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*IMPORTANT NEW RESEARCH FINDING* Just published Systematic Review by Honarmand et al, 2020:
“Patients with ARDS had higher prevalence of cognitive impairment than mixed ICU patients at ICU discharge”.
This finding is really important for OTs to note. A thread. https://twitter.com/icurehab/status/1248029357030989824
“Patients with ARDS had higher prevalence of cognitive impairment than mixed ICU patients at ICU discharge”.
This finding is really important for OTs to note. A thread. https://twitter.com/icurehab/status/1248029357030989824
A whopping 82 [78-86]% vs 48 [44-52]%. This is at discharge from ICU and illustrates just one of the unique roles that OTs will be providing to this patient cohort.
OTs have been previously cited (Algeo & Aitken, 2019) as key in addressing NICE Guidelines ’Rehabilitation after critical illness in adults’, particularly with a focus on non-physical morbidity.
This isn’t to say that there’s no role in physical morbidity for OTs. It’s huge - positioning, seating, pressure care, splinting, maintenance of ROM, etc. However, let’s look at some key facts of OTs in ICU and beyond at discharge from this unit from a non-physical morbidity POV.
What we know:
Non-physical morbidity includes impaired cognition (e.g reduced processing speed/capacity, memory loss, executive dysfunction), psychological distress and delirium (which is often a result of ICU Rx such as sedation, or sleep deprivation).
Non-physical morbidity includes impaired cognition (e.g reduced processing speed/capacity, memory loss, executive dysfunction), psychological distress and delirium (which is often a result of ICU Rx such as sedation, or sleep deprivation).
There’s evidence to suggest that earlier OT intervention w/ those in ICU can reduce delirium (Álvarez et al, 2017, Schweickert et al, 2009)... as well as increase functional status and REDUCE hospital length of stay.
Some cognitive screening/Ax tools which some OTs have cited to use in ICU in England include:- The Richmond Agitation-Sedation Scale
- The Confusion Assessment Method for the ICU
- The Wessex Head Injury Matrix
- The Oxford Cognitive Screen
- MOCA
(Algeo & Aitken, 2019)
Some non-physical Rx ideas include: - Orientation Boards
- Functional Re-Training
- Cognitive Apps (for higher functioning)
- Breathlessness Mx
- Anxiety Mx
- But what’s really important as part of Rx is the appropriate onward referral for ongoing rehab on discharge from ICU.
This is so important. A huge focus and rightly so has been on the patient in ICU. But what about after this period? The systematic review speaks for itself. There are going to be significant non-physical rehab needs (on top of physical).
OT in ICU in Ireland is mostly non-existent. I’m delighted to see the surge in OT roles appear in the UK. But, for now, OTs in Ireland will need to focus on the post-ICU piece. And this is where we’re really needed. Not in contact tracing or in HCA roles, but as OTs.
Some food for thought but @SRSMcMasterU have posted some guidance for OTs, Physios and SLTs to consider for each phase. @AOTInews @iaslt @_ISCP_ https://twitter.com/srsmcmasteru/status/1247969775797575684?s=21 https://twitter.com/srsmcmasteru/status/1247969775797575684
