Abstract
Purpose
To use the World Health Organisation’s International Classification of Functioning to measure disability following critical illness using patient-reported outcomes.
Methods
A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation’s Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU.
Results
We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08), P = 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P < 0.002), and reduced health-related quality of life (P < 0.001).
Conclusion
Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or divorce and a longer duration of mechanical ventilation.
Trial registration: NCT02225938.
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Change history
15 September 2017
In the Results section, under the subheading “Return to work or usual activities”, the second sentence should read.
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Acknowledgements
We would like to acknowledge the site co-ordinators at each of our hospitals, including Glenn Eastwood, Pauline Galt, Gabby Hanlon and Donna McCallum. We would like to acknowledge the support of Kathleen Collins and financial support from Monash Partners Academic Health Science Centre, Melbourne, Australia.
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Take-home message: Moderate to severe disability measured using the World Health Organisation’s Disability Assessment Schedule 2.0 was prevalent in 25% of survivors at 6 months after ICU admission, and was more common in people who were separated or divorced, had a history of anxiety or depression and who were mechanically ventilated for a longer period of time. Disability was associated with reduced health-related quality of life, especially in the domains of mobility, usual activities and pain.
An erratum to this article is available at https://doi.org/10.1007/s00134-017-4937-3.
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Hodgson, C.L., Udy, A.A., Bailey, M. et al. The impact of disability in survivors of critical illness. Intensive Care Med 43, 992–1001 (2017). https://doi.org/10.1007/s00134-017-4830-0
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DOI: https://doi.org/10.1007/s00134-017-4830-0