Describing and measuring recovery and rehabilitation after critical illness.
OBJECTIVE
Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data.


RESULTS
The International Classification of Functioning, Disability and Health (ICF) model is a useful framework to guide selection of outcome measures representing physical function at the level of impairment, activity limitation and participation restriction. Clinimetric data are emerging to support a number of physical function outcome measures in the ICU, albeit further research is required to corroborate tools used beyond ICU discharge. Factors associated with outcome measure selection have contributed to interpreting findings from recent interventional trials of physical rehabilitation.


CONCLUSIONS
Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
aLane Fox Clinical Respiratory Physiology Research Unit, St. Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust bDivision of Asthma, Allergy and Lung Biology, King's College London, Guy's Hospital cGuy's & St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre, Tower Wing, Guy's Hospital, London, UK.
Bronwen
B
Connolly
D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D016638:Critical Illness / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D006801:Humans; D010348:Patient Care Team; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome