14 CHAPTER 1 aftercare initiatives are accessible for all patients and caretakers, independent of mobility challenges, to improve quality of (after)care. AIM AND OUTLINE OF THE THESIS To improve the quality of aftercare of ICU-survivors and their informal caregivers in the northern part of the Netherlands, the Medical Centre Leeuwarden initiated a specialised post-ICU outpatient clinic in 2012. From this moment on, long-term ICU-patients, i.e. patients with a LOS/duration of mechanical ventilation of at least 48 hours, were invited to visit the clinic with their informal caregivers, if desired. To further investigate ways to improve the aftercare trajectory, the transdisciplinary project leading to this thesis was initiated. The general aim of this thesis is to describe the road to recovery after critical illness in long-term ICU-patients. This thesis specifically investigates which patients are at risk of limited recovery throughout the first year after discharge and looks for possible targets for future interventional research. In this thesis, the extensive consequences of critical illness for patients and their informal caregivers are assessed (part 1), the incidence and consequences ofmalnutrition and frailty in ICU-patients are investigated (part 2), and results of interdisciplinary initiatives to improve recovery are reported (part 3). At the end of part 3, a leap into the future of accessible aftercare is taken with a user-centred Virtual Reality game for physical rehabilitation during and after ICU-admission.
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