Predicting Physical Function and Health Related Quality of Life Following Intensive Care

Kimberley Haines

doi:10.4172/2329-9096.1000180

Abstract

Objective: This study investigated how well the Functional Comorbity Index (FCI) predicts patient reported physical function compared with objective physical function measures, return to home and health related quality of life (HRQoL) of survivors of a general intensive care unit (ICU) cohort at 12 months post ICU discharge. This study also investigated how well ICU physiotherapists and physicians predict mortality, return to home and HRQoL of survivors at 12 months post ICU discharge. Design: Prospective observational cohort study nested within a larger trial. FCI calculated at ICU admission and compared with patient reported physical function (SF36 version 2 Physical Component Score) and objective physical function measures (Six-Minute Walk Test, Timed Up and Go) at 12 months. ICU clinicians completed a four-item questionnaire at patient discharge from ICU predicting mortality, return to home and HRQoL and these were compared with 12-month patient outcomes. Setting: 18-bed closed mixed medical/surgical, tertiary ICU in a university teaching hospital in Melbourne, Australia. Participants: 34 ICU patients. 11 ICU clinicians (5 physicians and 6 physiotherapists) who were caring for the patients on day of discharge from ICU. Results: The correlations between the FCI and 12-month objective measures of physical performance were small (6MWT rho 0. 02, TUG rho 0. 15). The FCI had a large correlation with patient reported physical function (SF36 version 2 rho -0. 60). The sensitivity of the physicians’ predictions for mortality was the highest [83% (78-91%)], whilst the physiotherapists’ predictions had the greatest specificity [100% (89-100%)]. All clinicians were comparable in their predictions of who would return home. Physicians were more accurate than physiotherapists in predicting future HRQoL (p=0. 04). Conclusions: We conclude the FCI predicts patient reported physical function better than objective physical function measures. Intensive care physiotherapists and physicians have a variable ability to predict longer term outcomes for their patients and larger studies are needed to further evaluate this.

Highlights

The Functional Comorbity Index (FCI) had a large correlation with patient reported physical function
Improved survival from critical illness has focused the attention of patients, families and clinicians on the importance of future health related quality of life (HRQoL) and functional outcome following an intensive care unit (ICU) admission [1,2]
The levels of experience of physiotherapists were reflective of current ICU staff demographics for physiotherapists in the public hospital sector in Australia [28]

Summary

Introduction

Improved survival from critical illness has focused the attention of patients, families and clinicians on the importance of future health related quality of life (HRQoL) and functional outcome following an intensive care unit (ICU) admission [1,2]. Evaluating a patient’s premorbid physical function and HRQoL status is important as it assists understanding of potential return to functional levels, independence and societal participation and can may be used as a predictor of outcome in for these important patient reported outcomes [3]. This information can assist ICU physicians and physiotherapists in establishing and directing the most appropriate level of medical and rehabilitative therapy to patients whilst in the ICU and after discharge. Health care resources are limited and not all patients may benefit from the provision of on-going rehabilitation [8], identifying patients whose outcomes could be optimised by rehabilitation is important

Methods

Results

Conclusion