Factors influencing the acceptability of remote multicomponent rehabilitation versus standard care following critical illness: a theory-informed qualitative study embedded within the iRehab trial.

BACKGROUND

Adults who survive critical illness requiring mechanical ventilation frequently experience prolonged physical, psychological, and social difficulties following discharge, yet access to structured recovery support remains variable. This study explored how ICU survivors and staff perceived the acceptability of a remote multicomponent rehabilitation programme versus standard care following discharge from critical care.

METHODS

A theory-informed qualitative interview study was conducted, guided by the Theoretical Framework of Acceptability. ICU survivors who received either remote multicomponent rehabilitation or standard care, alongside staff involved in delivery, were purposively sampled from a pragmatic UK trial (iRehab) across 24 hospital sites. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis. Thirty-five ICU survivors and six staff members participated in interviews conducted between January 2023 and June 2025.

RESULTS

Eight inter-related themes captured the factors shaping acceptability during recovery after ICU discharge. Participants who received remote multicomponent rehabilitation generally found it acceptable, as it provided structure, continuity, and support for confidence-building and self-management. In contrast, standard care was often experienced as lacking coordination and follow-up, leaving individuals to navigate recovery with limited support. However, acceptability was not experienced in the same way by all participants. Digital delivery and optional components, such as peer support, were valued by many but not by everyone, depending on readiness, context, and capability.

CONCLUSIONS

Remote multicomponent rehabilitation was valued for its structure, continuity, and support, while standard care was often experienced as lacking these features. Acceptability of support was shaped by how well it aligned with survivors' needs and contexts. These findings support the integration of structured, flexible rehabilitation pathways into post-ICU care. Trial registration ISRCTN11266403; registered 26 July 2022.