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      Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program

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          Abstract

          Introduction

          Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery.

          Methods

          A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge.

          Results

          Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects ( P = 0.84) or group by time interactions ( P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores.

          Conclusions

          This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention.

          Trial registration

          Australia and New Zealand Clinical Trials Register ACTRN12605000166673

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          Most cited references35

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          SF-36 health survey update.

          J E Ware, xiaolong shen (2000)
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            Quality of life in adult survivors of critical illness: a systematic review of the literature.

            David Dowdy, Mark P Eid, Artyom Sedrakyan … (2005)
            To determine how the quality of life (QOL) of intensive care unit (ICU) survivors compares with the general population, changes over time, and is predicted by baseline characteristics. Systematic literature review including MEDLINE, EMBASE, CINAHL and Cochrane Library. Eligible studies measured QOL > or = 30 days after ICU discharge using the Medical Outcomes Study 36-item Short Form (SF-36), EuroQol-5D, Sickness Impact Profile, or Nottingham Health Profile in representative populations of adult ICU survivors. Disease-specific studies were excluded. Of 8,894 citations identified, 21 independent studies with 7,320 patients were reviewed. Three of three studies found that ICU survivors had significantly lower QOL prior to admission than did a matched general population. During post-discharge follow-up, ICU survivors had significantly lower QOL scores than the general population in each SF-36 domain (except bodily pain) in at least four of seven studies. Over 1-12 months of follow-up, at least two of four studies found clinically meaningful improvement in each SF-36 domain except mental health and general health perceptions. A majority of studies found that age and severity of illness predicted physical functioning. Compared with the general population, ICU survivors report lower QOL prior to ICU admission. After hospital discharge, QOL in ICU survivors improves but remains lower than general population levels. Age and severity of illness are predictors of physical functioning. This systematic review provides a general understanding of QOL following critical illness and can serve as a standard of comparison for QOL studies in specific ICU subpopulations.
            Article 0 comments Cited 153 times – based on 0 reviews     Review now
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              Neuromuscular dysfunction acquired in critical illness: a systematic review.

              A. Téllez, Richard D. Stevens, David Dowdy … (2007)
              To determine the prevalence, risk factors, and outcomes of critical illness neuromuscular abnormalities (CINMA). Systematic review. MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for reports on adult ICU patients who were evaluated for CINMA clinically and electrophysiologically. Studies were included if they contained sufficient data to quantify the association between CINMA and relevant exposures and/or outcome variables. CINMA was diagnosed in 655 of 1421 [46% (95% confidence interval 43-49%)] adult ICU patients enrolled in 24 studies, all with inclusion criteria of sepsis, multi-organ failure, or prolonged mechanical ventilation. Diagnostic criteria for CINMA were not uniform, and few reports unequivocally differentiated between polyneuropathy, myopathy, and mixed types of CINMA. The risk of CINMA was associated with hyperglycemia (and inversely associated with tight glycemic control), the systemic inflammatory response syndrome, sepsis, multiple organ dysfunction, renal replacement therapy, and catecholamine administration. Across studies, there was no consistent relationship between CINMA and patient age, gender, severity of illness, or use of glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam. Unadjusted mortality was not increased in the majority of patients with CINMA, but mechanical ventilation and ICU and hospital stay were prolonged. The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ failure, or protracted mechanical ventilation. The association of CINMA with frequently cited CINMA risk factors (glucocorticoids, neuromuscular blockers) and with short-term survival is uncertain. Available data indicate glycemic control as a potential strategy to decrease CINMA risk.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2011
                Publication date (Electronic): 9 June 2011
                Volume: 15
                Issue: 3
                Page: R142
                Affiliations
                [1 ]Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
                [2 ]University of Technology, Sydney and Northern Sydney Local Health Network, Sydney,15 Broadway, Ultimo, 2007, Australia
                [3 ]Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, 2141, Australia
                [4 ]Princess Alexandra Hospital and Griffith University, 199 Ipswich Road, Woolloongabba, 4102, Australia
                [5 ]School of Psychology, University of Sydney, Fisher Road, Sydney, 2006, Australia
                [6 ]School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University and Royal Perth Hospital, Kent Street, Bentley, 6102, Australia
                [7 ]Centre for Health Economics Research and Evaluation, University of Technology, Sydney, 15 Broadway, Ultimo, 2007, Australia
                [8 ]Critical Care Nursing Professorial Unit, University of Technology, Sydney and Northern Sydney Local Health Network, 15 Broadway, Ultimo, 2007, Australia
                [9 ]Nursing Practice and Development Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia
                Article
                Publisher ID: cc10265
                DOI: 10.1186/cc10265
                PMC ID: 3219014
                PubMed ID: 21658221
                SO-VID: 736f7e7f-0f09-420d-803c-35467308cda8
                Copyright © Copyright ©2011 Elliott et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 January 2011
                Date revision received : 27 April 2011
                Date accepted : 9 June 2011
                Categories
                Subject: Research

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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