{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:00:20Z","timestamp":1780491620220,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.19340.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000}},{"DOI":"10.12688\/wellcomeopenres.19340.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000}},{"DOI":"10.12688\/wellcomeopenres.19340.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000}}],"reference-count":38,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","award":["215522"],"award-info":[{"award-number":["215522"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health Mission, Odisha, India","award":["NHM\/PIP\/2020-21"],"award-info":[{"award-number":["NHM\/PIP\/2020-21"]}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Background The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients. Methods The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders\u2019 experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention. Results The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future. Conclusions Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.19340.4","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T14:15:21Z","timestamp":1740752121000},"page":"285","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["AIIMS ICU Rehabilitation (AIR): development and description of intervention for home rehabilitation of chronically ill tracheostomized patients"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5315-6477","authenticated-orcid":false,"given":"Swagata","family":"Tripathy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5438-4722","authenticated-orcid":false,"given":"Asha P.","family":"Shetty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5703-4135","authenticated-orcid":false,"given":"Upendra","family":"Hansda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanda Kumar","family":"P","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5006-5513","authenticated-orcid":false,"given":"Alok Kumar","family":"Sahoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahalingam","family":"V","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7712-0057","authenticated-orcid":false,"given":"Sujata","family":"Mahapatra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanta Kumar","family":"Mitra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Bhaskar","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasturi","family":"Sanyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itimayee","family":"Panda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1758-2900","authenticated-orcid":false,"given":"Guruprasad","family":"N","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagannath","family":"Sahoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Eborral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2707-2779","authenticated-orcid":false,"given":"Nazir","family":"Lone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8288-449X","authenticated-orcid":false,"given":"Rashan","family":"Haniffa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7046-1580","authenticated-orcid":false,"given":"Abi","family":"Beane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"151-158","DOI":"10.1016\/j.pulmoe.2019.09.006","article-title":"Prevalence 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indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-285\/v3#referee-response-104190","order":2,"name":"referee-response-104190","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Swagata Tripathy<\/b>; \n<i>Posted: 23 Jan 2025<\/i>; We thank the reviewer for their valuable insights and comments. A point to point response follows, with a edits incorporated in the revised&nbsp;&nbsp;manuscript &nbsp;Page 1 \u2022&nbsp;&nbsp; &nbsp;Is \u201cchronically ill\u201d ever defined? Can one have a tracheostomy and be well?&nbsp; \n<i><b>Response: <\/b>I understand the reviewers concern. Our team has debated with this concept, in an effort to identify the most appropriate term. There is a fairly large subset of patients who get tracheostomies for airway obstruction, post-surgery for cancer etc, who are mobile and not bed ridden. Therefore, we have carefully chosen this terminology to better describe the population which we are targeting.<\/i> \n<i>As mentioned in the manuscript, this is an accepted definition- &quot;. These patients who have survived a period of acute illness but are not yet free from life-sustaining therapies are referred to as chronic critically ill (CCI).&nbsp; The consensus definition for CCI combines two factors: care received in the ICU for at least eight days and at least one out of five eligible conditions (prolonged mechanical ventilation (MV); tracheostomy; sepsis; severe wounds and\/or multiple organ failure; ischemic stroke, intracerebral haemorrhage or traumatic brain injury) 2. Prolonged need for mechanical ventilation due to cardiopulmonary disease and inability to protect the airway due to neurological dysfunction or brain injury are the main reasons for tracheostomy in the CC&quot;<\/i>  Although I appreciate this phrase is used in the title and throughout the manuscript might it not be more appropriate to frame this as \u201cpatients discharged from hospital with long term tracheostomies\u201d particularly as the diagnoses of the patient group are never defined or specified. \n<i><b>Response: <\/b>We hope the reference provided and the definition will describe our cohort. See response above.<\/i>  Page 2 \u2022&nbsp;&nbsp; &nbsp;What is \u201cPatients-carer\u201d? Does this refer to patients and carers? \n<i><b>Response: <\/b>Yes, the dyad of the patient and their carer as a composite has been referred to as a patient-carer.<\/i>  Page 4 \u2022&nbsp;&nbsp; &nbsp;\u201creferred to as the chronic critically ill (CCI)\u201d \u2013 is there a reference for this statement \n<i><b>Response: <\/b>Consensus definition for CCI combines two factors: care received in the ICU for at least eight days, and at least one out of five eligible conditions (prolonged mechanical ventilation (MV); tracheostomy; sepsis; severe wounds and\/or multiple organ failure; ischemic stroke, intracerebral haemorrhage or traumatic brain injury) 2 . Reference- Number 2- Carson SS: Conference Proceedings Definitions and Epidemiology of the Chronically Critically Ill. Introduction Definitions of Chronic Critical Illness Defining CCI by Tracheostomy Prolonged Mechanical Ventilation Long-Term Mechanical Ventilation Composite Definitions Epidemiology of Chronic Critical Illness Outcomes Summary.2012.<\/i> \n<i>\u2022&nbsp;&nbsp; &nbsp;\u201cProlonged need for mechanical ventilation due to cardiopulmonary disease, inability to protect the airway due to neurological dysfunction or brain injury are the main reasons for tracheostomy in the CCI.\u201d \u2013 again, needs a reference Thank you for pointing out that the refernce is missing here. The reference is the same as the preceding sentence. We have now mentioned this in the manuscript.<\/i>  \u2022&nbsp;&nbsp; &nbsp;\u201cThe implications and outcomes (including cost) following protracted ICU stay are potentially devastating for patients and their families. Reasons for this include limited availability of and access to rehabilitation services, lower baseline health literacy, concomitant infections in the presence of antibiotic resistance, and spiralling financial burden associated with healthcare costs and loss of income\u201d \u2013 this needs rewriting so that it refers to specifically LMICs, antibiotic resistance is not really relevant and it would be worth emphasising the loss of income of family members needing to adopt caring roles. \n<i><b>Response: <\/b>&nbsp;We appreciate the suggestion. The statement has been modified to refer specifically to LMICs.<\/i>  \u2022&nbsp;&nbsp; &nbsp;\u201cCauses put forth\u201d \u2013 suggest add a word to make; \u201ccauses for lack of successful implementation put forth\u201d \n<i><b>Response:&nbsp;<\/b>Revised as suggested.<\/i> \u2022&nbsp;&nbsp; &nbsp;\u201cIn many instances\u201d \u2013 do you mean in many current instances (of other models)? \n<i><b>Response:&nbsp;<\/b>We meant &nbsp;\u2018In many instances (of published reports)\u2019. This has now been added.<\/i>  Page 6 \u2022&nbsp;&nbsp; &nbsp;\u201cST,JM,BR,UH, all intensive care physicians, noting repeated readmissions of tracheostomised patients discharged from the ICU due to hospital acquired infections, conducted an audit of hospital length of stay of inpatients. The results demonstrated unusually protracted lengths of stay for adult tracheostomised in comparison to non-tracheostomised patients\u201d \u2013 could you clarify this? Does this mean re-admissions to the ITU from general wards (Hospital acquired infections)? Or from home? Does admission length refer to re-admissions or admissions in general? There is no further reference to hospital or ICU re-admission (although this would be a good outcome measure \n<i><b>Response:&nbsp;<\/b>We have now rewritten the paragraph to clarify it. \u201c. ST,JM,BR,UH, all intensive care physicians, noting repeated readmissions of tracheostomised patients discharged from the ICU (from the hospital wards after step down) due to hospital acquired infections, conducted an audit of hospital length of stay of inpatients. The results demonstrated unusually protracted lengths of stay for adult tracheostomised with greater readmissions to the ICUs in comparison to non-tracheostomised patients\u201d Although we have not referenced ICU\/ hospital readmissions further, the LOGIC diagram and intervention programme theory focused to reduced length of stay and and decreased nosocomial infections, which we considered a representative measure in the intervention development stage. As correctly pointed out, ICU\/ hospital readmissions is a good outcome measure and we are measuring it presently in the ongoing Intervention Effectiveness Evaluation phase.<\/i>  Page 7 \u2022&nbsp;&nbsp; &nbsp;There are different qualitative methodologies referred to e.g \u201crealist review\u201d, \u201cinterpretative analysis\u201d; these require references so that readers can understand what they are.&nbsp; \n<i>References have been added as suggested.<\/i> \u2022&nbsp;&nbsp; &nbsp;If I have read the methods correctly, did the authors undertake a systematic review (albeit realist)? &nbsp;- this requires more description of search terms \/ strategies and results, as it is this appears not be properly described or explained. \n<i><b>Response:&nbsp;<\/b>The realist review was an extensive undertaking and is in the process of manuscript preparation presently. Detailed description will be beyond the purview of this manuscript. However, &nbsp; the methodology, databases referenced and search terms appear in the review protocol, for which we have provided the details so the interested reader may refer further.&nbsp; PROSPERO registration ID- CRD42022347389<\/i>  Page 8 \u2022&nbsp;&nbsp; &nbsp;I\u2019m not sure that \u201cstakeholder engagement\u201d in the sense of co-design or dissemination is really whats being described here. Suggest reviewing this as congratulating participants isn\u2019t the same as engaging them. \n<i><b>Response:&nbsp;<\/b>We wish to humbly differ here , and point out that stakeholder engagement refers to a broad variety of activities, although codesign and dissemination are among them.&nbsp; \u201cStakeholder engagement can be defined as practices that the organization undertakes to involve stakeholders in organizational projects or activities (Greenwood 2007).\u201d We believe the exercises mentioned truly encouraged cross engagement among all stakeholders and not only congratulated them.&nbsp;<\/i>  Page 9 \u2022&nbsp;&nbsp; &nbsp;As above \u201cFindings from literature review and codesign exercises\u201d needs more explanation. \n<i><b>Response:&nbsp;<\/b>Expanded.<\/i>  Page 10 \u2022&nbsp;&nbsp; &nbsp;\u201ceach carer was explained the need for the procedures (training modules) and then \u2022&nbsp;&nbsp; &nbsp;demonstrated the correct steps\u201d \u2013 suggest change to \u201ceach carer was educated in the need\u2026. And then shown the correct steps\u201d \u2022&nbsp;&nbsp; &nbsp;\u201cto score his confidence\u201d \u2013 suggest change to their confidence \n<i><b>Response:&nbsp;<\/b>Both suggested modifications are incorporated.<\/i> Page 11  \u2022&nbsp;&nbsp; &nbsp;Training rather than trainings \n<i><b>Response:&nbsp;<\/b><\/i>Revised as suggested.  \u2022&nbsp;&nbsp; &nbsp;On the mHealth diagram, discharge advice rather than advise \n<i><b>Response:&nbsp;<\/b><\/i>Corrected Page 14  \u2022&nbsp;&nbsp; &nbsp;\u201cof a superstition of \u2018the evil- eye\u2019 among some carers\u201d \u2013 could this be described or some sort of reference given? \n<i><b>Response:&nbsp;<\/b><\/i>&nbsp;Added  Page 15 \u2022&nbsp;&nbsp; &nbsp;The conclusion could be a bit stronger \/ more positive. Developing a novel tool for this challenging issue which could be utilised much more widely is worth stating with more confidence! \n<i><b>Response:&nbsp;<\/b><\/i>Thank you, we have now revised the conclusion .","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-285\/v4#referee-comment-6012","order":3,"name":"referee-comment-6012","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This research was supported by the National Health Mission Odisha (PI ST)  (NHM\/PIP\/2020-21) and Wellcome-funded Collaboration for Research, Training, and Implementation in Critical Care in Asia and Africa (215522, <a href=https:\/\/doi.org\/10.35802\/215522>https:\/\/doi.org\/10.35802\/215522<\/a>) (PI RH and AB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}