Factors influencing consumer engagement, experiences, and outcomes: A qualitative study of physical rehabilitation during critical illness

OBJECTIVES: The aim of this study was to determine which factors influence consumer engagement in, experience of, and outcome of physical rehabilitation interventions during critical illness. METHODS: An inductive qualitative study using semistructured interviews was conducted between September 2019 and July 2020. Ten adult, English-speaking intensive care survivors and five of their caregivers were recruited after discharge from a major metropolitan health service. Framework analysis was used to interpret the collected data following five key steps. (i) Audio transcription and data familiarisation; (ii) open inductive coding to guide development of an initial framework; (iii) two rounds of framework application, review, and refinement; (iv) charting of data into the matrix; and (v) interpretation of the findings. Analytical memo taking and independent coding were undertaken by two researchers. RESULTS: Five key themes were elicited that described factors important to the approach to rehabilitation, rehabilitation during critical illness, and the recovery phase following intensive care admission. The presence of pre-existing factors such as consumer beliefs, patient well-being, and therapist skills, as well as the strength of the therapeutic alliance, influenced consumer engagement in rehabilitation interventions while critically ill. Patients had diverse experiences and outcomes of rehabilitation. Caregivers and the social network of the patient play an invaluable but variable role in facilitating patient participation in rehabilitation during intensive care admission. CONCLUSION: Consumers identified important factors influencing participation in physical rehabilitation during critical illness. These factors should be considered in the future design and delivery of intensive care physiotherapy interventions to improve patient-centred care.