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Completed

NCT Number: NCT03972384

A Problem Solving Intervention for Post-ICU Cognitive Impairment in Older Adults

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.

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Key information

Conditions

Critical Illness Cognition Disorders Cognitive Dysfunction Cognitive Impairment Confusion Delirium Disease Attributes Mechanical Ventilation Complication Mental Disorders Nervous System Diseases Neurobehavioral Manifestations Neurocognitive Disorders Neurologic Manifestations Pathologic Processes Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

55 year–89 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

The Ohio State University College of Nursing

Columbus, Ohio, 43231, United States

About this study

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

  • Assessment session approximately one and a half hours long. Combination of questionnaires and goal setting interview. Baseline testing of 3 goals.
  • Treatment session + 2 surveys, approximately one hour long.
  • Treatment session 3, approximately one hour long.
  • Treatment session 4, approximately one hour long.
  • Treatment session 5, approximately one hour long.
  • Treatment session 6, approximately one hour long.
  • Treatment session 7, approximately one hour long.
  • Treatment session 8, approximately one hour long.
  • Treatment session 9, approximately one hour long.
  • Treatment session 10, followed by first post-intervention assessments, approximately 2 hours long.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • >55 years old
  • discharged home following an ICU stay,
  • reside at home and were functionally independent prior to admission to the ICU based on family report,
  • speak and read English,
  • mechanically ventilated for at least 48 hours,
  • have more than one positive clinical measurement of delirium during the ICU stay,
  • Montreal Cognitive Assessment score (MoCA) between 25-17.

Exclusion criteria

  • Pre-illness diagnosis of dementia or pre-morbid cognitive impairment (IQCODE score >3.51);
  • profound uncorrected visual or hearing impairment that precludes use of the telephone;
  • psychiatric condition that precludes full participation in the intervention;
  • substance abuse as measured by cut-off score of 2 on CAGE-Substance Abuse Screening Tool;
  • discharge to hospice care.

Treatment and study plan

Post-ICU Problem Solving

Behavioral

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 names: PIC-UPS

Primary outcomes

  1. Change of Cognitive function as measured by Self-Administered Gerocognitive Examination

    Time frame: Week 1 and week 12

    Measure of the program's effect on Cognitive Function as measured using the Self-Administered Gerocognitive examination (SAGE) The maximum score is 22. A score of 17 and above is considered normal.

  2. Change in development of Chronic Illness self management practices(as measured by Self-Efficacy Scale)

    Time frame: Week 2 and Week 12

    Determine the program's effect on Chronic Illness self- management as measured by the Self-Efficacy to Manage Chronic Disease Scale which is made up of 6-items on a visual analog scale, ranging from 1 (not at all confident) to 10 (totally confident).

  3. Change in medication adherence practices (as measured by Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE))

    Time frame: Week 2 and Week 12

    Measure change in medication Adherence by using the MedMaIDE scale that contains a maximum total score of 13.

  4. Change in participant's rate of depression as measured by Patient Health Questionnaire - 2)

    Time frame: Week 1 and Week 12

    Measure of the program's effect on rate of depression

  5. Change in anxiety levels as measured by Geriatric Anxiety Scale (GAS)

    Time frame: Week 1 and Week 12

    Measure change in participant's anxiety levels as measured by Geriatric Anxiety Scale that contains 10 questions on anxiety with a scoring scale of 1-6 = Minimal; 7-9 = Mild, 10 = Moderate; 12-30 = Severe.

  6. Change in depression levels as measured by Geriatric Depression Scale (GDS)

    Time frame: Week 1 and Week 12

    Measure change in participant's depression levels as measured by Geriatric Depression Scale that contains 15 questions on depression. A score of 5 or more suggests depression.

  7. Change in Health related Quality of Life by a Short Form Health Survey - 36

    Time frame: Week 1 and Week 12

    Measures Health Related Quality of Life

  8. Assess the effect of the Post-Intensive Care Problem Solving program through intervention completion rates

    Time frame: 15 months

    Assess the effect of the Post-intensive care program through intervention completion rates.

  9. Access change in participant use of the health system

    Time frame: Week 12

    Access change in frequency of use of health system by use of the health system by number of times the study participatns use emergency department services, phone calls to physicians.

  10. Assess change in functional independence when performing activities of daily living as measured by the Katz Activities of Daily Living Scale.

    Time frame: Week 1 and Week 12

    Measure change in participant's functional independence when performing activities of daily living using the Katz Activities of Daily Living Scale. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment.

  11. Assess change in functional independence when performing instrumental activities of daily living using the Lawton Instrumental Activities of Daily Living.

    Time frame: Week 1 and Week 12

    Assess changes in functional independence when performing instrumental activities of daily living using the Lawton Instrumental Activities of Daily Living. There are eight domains of function measured with the Lawton IADL scale.

    Women are scored on all 8 areas of function; historically, for men, the areas of food preparation, housekeeping, laundering are excluded.

    Clients are scored according to their highest level of functioning in that category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women, and 0 through 5 for men.

Sponsors and collaborators

Lead sponsor

Ohio State University

Other

Registry information

Acronym: PIC-UPS

Important dates

Study start
2022
Primary completion
2023
Study completion
2023
First posted
Jun 3, 2019
Registry last updated
Sep 25, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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