Table 3 Future research demands categorized by the three domains of impairment: physical rehabilitation, cognitive rehabilitation, and psychological rehabilitation
From: Guideline on multimodal rehabilitation for patients with post-intensive care syndrome
Diagnosis of PICS |
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Which combination and timing of assessments are most valid, reliable, and feasible for detection, report and evaluation of different symptoms of PICS in patients who survive critical illness? |
Rehabilitation of physical health |
Early mobilization Which patients require what type of early mobilization, and how should its intensity be adapted during rehabilitation? What impact does early rehabilitation have on long-term outcomes? Does early mobilization prevent or reduce specific symptoms of PICS? What is the impact of pre-existing frailty on long-term outcome after discharge from ICU? |
Physical therapy What length and frequency of interventions (i.e. strength training etc.) optimize potential effects? Is device-assisted physical therapy (i.e. wheelchair cycle ergometers, electrical stimulation etc.) effective for specific subgroups of patients with PICS? |
Speech-Language-Therapy Do interventions, such as swallowing assessments, FEES, tracheostomy tube management, swallowing therapy lead to improvements of physical symptoms typical for PICS such as diminished coordination of respiration, swallowing and coughing, and/or swallowing function? |
Rehabilitation of cognitive health |
Cognitive therapy Do cognitive therapies (training of attention, computer-based training psychoeducation, virtual reality, goal management training) improve attention, memory, and executive functions in patients with PICS and those at risk for PICS? |
Non-pharmacological delirium prevention and therapy Effect of non-pharmacological interventions (i.e. stress reduction, pain reduction, reduction of sleep deprivation) versus standard or no therapy on cognitive functions or reduction of cognitive PICS symptoms, activities, and participation |
Pharmacological delirium prevention and therapy Effects of pharmacological interventions vs standard or no therapy on delirium reduction regarding incidence, duration, and cognitive outcome |
Rehabilitation of psychological health |
Psychotherapy:When does psychotherapy improve psychological symptoms typical for PICS such as anxiety, depression, and traumatization? |
ICU-diary When is the best time to read diaries, how to reach non-responders/patients who avoid reading their diary, and is there a different impact of diaries written by families compared to those written by healthcare professionals |