Browsing by Person "Merriweather, Judith"

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The development and feasibility of a ward-based physiotherapy and nutritional rehabilitation package for people experiencing critical illness
(SAGE Publications, 2010-04-21) Salisbury, Lisa; Merriweather, Judith; Walsh, Timothy
Objective: To investigate ward-based rehabilitation after critical illness and undertake a pilot study exploring the feasibility of delivering enhanced physiotherapy and nutritional rehabilitation. Design: Service evaluation (part A) and pilot feasibility randomized controlled trial (part B). Setting: Hospital inpatient wards following discharge from intensive care. Participants: Part A involved 24 people with an intensive care stay of four days or more. Part B involved 16 participants randomized into a control (n = 8) or intervention (n = 8) group. Interventions: Part A defined the current ‘standard’ physiotherapy and nutritional interventions. In part B the control group received this ‘standard’ service while the intervention group received this ‘standard’ service plus enhanced rehabilitation. Main measures: Part A collected process outcomes of current interventions and outcomes that included calorie and protein intake and the Rivermead Mobility Index. In part B process outcomes determined differences between groups. Outcomes included those undertaken in part A plus an incremental shuttle test, handgrip dynamometry and visual analogue scales. Results: Part A found low levels of ward-based physiotherapy (walking and transfer practice once per week) and dietetic input (0.8 visits per week). Part B found an increased frequency of both physiotherapy (P = 0.002) and dietetic (P = 0.001) visits in the intervention group. Physical and nutritional outcomes were suitable for use after critical illness, but no statistically significant differences were found between groups. Power calculations indicated 100 participants per group would be required for a definitive study. Conclusions: This feasibility pilot work has informed the design of a larger study to evaluate enhanced rehabilitation following critical illness.
Rehabilitation after critical illness: could a ward-based generic rehabilitation assistant promote recovery?
(Wiley, 2010-02-09) Salisbury, Lisa; Merriweather, Judith; Walsh, Timothy
Aim: The aim of this paper is to explore issues surrounding the implementation of a generic rehabilitation assistant (GRA) to provide ward-based rehabilitation after critical illness. Background: Following critical illness a range of both physical and psychological problems can occur that include muscle wasting and weakness, fatigue, reduced appetite, post-traumatic stress, anxiety and depression. Limited research exists evaluating the provision of rehabilitation to this patient group. This paper explores one possible service delivery model providing ward-based rehabilitation after critical illness. The model explored is a GRA working in conjunction with ward-based staff. Results: We describe how a GRA worked effectively with ward-based teams to provide additional rehabilitation in the period after discharge from intensive care. Benefits included greater continuity of care that was flexible to the individual needs of patients. Some aspects of the role were challenging for the GRA and highlighted the need for good communication skills. A need for comprehensive training of the GRA was demonstrated. Conclusions: Our experience demonstrates that it is feasible to deliver ward-based rehabilitation after critical illness using the GRA service delivery model. Relevance to clinical practice: This model of service delivery offers the potential to improve outcomes for patients after a critical illness. Further research evaluating this model of care is required before implementation into clinical practice.