Associations of participation focused strategies and rehabilitation service use with caregiver stress following pediatric critical illness

Publication date: Available online 19 December 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jessica M. Jarvis, Karen Choong, Mary A. Khetani

Abstract

Objective

(s). Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over six months post-PICU discharge.

Design

Sub-study of a data from Wee-Cover, a prospective cohort study.Setting. Two PICU sites.

Participants

Caregivers (N = 168) of children 1-17 years old admitted into a PICU for > 48 hours.

Main Outcome Measures

Data were collected from caregivers at enrollment and 3 and 6 months post-PICU discharge. Caregiver stress was assessed using the Pediatric Inventory for Parents. Having strategies to support their child's participation in home-based activities was assessed using the Participation and Environment Measure (PEM). In PEM, caregivers report on strategies used to support their child's participation in home-based activities. Data were dichotomized (yes, no) to denote having participation-focused strategies and if their child received PICU rehabilitation services. Additional covariates were history of a pre-existing condition, child age, length of PICU stay, and change in functional capacities at PICU discharge.

Results

History of a pre-existing condition, time, and change in functional capacities significantly predicted caregiver stress frequency and difficulty. The interaction of having strategies-by-rehabilitation-by-time significantly predicted caregiver stress frequency and difficulty.

Conclusion(s). Results highlight the role of early rehabilitation and the importance of working with caregivers to develop participation-focused strategies to support their child's functioning post-PICU. Families of children with a pre-existing condition or those who experience a decrease in function during a PICU stay are susceptible to higher levels of stress and may be a priority population to target for rehabilitation services.

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