A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Using an Outdoor Learning Space to Teach Sustainability and Material Processes in HE product Design.

The world is facing environmental changes that are increasingly affecting how we think about manufacturing, the consumption of products and use of resources. Within the HE product design community, thinking and designing sustainability’ has evolved to become a natural part of the curriculum. Paradoxical as the rise in awareness of sustainability increases there is growing concern within HE product design of the loss of workshop facilities and as a consequence a demise in teaching traditional object-making skills and material experimentation. We suggest the loss of workshops and tangible ‘learning by making skills’ also creates a lost opportunity for a rich learning resource to address sustainable thinking, design and manufacture ‘praxis’ within HE design education. Furthermore, as learning spaces are frequently discussed in design research, there seems to be little focus on how the use of an outdoor environment might influence learning outcomes particularly with regard to material teaching and sustainability. This 'case study' of two jewellery workshops, used outdoor learning spaces to explore both its impact on learning outcomes and to introduce some key principles of sustainable working methodologies and practices. Academics and students mainly from Norway and Scotland collaborated on this international research project. Participants made models from disposable packaging materials, which were cast in tin, in the sand on a local beach, using found timber to create a heat source for melting the metal. This approach of using traditional making skills, materials and nature was found to be a relevant contribution to a sustainable discourse.