title: Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge.
abstract: BACKGROUND
  The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?
  
  
  METHODS
  A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5.
  
  
  RESULTS
  Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed.
  
  
  CONCLUSIONS
  A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.
authors: ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.|European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
authors: M E
authors: ME
authors: Major
authors: ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
authors: R
authors: R
authors: Kwakman
authors: McMaster University, School of Rehabilitation Science, Hamilton, Canada.
authors: M E
authors: ME
authors: Kho
authors: Guy's & St Thomas' NHS Foundation Trust and King's College London, Lane Fox Clinical Respiratory Physiology Research Unit, London, UK.
authors: B
authors: B
authors: Connolly
authors: University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Therapy Services, Birmingham, UK.
authors: D
authors: D
authors: McWilliams
authors: The University of Melbourne, Department of Physiotherapy, Melbourne, Australia.
authors: L
authors: L
authors: Denehy
authors: Stellenbosch University, Physiotherapy Division, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
authors: S
authors: S
authors: Hanekom
authors: The University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia.
authors: S
authors: S
authors: Patman
authors: KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
authors: R
authors: R
authors: Gosselink
authors: University of Liverpool, Musculoskeletal Biology, Institute of Ageing & Chronic Disease, Liverpool, UK.
authors: C
authors: C
authors: Jones
authors: Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
authors: F
authors: F
authors: Nollet
authors: Johns Hopkins University Baltimore, Outcomes after Critical Illness and Surgery Group, Baltimore, USA.|Johns Hopkins University School of Medicine Division of Pulmonary and Critical Care Medicine, Baltimore, USA.|Johns Hopkins University School of Medicine Baltimore, Department of Physical Medicine and Rehabilitation, Baltimore, USA.
authors: D M
authors: DM
authors: Needham
authors: ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.|Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
authors: R H H
authors: RH
authors: Engelbert
authors: ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands. m.vanderschaaf@amc.uva.nl.|Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD, Amsterdam, The Netherlands. m.vanderschaaf@amc.uva.nl.
authors: M
authors: M
authors: van der Schaaf
mesh_terms: D000203:Activities of Daily Living; D032921:Consensus; D016638:Critical Illness / Q000534:rehabilitation*; D003697:Delphi Technique; D006801:Humans; D010351:Patient Discharge / Q000639:trends; D026741:Physical Therapy Modalities / Q000592:standards*; D012046:Rehabilitation / Q000379:methods* / Q000592:standards; D017741:Survivors
keywords: Consensus statement; Critical illness; Intensive care; Physical therapy; Post-intensive care syndrome; Rehabilitation