Canterbury Christ Church University, Canterbury, UK.
National Institute of Health and Care Research, Applied Research Collaboration Kent, Surrey and Sussex, UK.
Crit Care. 2024 Sep 27;28(1):317. doi: 10.1186/s13054-024-05089-6.
It remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.
Studies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.
Thirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.
Our systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.
目前尚不清楚如何优化重症监护康复治疗，以减少所谓的重症监护后综合征（PICS）的一系列长期身体、心理和认知障碍。恢复不良的可能原因包括获得护理和治疗延迟。电子健康（eHealth）有可能帮助增加获得护理的机会并远程提供一致的护理。我们的综述旨在评估电子健康干预措施对 PICS 结果的有效性。
我们检索了 Medline、CINAHL、PsycINFO、Embase 和 Scopus 数据库，从 2010 年 1 月 30 日至 2024 年 2 月 12 日，纳入了针对 PICS 结果的电子健康干预措施的研究。两名评审员评估研究的合格性，如果存在分歧，则进行讨论或由第三名评审员解决。使用混合方法评估工具评估研究质量和偏倚风险。除了确定有效的策略外，我们的综述还旨在阐明所考虑的恢复时间线以及干预措施针对的结果或领域。
我们的综述纳入了 13 项研究。研究持续时间、电子健康干预传递形式和结果测量差异很大。没有研究报告行为改变理论，只有一项研究是与患者或护理人员共同制定的。大多数研究是在出院后早期（即<3 个月）进行的，并且以可行性为主要结局。认知领域是目标最少的领域，没有干预措施针对所有三个领域。针对心理领域的干预措施表明普遍有积极影响。然而，结果的效力不足且初步。尽管所有研究都被认为是可行的，但大多数研究并未评估可接受性。在评估可接受性的研究中，可接受性的主要促进因素是可用性和感知有用性，主要障碍是对心理健康和认知问题的敏感性。
我们的系统综述强调了电子健康的有希望的贡献，并初步支持了重症监护后康复早期干预措施的可行性。未来的研究应集中在证明有效性、可接受性、认知领域和多组分干预措施上。
