The association between major complications of immobility during hospitalization and quality of life among bedridden patients: A 3 month prospective multi-center study.

Xinjuan Wu,Xia Wan,Xianxiu Wen,Ying Liu,Yingli Wang,Jing Jiao,Shouzhen Cheng,Jing Cao,Ge Liu,Fangfang Li,Baoyun Song,Zhen Li,Yilan Liu,Jingfen Jin,Dafna Yahav

doi:10.1371/journal.pone.0205729

Abstract

PurposeTo describe the association between major complications of immobility (pressure ulcer, pneumonia, deep vein thrombosis and urinary tract infection) during hospitalization and the patients’ health-related quality of life after discharge.MethodsThe data were obtained from a multi-center study conducted in 2015. Complications of immobility during hospitalization was measured by case report form and quality of life after discharge was measured using the EQ-5D scale by telephone interview. Multilevel mixed-effects models were used to explore the association of complications and responses in the EQ-5D dimensions after controlling for important covariates.ResultsAmong the 20,515 bedridden patients, 2,601(12.72%) patients experienced at least one of the major complications of immobility during hospitalization, including pressure ulcer (527, 2.57%), deep vein thrombosis (343, 1.67%), pneumonia (1647, 8.16%), and urinary tract infection (265, 1.29%). Patients with any of the four complications during hospitalization reported more problems in all EQ-5D dimensions except for pain/discomfort, and had lower mean EQ-VAS scores than those without any complications. The four complications all showed significant associations with the proportion of reported problems in certain dimensions after adjustment for confounding variables.ConclusionsMajor complications of immobility were significantly associated with reduced health related quality of life. Prevention of complications is critical to reduce the burden of decreased quality of life for bedridden patients.

Highlights

Major complications of immobility were significantly associated with reduced health related quality of life
Prevention of complications is critical to reduce the burden of decreased quality of life for bedridden patients
Immobility is independently associated with the development of a series of complications, including pressure ulcer [1], deep vein thrombosis (DVT) [2], pneumonia [3], and urinary tract infection (UTI) [4]

Summary

Introduction

Immobility is independently associated with the development of a series of complications, including pressure ulcer [1], deep vein thrombosis (DVT) [2], pneumonia [3], and urinary tract infection (UTI) [4]. Many studies have shown that complications of immobility could result in numerous deleterious consequences, including increased morbidity and mortality [5, 6], prolonged length of stay[7], increased hospital cost[8, 9] and contribution to global disease burden [10, 11].The impact of complications of immobility on patients’ overall well-being and functioning is a topic of growing interest in clinical research and practice [12,13,14,15] Among these studies, health-related quality of life (HRQOL) assessments have been used as an outcome measure with hospitalized patients for many years. HRQOL has become an important indicator to inform patient management and policy development and plays a valuable role in clinical decision making[17]

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