title: Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness.
abstract: BACKGROUND
  Survivors of critical illness can experience long-standing functional limitations that negatively affect their health-related quality of life. To date, no model of rehabilitation has demonstrated sustained improvements in physical function for survivors of critical illness beyond hospital discharge.
  
  
  OBJECTIVE
  The aims of this study were: (1) to describe a model of rehabilitation for survivors of critical illness, (2) to compare the model to local standard care, and (3) to report the safety and feasibility of the program.
  
  
  METHODS
  This was a cohort study.
  
  
  METHODS
  As part of a larger randomized controlled trial, 74 participants were randomly assigned, 5 days following admission to the intensive care unit (ICU), to a protocolized rehabilitation program that commenced in the ICU and continued on the acute care ward and for a further 8 weeks following hospital discharge as an outpatient program. Exercise training was prescribed based on quantitative outcome measures to achieve a physiological training response.
  
  
  RESULTS
  During acute hospitalization, 60% of exercise sessions were able to be delivered. The most frequently occurring barriers to exercise were patient safety and patient refusal due to fatigue. Point prevalence data showed patients were mobilized more often and for longer periods compared with standard care. Outpatient classes were poorly attended, with only 41% of the patients completing more than 70% of outpatient classes. No adverse events occurred.
  
  
  CONCLUSIONS
  Limitations included patient heterogeneity and delayed commencement of exercise in the ICU due to issues of consent and recruitment.
  
  
  CONCLUSIONS
  Exercise training that commences in the ICU and continues through to an outpatient program is safe and feasible for survivors of critical illness. Models of care that maximize patient participation across the continuum of care warrant further investigation.
authors.affiliation: BPhysiotherapy, Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia. sue.berney@austin.org.au
authors.forename: Sue
authors.initials: S
authors.lastname: Berney
authors.forename: Kimberley
authors.initials: K
authors.lastname: Haines
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Skinner
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
mesh_terms: D000553:Ambulatory Care; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003266:Continuity of Patient Care; D016638:Critical Illness / Q000534:rehabilitation*; D015444:Exercise; D005080:Exercise Test; D005221:Fatigue / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge; D061214:Patient Safety; D010360:Patient Transfer; D026741:Physical Therapy Modalities; D017741:Survivors