Physical recovery after ICU stay

Advances in intensive care (ICU) have improved survival, but more than half of ICU survivors develop long-term physical, psychological, and cognitive impairments known as post-intensive care syndrome (PICS). The transition from ICU to ward care is often fragmented, with poor continuity. Interventions such as follow-up clinics, diaries, and enhanced rehabilitation show limited evidence of benefit, partly due to heterogeneous patient groups and inconsistent timing. Early mobilisation in the ICU is recommended to prevent muscle loss, shorten hospital stay, and support recovery. However, progress often declines on general wards, where patients are weakened, fatigued, and dependent on staff, and resources are insufficient to meet their needs. The overall aim was to investigate the feasibility and perceived value of extended ward-based physiotherapy and early multidisciplinary follow-up after ICU discharge. Paper I investigated the feasibility of providing extended physiotherapy to patients discharged to a surgical ward and assessed its potential benefits for their physical recovery following an ICU stay. Recruitment was conducted during January 29, and April 30, 2019. The intervention group (n=27) received extended number of physiotherapy sessions and an individual rehabilitation plan, whereas the comparison group (n=12) received usual numbers of physiotherapy sessions. Physical function was assessed with the Chelsea Critical Care Physical Assessment tool (CPAx). Extended number of physiotherapy sessions was safe and feasible, with 98.5% adherence and no adverse events. Both groups improved in physical function over time. The intervention group demonstrated a greater improvement in the ability to transfer from bed to chair (p = .039), and the ability to walk (p = .005). Trends toward shorter surgical ward stay, fewer ICU readmissions, and more patients discharged to independent living were observed, though not statistically significant. Paper II aimed to describe the experiences of ward nurses (n=17) of mobilising post-ICU patients provided with the extended physiotherapy intervention in Study I. Individual semi-structured interviews were performed between September 1, 2019, and March 30, 2020, and analysed with qualitative content analysis. Findings were presented in three main categories and nine sub-categories. The study illustrated that post-ICU patients have complex rehabilitation needs and that nurses find mobilisation difficult without physiotherapist support. A multi-professional teamwork can provide the expertise needed for safe mobilisation, promoting patients' autonomy and physical recovery. Paper III investigated the feasibility of an early multidisciplinary follow-up intervention for patients screened for increased risk of physical and psychological morbidity after ICU stay (n=41). The study was conducted as a single-armed interventional trial at two acute care hospitals between February 1, 2024, and May 23, 2025. Assessments were conducted in the hospitals, questionnaires were used, and individual interviews were conducted with participants and family members (n=20). Outcome measures were feasibility of study methods, the feasibility of the intervention programme, and the acceptability of the intervention from participants, family members and healthcare staff. Based on the results of this study a definitive trial to determine the effectiveness of an early multidisciplinary follow-up intervention among ICU survivors in the Swedish context would be feasible with some adaptions, being primarily logistical adjustments. List of scientific papers The following three papers, referred to by their roman numerals in the text, form this thesis: I. Siesage K, Joelsson-Alm E, Schandl A, Karlsson E. Extended physiotherapy after Intensive Care Unit (ICU) stay: A prospective pilot study with a before and after design. Physiotherapy Theory and Practise. 2024 Jun; 40(6): 1232-1240. PMID:36369693. https://doi.org/10.1080/09593985.2022.2143251 II. Siesage K, Schandl A, Johansson M, Nygren-Bonnier M, Karlsson E, Joelsson-Alm E. Mobilisation of post-ICU patients - a crucial teamwork between physiotherapists and nurses at surgical wards: a qualitative study. Disability and Rehabilitation.2025 May; 47(9): 2297-2303. PMID: 39155773. https://doi.org/10.1080/09638288.2024.2392036 III. Siesage K, Schandl, Joelsson-Alm E, Johansson M, Karlsson E, Milton A. A multidisciplinary intervention in ICU patients at risk for physical or psychological problems - a feasibility study. [Manuscript]