Katrine Astrup

Patients who survive critical illness and intensive care unit (ICU) admission often experience long-lasting physical, psychological, and cognitive impairments. Cognitive impairments are common and may persist well beyond ICU discharge. Few structured interventions address these impairments across the care continuum, from the ICU to post-discharge recovery. This gap informed the development of a stakeholder-driven cognitive rehabilitation intervention. The aim was to develop a cognitive rehabilitation intervention for critically ill patients that bridges the period from ICU admission to post-discharge recovery. The intervention was developed using a multiphase process guided by the 2021 Medical Research Council (MRC) framework for complex interventions and reported in line with the GUIDED and TIDieR checklists. Stakeholder input was gathered through: (1) a workshop (n = 11) to identify end-user needs; (2) a three-round Delphi process (n = 39) to prioritise interventions using a seven-point Likert scale; and (3) expert consultations to refine selected components. Qualitative data from the workshop and open-ended Delphi responses were analysed thematically, while quantitative analysis identified consensus, defined a priori as ≥80% agreement on importance. The process generated a range of proposed interventions, including both novel and established elements. Interventions reaching stakeholder consensus were further reviewed by experts for clinical relevance and feasibility. Two prototype interventions were selected: (1) a Mindfulness-based intervention and (2) a Brain Training intervention. This study outlines a stakeholder-informed process for developing a cognitive rehabilitation intervention tailored to ICU patients across the care continuum. The co-design approach improved contextual fit and clinical applicability. These findings support the planned feasibility evaluation of the proposed interventions. The overall research study received ethics approval, while formal ethics committee approval was not required for the workshop and Delphi activities under Danish legislation (osf.io/5a4xq).

Background: Cognitive impairment is common after critical illness, yet structured cognitive rehabilitation is rarely integrated into routine intensive care practice. ICU CogHab is a stakeholder‐ and theory‐informed intervention comprising two components: Mindfulness and Brain Training, developed to support recovery from intensive care to 6‐month follow‐up. Aim: To evaluate the feasibility of the ICU CogHab intervention, focussing on acceptability and fidelity among ICU patients and nurses. Study Design: A multi‐method feasibility evaluation was conducted alongside a pragmatic, five‐arm randomised controlled feasibility trial in four Danish ICUs. Data were collected using patient and nurse surveys and semi‐structured interviews. Acceptability was explored in terms of three domains: affective attitude, burden and perceived effectiveness. Fidelity was assessed in relation to adherence and dose, with participant responsiveness and quality of delivery examined within adherence. Quantitative data were analysed descriptively, and qualitative data were analysed using deductive content analysis. Results: Thirty‐one patients contributed with survey data and nine participated in interviews. In addition, 53 nurses contributed with 194 session‐based surveys and seven interviews, informing evaluation of delivery during ICU admission. Both components were generally perceived as relevant and appropriate by patients and nurses. Patients described the components as meaningful and supportive. Fidelity varied across settings and over time, with adherence and dose influenced by clinical condition, fatigue, patient readiness and competing rehabilitation demands, meaning that intervention use often required adaptation in timing and duration across recovery phases. Nurses reported contextual barriers to delivery, including high workload and competing clinical priorities. Conclusion: The ICU CogHab intervention components demonstrated overall acceptability across ICU and post‐discharge phases. Variation in fidelity reflected the patient condition, clinical context and competing demands, providing direction for further refinement before larger‐scale evaluation. Relevance to Clinical Practice: Cognitive rehabilitation may be acceptable and feasible to introduce within intensive care pathways but delivery may require flexible timing, integration into routine care and support across the ICU‐to‐home transition.

Background: Survivors of critical illness frequently experience persistent cognitive impairment. However, structured cognitive rehabilitation interventions remain limited within intensive care pathways. While physical rehabilitation has received increasing attention, evidence guiding cognitive rehabilitation in intensive care unit (ICU) populations is sparse, and the feasibility of study procedures must be established before large‐scale evaluation. Aim: To assess the feasibility of conducting a multi‐arm randomised controlled trial evaluating a cognitive rehabilitation intervention (ICU CogHab) for ICU survivors. Study Design: A pragmatic, five‐arm randomised feasibility study was conducted across four ICUs at two Danish university hospitals. Feasibility outcomes included screening and recruitment, randomisation procedures, retention through 6‐month follow‐up and completion of patient‐reported and performance‐based outcome measures. Data were analysed descriptively to summarise feasibility parameters and outcome variability. Results: Of 1679 patients screened, 115 met eligibility criteria and 83 were randomised. Recruitment was lower than anticipated, and retention at 6 months was 40%. Clinical data obtained from medical records were largely complete, whereas cognitive and patient‐reported outcomes were more difficult to complete at ICU discharge. Outcome measures demonstrated substantial variability. Conclusion: This study shows that screening and randomisation procedures for a cognitive rehabilitation intervention are feasible within routine ICU practice. Retention and data completeness, particularly after hospital discharge, represent key challenges requiring refinement before further evaluation. Relevance to Clinical Practice: Cognitive rehabilitation can be introduced within routine ICU workflows. However, the timing of assessments, follow‐up procedures and integration into clinical practice require optimisation. These findings inform pragmatic adaptations to support future evaluation and implementation of cognitive rehabilitation for ICU survivors. Trial Registration: The study was prospectively registered on the Open Science Framework ( https://osf.io/b57fv/overview )

In neurocritical care, the focus is on treating life-threatening diseases of the nervous system. These conditions are often associated with a complex picture of symptoms, including physical, cognit...

To improve the quality of physical function assessment through routine use of the Chelsea Critical Care Physical Assessment Tool (CPAx-D) in Danish ICUs. The methodological framework was "The Model for Improvement," including the Plan-Do-Study-Act (PDSA) cycle. The context consisted of two ICUs at Aarhus University Hospital with 38 beds. Eligible patients were aged 18 years or older and considered stable and ready for physiotherapy treatment. Evaluation methods used were questionnaires, clinical practice observations, continuous feedback, status meetings, and an audit of the medical records including patients during a three-month period in the ICUs. The quality improvement process required three PDSA cycles and two years before CPAx-D was successfully implemented into clinical practice. The following barriers were identified; the COVID-19 pandemic increased workloads and caused reorganization of care; leave of absence of the project manager caused a lack of leadership; local instructions were not sufficiently aligned with practice; and detailed manuals were missing. A facilitator for implementation was the clinicians' perception of CPAx-D as a meaningful tool, adding value to interdisciplinary collaboration and communication, and stimulated patient motivation. By employing various interventions, routine use of CPAx-D has been successfully implemented into clinical practice at two Danish ICUs.

Measurement instruments are important in clinical practice and research for assessing physical function in critically ill patients in the intensive care unit (ICU).To investigate inter-rater reliab...

Purpose: The aim of the study was to validate the Chelsea Critical Care Physical Assessment Tool (CPAx) in Danish, including translation, cross-cultural adaptation and evaluation of clinemetric properties. Method: International recommendations for translation and cross-cultural adaptation of outcome measures were followed. Physiotherapists with ICU experience investigated the clinemetric properties of the Danish CPAx version among 30 critically ill patients at three different ICUs. Furthermore, a focus group interview was carried out to examine cross-cultural adaptation of the CPAx tool. Results: Translation and pre-test of the Danish version of CPAx resulted in a measurement tool with good clinemetric properties. Few adaptations were made with consideration of comparability between the Danish and the English version. The author of the original version of CPAx, Eve Corner, approved the Danish translation. Conclusion: The Danish version of the CPAx seems to be an appropriate measurement instrument for evaluation of physical function in ICU patients. This study is the first step toward a validation of a Danish version of the CPAx tool. However, further research is needed to investigate reliability and responsiveness among patients in the ICU.