Journal
INTENSIVE CARE MEDICINE
Volume 43, Issue 4, Pages 531-542Publisher
SPRINGER
DOI: 10.1007/s00134-017-4685-4
Keywords
Critical care; Rehabilitation; Physical therapy; Review; Behaviour change; Physical activity
Categories
Funding
- National Health and Medical Research Council (NHMRC) Early Career Fellowship
- short-term European Respiratory Society (ERS) travelling fellowship
- NHMRC Translating Research into Practice Fellowship - Cancer Australia
- National Institute of Health Research (NIHR) Postdoctoral Fellowship
- NIHR Biomedical Research Centre based at Guy's and St. Thomas' NHS Foundation Trust and King's College London
- National Institutes of Health Research (NIHR) [PDF-2015-08-015] Funding Source: National Institutes of Health Research (NIHR)
- National Institute for Health Research [PDF-2015-08-015] Funding Source: researchfish
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Purpose: To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers. Methods: Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454. Results: Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment. Conclusions: The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.
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