Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial

Elizabeth King; Nicola Wyer; Dalia Barghouthy; Ellen Reynolds; Holly Richardson; Miles Negus-Fancey; Louise Gallie; Zudin Puthucheary; Owen Gustafson; David McWilliams

doi:10.1016/j.eclinm.2026.104085

Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial

Elizabeth King
, Nicola Wyer
, Dalia Barghouthy
, Ellen Reynolds
, Holly Richardson
, Miles Negus-Fancey
, Louise Gallie
, Zudin Puthucheary
, Owen Gustafson
, David McWilliams

Centre for Healthcare and Community Transformation

Oxford University Hospitals NHS Foundation Trust
University of Oxford
University Hospitals Coventry and Warwickshire NHS Trust
William Harvey Research Institute
Queen Mary University of London
The Royal London Hospital

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Recovery after critical illness is complex and multi-faceted. There are widespread variations of rehabilitation interventions delivered when patients step-down onto the ward. The aim of the study was to evaluate the acceptability of a structured, individualised physiotherapy and nutritional intervention delivered to patients following discharge from intensive care, from the perspectives of both patients and healthcare professionals.

Methods This qualitative study was embedded within a two-centre randomised controlled feasibility trial of an enhanced physiotherapy and optimised nutrition intervention delivered in the ward setting after ICU discharge. It evaluated acceptability, a pre-specified co-primary feasibility outcome of the trial. Between May 2024 and January 2025, patients stepped down from ICU to ward based care, alongside healthcare professionals involved in or affected by intervention delivery were invited to participate. Semi-structured interviews were conducted, audio recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Themes were then mapped across the constructs of the Theoretical Framework of Acceptability (TFA). The trial was prospectively registered (ClinicalTrials.gov NCT06159868).

Findings Eleven patients and eight healthcare professionals participated in interviews. Three overarching themes were identified. ‘Increased awareness of combined nutrition and physical recovery’ focused on recognition of the complementary nature of nutritional intake and rehabilitation progress. The second theme–‘Accurate nutritional goals to enable focused rehab’ emphasised the need for individualised nutritional prescriptions to underpin rehabilitation. The final theme–‘Supporting patient recovery to restore independence and purpose’ highlighted the need for a holistic recovery following critical illness. These themes were mapped to six of the seven TFA constructs.

Interpretation Both patients and staff perceived the integrated physiotherapy and nutrition delivered in the ward setting as acceptable.

Original language	English
Article number	104085
Number of pages	10
Journal	eClinicalMedicine
Volume	98
Early online date	20 Jul 2026
DOIs	https://doi.org/10.1016/j.eclinm.2026.104085
Publication status	Published - Aug 2026

Bibliographical note

This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).

Funding

This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR205370).

Funders
National Institute for Health and Care Research

Keywords

Intensive care unit
Rehabilitation
Nutrition
Critical illness
Survivorship

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10.1016/j.eclinm.2026.104085

1-s2.0-S258953702600338X-mainFinal published version, 645 KBLicence: CC BY

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King, E., Wyer, N., Barghouthy, D., Reynolds, E., Richardson, H., Negus-Fancey, M., Gallie, L., Puthucheary, Z., Gustafson, O., & McWilliams, D. (2026). Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial. eClinicalMedicine, 98, Article 104085. https://doi.org/10.1016/j.eclinm.2026.104085

Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial. / King, Elizabeth; Wyer, Nicola; Barghouthy, Dalia et al.
In: eClinicalMedicine, Vol. 98, 104085, 08.2026.

Research output: Contribution to journal › Article › peer-review

King, E, Wyer, N, Barghouthy, D, Reynolds, E, Richardson, H, Negus-Fancey, M, Gallie, L, Puthucheary, Z, Gustafson, O & McWilliams, D 2026, 'Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial', eClinicalMedicine, vol. 98, 104085. https://doi.org/10.1016/j.eclinm.2026.104085

King E, Wyer N, Barghouthy D, Reynolds E, Richardson H, Negus-Fancey M et al. Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial. eClinicalMedicine. 2026 Aug;98:104085. Epub 2026 Jul 20. doi: 10.1016/j.eclinm.2026.104085

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abstract = "Background Recovery after critical illness is complex and multi-faceted. There are widespread variations of rehabilitation interventions delivered when patients step-down onto the ward. The aim of the study was to evaluate the acceptability of a structured, individualised physiotherapy and nutritional intervention delivered to patients following discharge from intensive care, from the perspectives of both patients and healthcare professionals. Methods This qualitative study was embedded within a two-centre randomised controlled feasibility trial of an enhanced physiotherapy and optimised nutrition intervention delivered in the ward setting after ICU discharge. It evaluated acceptability, a pre-specified co-primary feasibility outcome of the trial. Between May 2024 and January 2025, patients stepped down from ICU to ward based care, alongside healthcare professionals involved in or affected by intervention delivery were invited to participate. Semi-structured interviews were conducted, audio recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Themes were then mapped across the constructs of the Theoretical Framework of Acceptability (TFA). The trial was prospectively registered (ClinicalTrials.gov NCT06159868). Findings Eleven patients and eight healthcare professionals participated in interviews. Three overarching themes were identified. {\textquoteleft}Increased awareness of combined nutrition and physical recovery{\textquoteright} focused on recognition of the complementary nature of nutritional intake and rehabilitation progress. The second theme–{\textquoteleft}Accurate nutritional goals to enable focused rehab{\textquoteright} emphasised the need for individualised nutritional prescriptions to underpin rehabilitation. The final theme–{\textquoteleft}Supporting patient recovery to restore independence and purpose{\textquoteright} highlighted the need for a holistic recovery following critical illness. These themes were mapped to six of the seven TFA constructs. Interpretation Both patients and staff perceived the integrated physiotherapy and nutrition delivered in the ward setting as acceptable.",

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author = "Elizabeth King and Nicola Wyer and Dalia Barghouthy and Ellen Reynolds and Holly Richardson and Miles Negus-Fancey and Louise Gallie and Zudin Puthucheary and Owen Gustafson and David McWilliams",

note = "This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).",

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T2 - a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial

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AU - Wyer, Nicola

AU - Barghouthy, Dalia

AU - Reynolds, Ellen

AU - Richardson, Holly

AU - Negus-Fancey, Miles

AU - Gallie, Louise

AU - Puthucheary, Zudin

AU - Gustafson, Owen

AU - McWilliams, David

N1 - This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

PY - 2026/8

Y1 - 2026/8

N2 - Background Recovery after critical illness is complex and multi-faceted. There are widespread variations of rehabilitation interventions delivered when patients step-down onto the ward. The aim of the study was to evaluate the acceptability of a structured, individualised physiotherapy and nutritional intervention delivered to patients following discharge from intensive care, from the perspectives of both patients and healthcare professionals. Methods This qualitative study was embedded within a two-centre randomised controlled feasibility trial of an enhanced physiotherapy and optimised nutrition intervention delivered in the ward setting after ICU discharge. It evaluated acceptability, a pre-specified co-primary feasibility outcome of the trial. Between May 2024 and January 2025, patients stepped down from ICU to ward based care, alongside healthcare professionals involved in or affected by intervention delivery were invited to participate. Semi-structured interviews were conducted, audio recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Themes were then mapped across the constructs of the Theoretical Framework of Acceptability (TFA). The trial was prospectively registered (ClinicalTrials.gov NCT06159868). Findings Eleven patients and eight healthcare professionals participated in interviews. Three overarching themes were identified. ‘Increased awareness of combined nutrition and physical recovery’ focused on recognition of the complementary nature of nutritional intake and rehabilitation progress. The second theme–‘Accurate nutritional goals to enable focused rehab’ emphasised the need for individualised nutritional prescriptions to underpin rehabilitation. The final theme–‘Supporting patient recovery to restore independence and purpose’ highlighted the need for a holistic recovery following critical illness. These themes were mapped to six of the seven TFA constructs. Interpretation Both patients and staff perceived the integrated physiotherapy and nutrition delivered in the ward setting as acceptable.

AB - Background Recovery after critical illness is complex and multi-faceted. There are widespread variations of rehabilitation interventions delivered when patients step-down onto the ward. The aim of the study was to evaluate the acceptability of a structured, individualised physiotherapy and nutritional intervention delivered to patients following discharge from intensive care, from the perspectives of both patients and healthcare professionals. Methods This qualitative study was embedded within a two-centre randomised controlled feasibility trial of an enhanced physiotherapy and optimised nutrition intervention delivered in the ward setting after ICU discharge. It evaluated acceptability, a pre-specified co-primary feasibility outcome of the trial. Between May 2024 and January 2025, patients stepped down from ICU to ward based care, alongside healthcare professionals involved in or affected by intervention delivery were invited to participate. Semi-structured interviews were conducted, audio recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Themes were then mapped across the constructs of the Theoretical Framework of Acceptability (TFA). The trial was prospectively registered (ClinicalTrials.gov NCT06159868). Findings Eleven patients and eight healthcare professionals participated in interviews. Three overarching themes were identified. ‘Increased awareness of combined nutrition and physical recovery’ focused on recognition of the complementary nature of nutritional intake and rehabilitation progress. The second theme–‘Accurate nutritional goals to enable focused rehab’ emphasised the need for individualised nutritional prescriptions to underpin rehabilitation. The final theme–‘Supporting patient recovery to restore independence and purpose’ highlighted the need for a holistic recovery following critical illness. These themes were mapped to six of the seven TFA constructs. Interpretation Both patients and staff perceived the integrated physiotherapy and nutrition delivered in the ward setting as acceptable.

KW - Intensive care unit

KW - Rehabilitation

KW - Nutrition

KW - Critical illness

KW - Survivorship

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DO - 10.1016/j.eclinm.2026.104085

M3 - Article

SN - 2589-5370

VL - 98

JO - eClinicalMedicine

JF - eClinicalMedicine

M1 - 104085

ER -

Patient and clinician acceptability of an integrated physiotherapy and nutrition intervention after ICU discharge: a qualitative exploration of a pre-specified co-primary feasibility outcome of the PHOENIX trial

Abstract

Bibliographical note

Funding

Keywords

Access to Document

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