title: Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.
abstract: BACKGROUND
  Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes.
  
  
  METHODS
  This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores.
  
  
  RESULTS
  Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p < .01). Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently used measures of functional status (Functional Activities Questionnaire at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p = .04).
  
  
  CONCLUSIONS
  A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.
authors.affiliation: Department of Medicine, Center for Health Services Research, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. james.c.jackson@vanderbilt.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Morey
authors.forename: Venice M
authors.initials: VM
authors.lastname: Anderson
authors.forename: Laural B
authors.initials: LB
authors.lastname: Denne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Clune
authors.forename: Carol S
authors.initials: CS
authors.lastname: Siebert
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: Renee
authors.initials: R
authors.lastname: Torres
authors.forename: David
authors.initials: D
authors.lastname: Janz
authors.forename: Elena
authors.initials: E
authors.lastname: Schiro
authors.forename: Julie
authors.initials: J
authors.lastname: Jones
authors.forename: Ayumi K
authors.initials: AK
authors.lastname: Shintani
authors.forename: Brian
authors.initials: B
authors.lastname: Levine
authors.forename: Brenda T
authors.initials: BT
authors.lastname: Pun
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thompson
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Brummel
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation; D003422:Critical Care; D016638:Critical Illness / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009788:Occupational Therapy / Q000379:methods; D010865:Pilot Projects; D017741:Survivors; D017216:Telemedicine; D016896:Treatment Outcome
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