Critical care patients sought for rehabilitation study

Patients who have spent time in critical care are being sought to take part in ground-breaking research that aims to speed up their recovery.

Each year, more than 140,000 people are discharged alive from critical care units in the UK and many have ongoing physical and psychological issues which last for many years.

Over the longer term, a third of working age patients still need help with basic activities such as getting dressed or going to the toilet. Around 50% of patients have been readmitted to hospital and less than half have returned to work a year after leaving an intensive care unit (ICU).

The new PHOENIX* study, sponsored by University Hospitals Coventry and Warwickshire (UHCW) NHS Trust and funded by the National Institute for Health and Care Research (NIHR), is looking at the feasibility and cost effectiveness of providing structured, personalised physical rehabilitation and nutrition plans for patients who are recovering on a ward after leaving ICU. Patients would be provided with physiotherapy and optimised nutrition on the ward for two weeks, Monday to Friday, to support their rehabilitation.

The study’s chief investigator is David McWilliams, Professor for Critical Care and Rehabilitation at the Centre for Care Excellence, a collaborative partnership between UHCW NHS Trust and Coventry University. He says that if the PHOENIX study is successful it may lead to a wide-scale evaluation of this new approach to rehabilitation.

“When a patient stays in critical care there is a strong focus on supporting their organs and saving their life,” said Professor McWilliams. “But while they are receiving this life-saving care they’re lying in bed, losing muscle and not receiving adequate nutrition. When they’re moved to a ward, service pressures often mean they may only receive physiotherapy input once or twice a week.

“The aim of the PHOENIX trial is to assess the needs of each individual patient and combine physical exercise with nutrition so we can optimise their rehabilitation and overall recovery in both the short and long term. This approach could help to shorten the length of time a patient stays in hospital, reduce the burden on social care, and result in fewer GP visits and readmissions.”

The PHOENIX study will recruit until the end of September. Sixty patients in total are being recruited to receive either the standard care or enhanced care, and patients and staff will also be interviewed. 30 patients will be recruited from UHCW and 30 from Oxford University Hospitals (OUH) NHS Foundation Trust, where Dr Owen Gustafson is the Principal Investigator. Depending on the results, the ambition is to roll out a much larger scale trial across multiple NHS trusts.

Dr Nicky Wyer, Consultant Dietitian at UHCW, said: “We are delighted to have this opportunity to investigate whether a combined enhanced physiotherapy and nutrition intervention results in improved outcomes for post critical care patients. We know that there are numerous challenges to the delivery of nutrition for these patients because of how ill they have been. We hope that by providing increased involvement by dietitians - the experts in clinical nutrition - to plan nutritional care, support patients with their individual needs, and through the use of technology to accurately determine their nutritional goals that it will help patients regain lost weight, muscle and function and help them with their recovery from critical illness.”

Miles Negus-Fancey, a patient whose life was saved in ICU, is a patient and public involvement (PPI) contributor for the study and is also Chair of the Critical Care Support Network, a national charity.

“Thanks to the expertise of ICU staff where I spent three months fighting for my life, I survived,” said Miles. “The significant role nutritionists and physiotherapists played in making recovery and a return to normal life shouldn’t be underestimated. How to improve the effectiveness of both is of paramount importance.”

*PHOENIX stands for ‘Physiotherapy and Optimised Enteral Nutrition In the post-acute phase of critical illness’.