PERMIT observational study
Research type
Research Study
Full title
Paediatric Early Rehabilitation & Mobilisation during InTensive care observational study
IRAS ID
263127
Contact name
Barnaby Scholefield
Contact email
Duration of Study in the UK
2 years, 0 months, 31 days
Research summary
Summary of Research
Each year 20,000 children and young people (CYP) become so ill or badly injured that they need to be admitted to a Paediatric Intensive Care Unit (PICU). Thankfully over 95% of them survive and are discharged but they can have a number of problems for many weeks and months afterwards.
We want to see if patients recover quicker if they are given rehabilitation early on and are encouraged to get moving while they are still in PICU. This is known as ‘early rehabilitation and mobilisation’ (ERM).
PERMIT is a full NIHR/HTA funded programme with four phases:
1) Find out how much ERM is currently being offered to CYP in UK PICUs and what form this support takes;
2) Learn what families and staff think are the most important aspects to help recovery;
3) Put together guidelines to deliver ERM. We will then try out these guidelines in 2 PICUs to see if they are useful and
4) Make suggestions about further research.
This application applies to the PERMIT Observational study, which is the first phase of this programme.
We plan to collect information on 150 patients admitted to 14 PICUs in the same three-week observational period. Using routinely collected data, via the established national Paediatric Intensive Care Audit Network (PICANet), and additional local data of routine ERM practice, we will calculate the amount of ERM being provided to patients. We will also use this data to analyse which types of patients are receiving ERM, and who is not. This will be to establish if clinical practice is consistent across UK PICUs, or if there are patient populations most likely to benefit from ERM in a future randomised controlled trial (RCT). The potential number of patients available for a future RCT will then be calculated by examining the number of suitable patients in the UK PICANet dataset.Summary of Results
Why study early rehabilitation and mobilisation?
Early rehabilitation and mobilisation, within the first week of intensive care admission, can improve the speed of recovery from illness or injury in adults. However, there is a lack of evidence about whether critically unwell children benefit from early rehabilitation and mobilisation.
What did we want to find out?
We aimed to identify which patients may benefit from early rehabilitation and mobilisation. Also, to develop and test a manual of early rehabilitation and mobilisation using the best evidence and expertise – called the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual. Then evaluate whether the manual could be implemented safely in paediatric intensive care units and was acceptable to staff and families.
What did we do?
We undertook in respect of early rehabilitation and mobilisation:
• review of existing research;
• national survey of practice (124 staff); • gathered information about current conduct (15 paediatric intensive care units, 169 patients); • spoke to experts (18 people); • developed the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual to guide paediatric intensive care unit staff; • Tested the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual in three paediatric intensive care units with 30 patients; • gathered feedback from healthcare professionals via weekly ‘debriefs’ (47), interviews (13) and surveys (118), and from parents via parent-completed questionnaires (21) and interviews (14).
What did we find?
Despite being regarded as important, currently early rehabilitation and mobilisation practice is inconsistent, not considered ‘early’ enough and often focuses on low-risk activities conducted on the bed. Introducing the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual as part of a trial was acceptable and feasible and helps standardise delivery to unwell children. Measuring child and parent reported outcomes was acceptable but follow-up at 30 days was incomplete.
What does this mean?
A larger trial of early rehabilitation and mobilisation, involving more paediatric intensive care units, is feasible and required to demonstrate benefit to children.REC name
East of Scotland Research Ethics Service REC 2
REC reference
19/ES/0102
Date of REC Opinion
2 Sep 2019
REC opinion
Further Information Favourable Opinion