InS:PIRE- Questionnaire Study
Research type
Research Study
Full title
Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)\nA multi centre questionnaire study
IRAS ID
219910
Contact name
Joanne McPeake
Contact email
Duration of Study in the UK
2 years, 10 months, 24 days
Research summary
Summary of Research
Survival from critical care is improving. However, this survival results in many significant physical, psychological, memory and social problems for patients and their family members in the months and years following discharge.\n\nIn the last decade a number of research studies have sought to address these issues and improve quality of life in this patient group. Past research has focussed on Nurse led follow up clinics, community support, as well as support within the hospital setting. However, there is limited evidence demonstrating the effectiveness of any of this work. \n\nWe propose to undertake a quality improvement project with an intervention which has been co-designed by patients and family members to help support recovery after critical care. \n\nThe questionnaire aspect of this quality improvement project will take place in four sites comprising five hospitals across Scotland as well as a control site which is not participating in the intervention. \n\nIn the sites participating in the intervention there will be 2 different cohorts who will be asked to complete questionnaires at different time points:\na) Those patients and family members attending the InS:PIRE rehabilitation service. b) Those patients and caregivers admitted to critical care, prior to the Quality Improvement project starting. This group will act as a historical control to allow the team to understand any benefits attributed to the intervention.\n \nPatients and carers from a site without the intervention will also be asked to complete questionnaires at the start of the project and a different cohort will repeat the same task at the end of the project period (2 years later). This will allow us to determine whether improvements in service delivery in general have improved outcomes for patients as opposed to it being the InS:PIRE intervention.
Summary of Results
Background: Survival from critical care is improving. However, this survival may result in significant physical, psychological, cognitive and social problems for patients and their caregivers.
Primary objective of this study: Does a quality improvement (QI) initiative designed to support recovery from critical care, improve outcomes for survivors and their caregivers?
Methodology: This study ran a QI project in five hospital across Scotland between 2017-2020. This QI project was called Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). InS:PIRE is a complex, integrated, health and social care intervention for patients who have survived critical illness, alongside their family members. It was co-designed with patients and caregivers from each of the sites involved.
Outcomes: In order to assess the impact of the programme, we examined the outcomes of patients and caregivers who had received the intervention vs patients and caregivers in a further four hospitals who had not received the InS:PIRE intervention. For patients, we examined outcomes such as quality of life, anxiety, depression and pain. For caregivers, we examined caregiver strain, anxiety, depression and sleep. We measured and compared outcomes between those who did and did not receive the InS:PIRE intervention at 12 months following hospital discharge. This study was not randomised.
Results: This study recruited 654 participants (396 patients and 258 caregivers). After adjustment, there was a significant absolute improvement in HRQoL in the InS:PIRE cohort, in comparison to the usual care cohort (0.12, 95% CI 0.04 to 0.20, p=0.01). Patients who attended InS:PIRE also reported self-efficacy scores that were 7.7% higher (2.32 points higher, 95% CI 0.32 to 4.31, p=0.02) and fewer symptoms of depression (OR 0.38, 95% CI 0.19 to 0.76, p=0.01). There was no difference in symptoms of anxiety (OR 0.58, 95% CI 0.30 to 1.13, p=0.11).
In relation to caregiver outcomes, after adjustment, those caregivers who attended InS:PIRE demonstrated a significant improvement in symptoms of anxiety (OR: 0.42, 95% CI: 0.20–0.89, p = 0.02), carer strain (OR: 0.39; 95% CI: 0.16–0.98 p = 0.04) and clinical insomnia (OR: 0.40; 95% CI: 0.17–0.77 p < 0.001). There was no significant difference in symptoms of depression at 12 months between those who did and did not receive the intervention.
COVID-19 cohort: We continued recruiting during the COVID-19 pandemic in order to understand any differences in outcomes between those surviving critical illness, with and without COVID-19. In this analysis, COVID-19 patients were matched (compared) with non-COVID-19 patients, all of whom attended the InS:PIRE intervention. There were no significant differences in any measured outcomes between the two cohorts.
Conclusion: The InS:PIRE intervention appeared to have benefit for patients and caregivers who undertook the intervention. However, in order to definitively understand benefit, a future randomised control trial should be undertaken.REC name
North West - Liverpool Central Research Ethics Committee
REC reference
17/NW/0119
Date of REC Opinion
14 Feb 2017
REC opinion
Favourable Opinion