Feasibility and acceptability of family- led rehabilitation program for patients with tetanus

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Patients with tetanus form the largest group of critically ill patients at the Hospital for Tropical Diseases (HTD), staying an average of 3 weeks in the intensive care unit and often several months in the hospital. They suffer from muscle loss, weakness, and long-term disability related to this. Currently, there are no rehabilitation facilities for these patients at HTD and high-income country models of care are expensive and unfeasible in such a setting. The principal aim of this project is to engage with non-academic stakeholders to design and implement a healthcare worker and carer partnership to deliver a rehabilitation program for patients with tetanus, evaluating the feasibility, sustainability, and acceptability of this approach.

Design and producing materials

We completed the participatory design of a rehabilitation program for patients with tetanus. This involved a multidisciplinary team of experts in rehabilitation and tetanus for the initial design. Printed material and a video of the exercises were designed and produced, using feedback from patients, carers, and healthcare workers. These were used to support the feasibility study in which 30 patients were enrolled. Patients underwent the planned rehabilitation programme. This involved healthcare workers, the study team, and carers. The number of exercises performed was recorded. Interviews with patients, carers, and healthcare workers allowed for a more in-depth understanding of the barriers and benefits of this program.

We won a prize!

This engagement project was presented as part of a wider ICU rehabilitation project at the Australia and New Zealand Intensive Care Meeting in Singapore in April 2019. Dr. Kim Anh of the Adult Intensive Care Unit (AICU) won the best poster prize for her report on this work, and this approach received a lot of interest from other medics at the conference. A poster presentation and oral presentation of the project were also given at the Asia Pacific Early Mobilization in ICU conference in Malaysia in August 2019. We have evaluated the acceptability of the program with short interviews and staff and patients are very supportive and enthusiastic about the program. Patients feel there are many benefits to printed material and videos.