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一项评估重症监护病房出院患者综合康复干预措施的随机对照试验:RECOVER研究。

A randomised controlled trial evaluating a rehabilitation complex intervention for patients following intensive care discharge: the RECOVER study.

作者信息

Walsh Timothy Simon, Salisbury Lisa G, Boyd Julia, Ramsay Pamela, Merriweather Judith, Huby Guro, Forbes John, Rattray Janice Z, Griffith David M, Mackenzie Simon J, Hull Alastair, Lewis Steff, Murray Gordon D

机构信息

Centre for Inflammation Research, Queens Medical Research Institute, Edinburgh, UK.

出版信息

BMJ Open. 2012 Jul 2;2(4). doi: 10.1136/bmjopen-2012-001475. Print 2012.

Abstract

INTRODUCTION

Patients who survive an intensive care unit admission frequently suffer physical and psychological morbidity for many months after discharge. Current rehabilitation pathways are often fragmented and little is known about the optimum method of promoting recovery. Many patients suffer reduced quality of life.

METHODS AND ANALYSIS

The authors plan a multicentre randomised parallel group complex intervention trial with concealment of group allocation from outcome assessors. Patients who required more than 48 h of mechanical ventilation and are deemed fit for intensive care unit discharge will be eligible. Patients with primary neurological diagnoses will be excluded. Participants will be randomised into one of the two groups: the intervention group will receive standard ward-based care delivered by the NHS service with additional treatment by a specifically trained generic rehabilitation assistant during ward stay and via telephone contact after hospital discharge and the control group will receive standard ward-based care delivered by the current NHS service. The intervention group will also receive additional information about their critical illness and access to a critical care physician. The total duration of the intervention will be from randomisation to 3 months postrandomisation. The total duration of follow-up will be 12 months from randomisation for both groups. The primary outcome will be the Rivermead Mobility Index at 3 months. Secondary outcomes will include measures of physical and psychological morbidity and function, quality of life and survival over a 12-month period. A health economic evaluation will also be undertaken. Groups will be compared in relation to primary and secondary outcomes; quantitative analyses will be supplemented by focus groups with patients, carers and healthcare workers.

ETHICS AND DISSEMINATION

Consent will be obtained from patients and relatives according to patient capacity. Data will be analysed according to a predefined analysis plan.

TRIAL REGISTRATION

The trial is registered as ISRCTN09412438 and funded by the Chief Scientist Office, Scotland.

摘要

引言

在重症监护病房接受治疗后存活下来的患者,出院后的数月内经常会出现身体和心理方面的疾病。目前的康复途径往往零散,对于促进康复的最佳方法知之甚少。许多患者的生活质量下降。

方法与分析

作者计划开展一项多中心随机平行组复杂干预试验,对结果评估者隐瞒分组情况。需要机械通气超过48小时且被认为适合从重症监护病房出院的患者将符合条件。原发性神经疾病诊断患者将被排除。参与者将被随机分为两组之一:干预组将接受由英国国家医疗服务体系提供的标准病房护理,并在住院期间由经过专门培训的普通康复助理提供额外治疗,出院后通过电话联系跟进;对照组将接受英国国家医疗服务体系现行服务提供的标准病房护理。干预组还将获得有关其危重病的额外信息,并可接触到重症监护医生。干预的总时长将从随机分组至随机分组后3个月。两组的总随访时长将为随机分组后的12个月。主要结局将是3个月时的Rivermead运动指数。次要结局将包括身体和心理疾病及功能、生活质量的测量指标以及12个月期间的生存率。还将进行健康经济学评估。将对两组的主要和次要结局进行比较;定量分析将辅以对患者、护理人员和医护人员的焦点小组访谈。

伦理与传播

将根据患者的能力从患者及其亲属处获得同意。数据将根据预定义的分析计划进行分析。

试验注册

该试验已注册为ISRCTN09412438,由苏格兰首席科学家办公室资助。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a45/3391367/50964ac15da5/bmjopen-2012-001475fig1.jpg

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