Increasing numbers of patients are surviving critical illnesses, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period.
If we consider the definition of rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”, then rehabilitation is in effect composed of multiple components or “interventions”.
Most individuals participating in rehabilitation require interventions addressing one, many factors that are contributing to reduced functioning, with the overriding goal of rehabilitation being to utilise appropriate interventions that allow the individual to optimise their function.
The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors which include: the aetiology and severity of the person’s health condition; the prognosis; the way in which the person’s condition affects their ability to function in their environment; as well as the individual’s identified personal goals and what it is they want to achieve from the rehabilitation process.
Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies, and rehabilitation itself may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The selection of rehabilitation interventions and intensity of rehabilitation should always be based on the individual patient’s needs, which should include their tolerance of therapeutic activities.
More importantly, rehabilitation interventions should be generally outcome-oriented, in that rehabilitation goals are developed to achieve a specific outcome that is based on the following five broad areas:
- Prevention of the loss of function
- Slowing the rate of loss of function
- Improvement or restoration of function
- Compensation for loss of function (compensatory strategies)
- Maintenance of current function
Rehabilitation intervention is provided across the whole range of healthcare settings including the primary care setting, in the acute hospital setting (during an inpatient episode or as an outpatient referral) or in the community settings. The breadth of rehabilitation means that a range of organisations may contribute to meeting a person’s individual needs.
Rehabilitation interventions are hugely diverse and, except in rare instances, require the involvement of many different health and rehabilitation professionals and cross multiple disciplines often at the same time, which as a result make the classification of rehabilitation interventions quite complex. It is this complexity that makes the classification of rehabilitation interventions a challenge, and as a result, there is still no classification that has been universally accepted across all fields of rehabilitation currently, despite several attempts made to develop a classification system to fully describe rehabilitation interventions.
The success of most, if not all, rehabilitation interventions is entirely dependent on the commitment and engagement of the people receiving the service. For example, assistive technology or strength training is irrelevant if the person does not want to use the device or undertake exercises. Therefore, rehabilitation requires some level of patient motivation and adherence to be effective.