Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial.

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

A framework for the transformation of the creative industries in a digital age.

The creative industries sector faces a constantly changing context characterised by the speed of the development and deployment of digital information systems and Information Communications Technologies (ICT) on a global scale. This continuous digital disruption has had significant impact on the whole value chain of the sector: creation and production; discovery and distribution; and consumption of cultural goods and services. As a result, creative enterprises must evolve business and operational models and practices to be sustainable. Enterprises of all scales, type, and operational model are affected, and all sectors face ongoing digital disruption. Management consultancy practitioners and business strategy academics have called for new strategy development frameworks and toolkits, fit for a continuously changing world. This thesis investigates a novel approach to organisational change appropriate to the digital age, in the context of the creative sector in Scotland. A set of concepts, methods, tools, and processes to generate theoretical learning and practical knowing was created to support enterprises to digitally adapt through undertaking journeys of change and organisational development. The framework is called The AmbITion Approach. It was developed by blending participatory action research (PAR) methods and modern management consultancy, design, and creative practices. Empirical work also introduced to the framework Coghlan and Rashford’s change categories. These enabled the definition and description of the extent to which organisations developed: whether they experienced first order (change), second order (adaptation) or third order (transformation) change. Digital research tools for inquiry were tested by a pilot study, and then embedded in a longitudinal study over two years of twentyone participant organisations from Scotland’s creative sector. The author applied and investigated the novel approach in a national digital development programme for Scotland’s creative industries. The programme was designed and delivered by the author and ran nationally between 2012-14. Detailed grounded thematic analysis of the data corpus was undertaken, along with analysis of rich media case studies produced by the organisations about their change journeys. The results of studies on participants, and validation criteria applied to the results, demonstrated that the framework triggers second (adaptation) and third order change (transformation) in creative industry enterprises. The AmbITion Approach framework is suitable for the continuing landscape of digital disruption within the creative sector. The thesis contributes to practice the concepts, methods, tools, and processes of The AmbITion Approach, which have been empirically tested in the field, and validated as a new framework for business transformation in a digital age. The thesis contributes to knowledge a theoretical and conceptual framework with a specific set of constructs and criteria that define first, second, and third order change in creative enterprises, and a robust research and action framework for the analysis of the quality, validity and change achieved by action research based development programmes. The thesis additionally contributes to the practice of research, adding to our understanding of the value of PAR and design thinking approaches and creative practices as methods for change.