Introduction The REVIVE RCT investigated the effectiveness of an individually tailored (personalised) exercise programme for patients discharged from hospital after critical illness.¹ By including qualitative methods, we aimed to explore their perceptions of engaging in the 6 week programme to facilitate a better understanding of the intervention and trial outcomes.

Methods Patients allocated to the exercise group were invited to participate in semi-structured interviews following their final outcome assessment (6 months following randomisation). Interviews were conducted by a trained member of the research team not involved in the intervention. Interviews were audio recorded, transcribed verbatim and content analysis used to explore themes arising from the data.

Results Of 30 patients allocated to the exercise group 21 completed interviews. Seven core themes were identified (1) sequelae of critical illness and critical care recovery; (2) satisfaction and endorsement of the exercise programme; (3) beneficial impact of the exercise programme on physical and psychological health; (4) facilitators of beneficial impact; (5) barriers to beneficial impact; (6) challenges to continuing exercise; (7) contrasting views on outcome measures.

Patients provided insight into the physical and mental sequelae they experienced following critical illness. There was a strong sense of patients’ need for the exercise programme and its importance for their recovery following discharge home. The programme was described as invaluable, and provided feelings of motivation and hope. Key facilitators of beneficial impact included supervision, tailoring of the exercises to personal needs, and the manual. Barriers to the beneficial impact of the programme included poor mental health, existing physical limitations and lack of motivation. Patients’ views of the questionnaires and performance based outcome measures in the REVIVE trial varied. Many patients were unsure about what would be the best way of measuring how the programme affected their health.

Conclusion The benefits of physical rehabilitation programmes, needs to be counterbalanced against patients’ mental health status post-ICU and any pre-admission limitations, if they are to be successful. Including this qualitative component improved our understanding of the mechanisms underpinning the impact of the programme and how programmes should be evolved for future trials.

Reference

1. O’Neill B, et al. Effectiveness of a programme of exercise on physical function in survivors of critical illness following discharge from the ICU: study protocol for a randomised controlled trial (REVIVE). Trials 2014;15:146.