A Problem Solving Intervention for Post-ICU Cognitive Impairment in Older Adults
Condition: Critical Illness; Mechanical Ventilation Complication; Delirium; Cognitive Impairment
MeSH terms: Critical Illness; Cognitive Dysfunction
Study type: Interventional

Summary: 
      This study will apply an evidence based program to assist ICU survivors to overcome cognitive
      problems as a result of their critical illness. This study will determine feasibility of
      recruitment, retention and engagement with the program as well as acceptability of the
      program to the participants.
    

Detailed description: 
      The Post-Intensive Care Unit Problem Solving (PIC-UPS) is an adaptation of a problem solving
      strategy developed and tested in diverse patient populations. Its effectiveness has been
      demonstrated in children with movement disorders or learning difficulties as well as adults
      with cognitive problems following acute stroke. Participants will be randomized onto usual
      care and intervention groups. The usual care group will complete study surveys after
      enrollment and 10 weeks after enrollment. The intervention group will receive the following:
      In the (PIC-UPS) program, participants will be engaged for 10 sessions, learning how to do
      skills they select as treatment goals. The first session consists of an assessment, and
      selecting the goals to meet during the 10 sessions. In the next sessions, conducted at the
      participant's home, participants practice the skills selected as treatment goals, and
      assisted by the study team, use strategies to help better learn and perform those skills.
      Some examples of tasks that others have addressed in these sessions are gardening, yoga
      breathing, handwriting, managing family finances, medication management, or initiating an
      exercise regimen. Participants will be encouraged to select tasks most relevant and
      problematic to their unique situation. In addition to attending the sessions, the
      participants will be asked to rate the sessions and asked about how useful they were in
      helping to achieve goals. This involves the completion of some written questionnaires and
      will take about a half hour.

      Sample Assessment and Treatment Schedule Session Description

        1. Assessment session approximately one and a half hours long. Combination of
           questionnaires and goal setting interview. Baseline testing of 3 goals.

        2. Treatment session + 2 surveys, approximately one hour long.

        3. Treatment session 3, approximately one hour long.

        4. Treatment session 4, approximately one hour long.

        5. Treatment session 5, approximately one hour long.

        6. Treatment session 6, approximately one hour long.

        7. Treatment session 7, approximately one hour long.

        8. Treatment session 8, approximately one hour long.

        9. Treatment session 9, approximately one hour long.

       10. Treatment session 10, followed by first post-intervention assessments, approximately 2
           hours long.
    

Intervention name(s): Post-ICU Problem Solving
Intervention type(s): Behavioral
Intervention description(s): We have adapted the Cognitive Orientation to Daily Occupational Performance (CO-OP) as the Post-ICU Problem Solving intervention to be delivered in the home to patients following an illness that required an ICU stay. CO-OP is a form of meta-cognitive strategy training that teaches individuals to identify and prioritize problematic daily activities, identify barriers impeding performance, generate and evaluate strategies addressing these barriers, and generalize learning through practice. Thus, strategy training teaches skills that can be used to address disability in "real-life" activities, and is integral to personalized rehabilitation services. CO-OP has been adapted in numerous settings and most recently, it is being utilized successfully in patients with acquired cognitive dysfunction following acute stroke. This represents a useful intervention, tested in similar populations with minimal risk to the participants and potential for maximal benefit for this population.
Other intervention name(s): PIC-UPS
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups randomized to treatment (Post-ICU problem solving program) or usual care (no Post-ICU problem solving program).
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Post-ICU Syndrome; Recovery; Home Discharge; Problem Solving; Adaptation