PHOENIX
Research type
Research Study
Full title
Physiotherapy and Optimised Enteral Nutrition In the post-acute phase of critical illness: A randomised controlled feasibility trial
IRAS ID
326633
Contact name
David McWilliams
Contact email
Sponsor organisation
University Hospitals Coventry & Warwickshire NHS Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Summary of Research
Patients with severe illness require life-saving treatment in intensive care units (ICU). During this treatment, patients often need to stay in bed. The combination of severe illness and immobility can have a devastating impact on the patient’s body. Patients discharged from ICU to the ward are weak, tired and malnourished. However, due to pressures on ward based teams, provision of the essential rehabilitation required is inconsistent. This can cause further muscle loss, delays to patients leaving hospital and incomplete recovery. Inadequate nutrition and failure to receive enough calories means patients also struggle to regain muscle and become tired very quickly.We have previously shown the benefits of delivering enhanced physiotherapy, using a structured approach to rehabilitation for patients within ICU. We plan to replicate this intervention in the ward environment. We will also include a specialist nutritional assessment. This will ensure they have the required protein and calories to
rebuild muscle, further improving recovery.We are planning a future study to see if a combination of enhanced physiotherapy and optimal nutrition improves recovery and is cost-effective for the NHS. To do this, we will compare patients who receive our structured rehabilitation intervention with those who receive normal ward care. Before this future study takes place, it is important to make sure it is designed in the best way by asking the following questions
1. Will patients agree to be a part of this trial?
2. Are we able to deliver more consistent rehabilitation and nutrition?
3. Will patients and staff members be happy for us to randomly select who receives this extra treatment?We will recruit 60 patients from 2 hospitals in the UK over 6 months. Half of those who agree to take part will have a specialist nutritional assessment and be seen by the specialist rehabilitation team. The other half will receive current
standard care.Summary of Results
What is this study about?
Many people who survive time in intensive care (ICU) have long-lasting problems. They may feel very weak, lose muscle strength, and struggle with basic daily activities like walking or washing. Poor nutrition, muscle loss and weakness during illness can make this worse.
Patients often receive good care while they are in ICU. However, once they move to a general hospital ward, the support they receive can vary a lot. This stage of recovery is known to be a weak point.What did the study aim to do?
The PHOENIX study looked at whether it is possible to provide a more structured programme of physiotherapy (to improve movement and strength), and nutritional support (to improve diet and energy levels) after patients leave ICU.
The study also looked at whether a larger trial could be carried out in the future to test if this approach improves recovery.How was the study carried out?
This study took place in two hospitals in the UK.
Adults were invited to take part if they:
• Had needed breathing support in ICU for at least four days, and
• Still needed help with movement and nutrition when leaving ICU
Participants were randomly placed into one of two groups:
1. Usual care – standard support on the hospital ward
2. Enhanced care – extra physiotherapy and tailored nutrition support for up to 14 days
Patients in the enhanced care group received:
• Daily physiotherapy (on weekdays), with simple goals and exercises to improve movement and independence
• Daily review by a specialist dietitian, with a personalised nutrition plan
• Support to meet energy and protein needs using food, drinks, or tube feeding if needed
• Nutrition timed to help recovery after exercise where possible
The main goal was not to prove that the treatment worked. Instead, the study looked at whether this type of programme could be delivered in real hospital settings.What did the study find?
• 60 patients took part, and all those eligible agreed to join
• All patients were followed up after 30 days
• The enhanced programme was successfully delivered on most planned days
• Patients were able to take part without problems
• Staff were able to deliver the programme safely, even in busy wards
Early signs suggested that patients in the enhanced care group:
• May recover physical strength more quickly
• May spend more time at home rather than in hospital
• May be less likely to be undernourished when leaving hospital
However, these results are only early findings and need to be confirmed in a larger study.What does this mean?
This study shows that a combined physiotherapy and nutrition programme after ICU is:
• Practical to deliver
• Acceptable to patients and staff
The results support moving forward to a larger study to test whether this approach improves recovery and is good value for the NHS.REC name
Wales REC 2
REC reference
24/WA/0050
Date of REC Opinion
13 Mar 2024
REC opinion
Further Information Favourable Opinion