hospital discharge, exact time-frame not specified/12 weeks Primarily targeted to lower extremity function and endurance Six televideo visits and six motivational telephone calls Baseline, 3/12 Significant improvement in cognitive executive functioning (P < 0.01) and functional status (P = 0.04)
    Exercise prescription tailored to individual functional status Unsupervised exercise in Interim Physical function measured using TUG Non-significant improvement in TUG(P = 0.51)
  1. aStudy also includes rehabilitation within ICU and on ward; detail of post-hospital discharge stage only reported. bExercise intensity set using Borg score and 6MWT distance. Exercise prescription determined on results of submaximal cycling or walking tests. cExercise intensity set using Borg score and ISWT distance. Exercise prescription based on ISWT and 80% 10RM. dInterval approach - alternating cardiovascular exercise involving all major muscle groups and active recovery. eExercise intensity set according to four defined levels of varying ratios between cardiovascular exercise and active recovery. Exercise prescription based on target heart rate and Borg score. fStudy also includes rehabilitation in hospital; detail of post-hospital discharge stage only reported. gExercise intensity set using 6MWT distance and Borg score. Exercise prescription based on results of 6MWT and 8RM. 6MWT, six minute walk test; HRQL, health-related quality of life; ISWT, incremental shuttle walk test; PF, physical function; RCT, randomised, controlled trial; RM, repetition maximum; SF-36, Short-Form 36; TUG, Timed Up And Go.