Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
PLoS One. 2021 Mar 3;16(3):e0247406. doi: 10.1371/journal.pone.0247406. eCollection 2021.
Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10-18) days after admission. Each patient received a median of 25.5 (IQR 22.8-34.8) rehabilitation sessions out of a median 27 (22.8-35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.
全世界范围内，越来越多的重病患者幸存下来，但幸存者往往伴有长期残疾。在高收入国家，通常采用物理康复治疗来应对这一问题，以改善预后。这些治疗需要高度专业化的多学科团队，而在大多数低收入和中等收入国家（LMICs），这些团队既无法获得，也负担不起。我们旨在设计一个可持续的重症监护病房（ICU）康复项目，并在 LMIC 环境中评估其可行性。在这个项目中，患者、护理人员和专家共同设计了一种创新的康复方案，这种方案可以由非专业的 ICU 工作人员和家庭护理人员在 LMIC 中实施。我们在胡志明市热带病医院对破伤风患者实施了该方案，为期 5 个月，评估了方案的可接受性、促成因素和障碍。该方案共设计了 6 个阶段，每个阶段都有书面和视频材料支持。该方案共在 30 名患者中进行了试点。康复治疗在入院后中位数 14 天（四分位距（IQR）10-18）开始。每位患者接受了中位数为 25.5 次（IQR 22.8-34.8）的康复治疗，而中位数 27 次（IQR 22.8-35）为计划（规定）的治疗次数。没有相关的不良事件。患者和工作人员认为康复治疗有益，增强了护理人员、患者和工作人员之间的关系，被认为是康复和重返工作岗位的积极步骤。主要障碍是工作人员时间。该方案对破伤风患者是可行的，并且得到了工作人员和参与者的积极评价。工作人员时间被确定为持续实施的主要障碍。
