On 2016 Nov 07, Cicely Saunders Institute Journal Club commented:

The Cicely Saunders Institute journal club discussed this paper on 02/11/2016

The need to address early rehabilitation in individuals with critical illness is an important clinical priority. In meeting the needs of this group, clinicians need to consider who is likely to benefit and to what extent, it is also important to address possible harms that may arise from intervention (see AVERT, Lancet 2015). This paper addresses an important area of practice in the surgical intensive care environment.

We valued our discussion of the paper, which generated a number of reflections on the methods used and the wider applicability of the intervention. In rehabilitation and palliative care practice goal-setting to target intervention is a widely used approach. In many rehabilitation contexts, goals are set in conjunction with patients, carers and the clinical team. The method used here was somewhat different and used the Surgical ICU Optimal Mobilisation Score (SOMS), which in our view was more akin to a protocol. Nevertheless, the SOMS facilitated targeting of intervention at the individual ability level and seemed appropriate to the ICU environment, where patient engagement in goal setting maybe less practical in some instances.

We noted that a significant difference was identified in delirium-free days in favour of the experimental group and that the mean difference was three days. We wondered if the authors had any further comment on this and its relationship to the beneficial outcomes identified, particularly reduced length of stay. We reflected that reduced delirium may result in improved ability to engage in rehabilitation practice.

Commentary by Lucy Fettes & Stephen Ashford

On 2016 Nov 07, Cicely Saunders Institute Journal Club commented:

The Cicely Saunders Institute journal club discussed this paper on 02/11/2016

The need to address early rehabilitation in individuals with critical illness is an important clinical priority. In meeting the needs of this group, clinicians need to consider who is likely to benefit and to what extent, it is also important to address possible harms that may arise from intervention (see AVERT, Lancet 2015). This paper addresses an important area of practice in the surgical intensive care environment.

We valued our discussion of the paper, which generated a number of reflections on the methods used and the wider applicability of the intervention. In rehabilitation and palliative care practice goal-setting to target intervention is a widely used approach. In many rehabilitation contexts, goals are set in conjunction with patients, carers and the clinical team. The method used here was somewhat different and used the Surgical ICU Optimal Mobilisation Score (SOMS), which in our view was more akin to a protocol. Nevertheless, the SOMS facilitated targeting of intervention at the individual ability level and seemed appropriate to the ICU environment, where patient engagement in goal setting maybe less practical in some instances.

We noted that a significant difference was identified in delirium-free days in favour of the experimental group and that the mean difference was three days. We wondered if the authors had any further comment on this and its relationship to the beneficial outcomes identified, particularly reduced length of stay. We reflected that reduced delirium may result in improved ability to engage in rehabilitation practice.

Commentary by Lucy Fettes & Stephen Ashford