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Determinants of change in home participation among critically ill children

Mary A Khetani¹, Erin C Albrecht², Jessica M Jarvis¹

¹Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA.

Developmental Medicine and Child Neurology

|March 26, 2018

Insights

Home participation for critically ill children remained stable post-pediatric intensive care unit (PICU) discharge. Pre-illness function and home support influenced involvement, suggesting targeted interventions for recovery.

Area of Science:

Pediatric critical care medicine
Child rehabilitation
Family-centered care

Background:

Critically ill children face challenges in resuming home activities post-pediatric intensive care unit (PICU) discharge.
Understanding factors influencing home participation is crucial for optimizing recovery and long-term well-being.
Limited research exists on the trajectory of home participation in the initial months after PICU admission.

Purpose of the Study:

To estimate changes in home participation for critically ill children within 6 months of pediatric intensive care unit (PICU) discharge.
To explore the influence of child-specific, service-related, and environmental factors on alterations in home participation.
To identify predictors of home participation frequency and involvement post-PICU.

Main Methods:

Prospective, bi-center, longitudinal cohort study involving 180 children (1-17 years) with ≥48-hour PICU stay.
Caregiver-reported outcomes captured child's home participation and environmental support at baseline, 3, and 6 months post-discharge.
Patient-reported outcome measures assessed functional status, capabilities, and environmental supports.

Main Results:

No significant overall changes in home participation frequency or involvement were observed 6 months post-PICU.
Functional status significantly moderated involvement rates over time.
Pre-PICU functional status, capabilities, and home environmental support were significant predictors of participation.

Conclusions:

Home participation trajectories are relatively stable in the 6 months following PICU admission.
Children with poorer pre-PICU function showed greater increases in home involvement.
Interventions focusing on functional capabilities and home environment support may enhance recovery and participation.

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Abstract

Aim:

To estimate changes in home participation among critically ill children in the first 6 months after discharge from a pediatric intensive care unit (PICU), and to explore the effect of child, service, and environmental factors on change in home participation.

Method:

This was a prospective bi-center, longitudinal cohort study. Caregivers of 180 children, aged 1 to 17 years, who were admitted into the PICU for at least 48 hours were included. Patient-reported outcomes were used to capture caregivers' perspectives of their child's participation and environmental supports for participation in home activities. Data were collected at enrollment, and 3 and 6 months after discharge.

Results:

There were no significant changes in home participation frequency or involvement, but involvement rates across time were moderated by functional status. Age significantly predicted participation frequency. Pre-PICU functional status and capabilities were significant predictors of participation frequency and involvement, and home environmental support significantly predicted home involvement.

Interpretation:

Results suggest relatively stable participation trajectories in the 6 months after PICU admission. Children with abnormal baseline function experienced a greater increase in home involvement after PICU. Rehabilitation interventions targeting functional capabilities and home environment may be viable approaches during the early phase of recovery. Environmental interventions may be more time-efficient after PICU stay and merit further study.

What This Paper Adds:

Children's pre-pediatric intensive care unit (PICU) functional status and capabilities impact their participation after critical illness. Children's trajectories of home involvement may differ over time based on their pre-PICU functional status. Caregiver perceptions of environmental support impact a child's home involvement after discharge from a PICU.

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