The iRehab Trial, funded by the National Institute for Health and Care Research (NIHR), tested an online rehabilitation programme for people recovering at home after being on a ventilator in intensive care. The trial was conducted across 52 NHS hospitals and managed by Warwick Clinical Trials Unit, with leadership from Ulster University and Queen's University Belfast.
Overall, the programme did not show a significant benefit in quality of life at the eight-week follow-up. However, patients who had been ventilated for less than a week saw substantially greater improvements in quality of life than those ventilated for longer, suggesting that online home-based rehabilitation can be worthwhile for people following shorter periods of ventilation.
Julie, a patient from Middlesbrough who took part in the iRehab trial, was admitted to intensive care after sepsis. After a stay in the intensive care unit (ICU) and the ward, she was allowed home.
Julie said: "I was elated to be allowed home, but terrified. As for iRehab, it gave me the chance to make me feel better and have someone else look at my care. I joined whatever I could, the check in with my 1:1 support weekly, my exercise class with others once a week and the community cafe which was a get together of all those that had joined the programme to discuss how they were feeling and support network, brilliant. Staff were fabulous. Checking in and caring and it went too quickly.
"All in all, if I could support the system to give this to everyone who attended ICU I would. Thank you from the bottom of mine and my family's hearts, I'm here. I'm fitter. I'm happy."
The results were presented at the American Thoracic Society (ATS) International Conference in Orlando on Monday 18 May and published in the Journal of the American Medical Association (JAMA).
Professor Brenda O'Neill, Chief Investigator of the iRehab Trial said: "The iRehab programme helped many people to recover after they went home from the intensive care unit. Rehabilitation for survivors of critical illness is underfunded but findings from the iRehab trial demonstrate that fully remote processes in healthcare research and delivery are feasible from the consent stage through to intervention delivery."
People treated in intensive care often need significant support during recovery. After being discharged home, many experience muscle weakness, fatigue, breathlessness, memory problems, and poor emotional wellbeing, making everyday tasks a real challenge. The iRehab programme addressed this with a six-week remote rehabilitation intervention, combining weekly symptom management, targeted exercise, psychological support, and peer information. The findings suggest that this kind of scalable, home-based rehabilitation may help certain patients recover better following serious illness requiring ventilation in intensive care.
Professor Anthony Gordon, Director for NIHR's Health Technology Assessment (HTA) Programme, said: "Recovery from a critical illness can be a challenging and lengthy process for patients and their loved ones. This research demonstrates how using remote technology and moving from analogue to digital solutions, which is a key government priority, can make a difference to their rehabilitation and quality of life.
"The benefits the study team has identified are important. Not only can patient care be safely and effectively managed online, it also allows them to continue their recovery in familiar and comfortable surroundings. It ensures any disruption to their day-to-day lives is kept to a minimum, while at the same time, eases pressure on vital healthcare resources. Ensuring the right patients receive treatments that work also helps the NHS deliver care efficiently."
Professor Danny McAuley (Consultant in Intensive Care Medicine) Co-Chief Investigator, iRehab Trial said: "We now need to deliver this package of care for the patients who will benefit, while at the same time continue to try to find better personalised treatments to improve the outcomes for patients where this intervention may not work as well. It's not just clinicians that need to be considered; we really need to engage with policy makers to deliver care to improve the outcomes for patients who survive critical illness. We could not have delivered this without the support of the National Institute for Health and Care Research."
