Factors influencing physical functional status in intensive care unit survivors two years after discharge

Abstract

BackgroundStudies suggest that in patients admitted to intensive care units (ICU), physical functional status (PFS) improves over time, but does not return to the same level as before ICU admission. The goal of this study was to assess physical functional status two years after discharge from an ICU and to determine factors influencing physical status in this population.MethodsThe study reviewed all patients admitted to two non-trauma ICUs during a one-year period and included patients with age ≥ 18 yrs, ICU stay ≥ 24 h, and who were alive 24 months after ICU discharge. To assess PFS, Karnofsky Performance Status Scale scores and Lawton-Instrumental Activities of Daily Living (IADL) scores at ICU admission (K-ICU and L-ICU) were compared to the scores at the end of 24 months (K-24mo and L-24mo). Data at 24 months were obtained through telephone interviews.ResultsA total of 1,216 patients were eligible for the study. Twenty-four months after ICU discharge, 499 (41.6%) were alive, agreed to answer the interview, and had all hospital data available. PFS (K-ICU: 86.6 ± 13.8 vs. K-24mo: 77.1 ± 19.6, p < 0.001) and IADL (L-ICU: 27.0 ± 11.7 vs. L-24mo: 22.5 ± 11.5, p < 0.001) declined in patients with medical and unplanned surgical admissions. Most strikingly, the level of dependency increased in neurological patients (K-ICU: 86 ± 12 vs. K-24mo: 64 ± 21, relative risk [RR] 2.6, 95% CI, 1.8–3.6, p < 0.001) and trauma patients (K-ICU: 99 ± 2 vs. K-24mo: 83 ± 21, RR 2.7, 95% CI, 1.6–4.6, p < 0.001). The largest reduction in the ability to perform ADL occurred in neurological patients (L-ICU: 27 ± 7 vs. L-24mo: 15 ± 12, RR 3.3, 95% CI, 2.3–4.6 p < 0.001), trauma patients (L-ICU: 32 ± 0 vs. L-24mo: 25 ± 11, RR 2.8, 95% CI, 1.5–5.1, p < 0.001), patients aged ≥ 65 years (RR 1.4, 95% CI, 1.07–1.86, p = 0.01) and those who received mechanical ventilation for ≥ 8 days (RR 1.48, 95% CI, 1.02–2.15, p = 0.03).ConclusionsTwenty-four months after ICU discharge, PFS was significantly poorer in patients with neurological injury, trauma, age ≥ 65 tears, and mechanical ventilation ≥ 8 days. Future studies should focus on the relationship between PFS and health-related quality of life in this population.

Assessment of functional status in the ICU: instruments used in Brazilian settings

“…The authors reported that raters had been previously trained on the use of the scale, but they did not describe how the scale is used. The results demonstrated a reduction in patients' ability to perform activities of daily living, even 24 months after ICU discharge (16).…”

“…According to the results of this review, the Karnofsky/Performance Status Scale Scores is the most widely used tool among researchers in Brazil (15,16,17,18). It has been largely used to assess functional status in patients with incapacitating chronic disease, such as critically ill ICU patients.…”

“…Only one of the four studies that used this tool described how it assesses functional status and also reported that the researchers who administered it had been previously trained on the use of the scale (15). Two of the aforementioned studies just reported that the researchers had been trained to administer the scale (16,18).…”

“…The Lawton Instrumental Activities of Daily Living (IADL) Scale, used by Hass et al (16), comprises eight items, including physical and cognitive function. The total scores range from 0 (low function) to 8 (high function).…”

“…According to the literature, the following tools are used to assess the physical functional status of ICU patients in Brazil: the Barthel scale (15), Karnofsky Performance Status Scale Scores (15,16,17,18), Functional Independence Measure (FIM) (19,20), Lawton Instrumental Activities of Daily Living (IADL) Scale (16), Eastern Cooperative Oncology Group Scale (21,22), the extended version of the Glasgow Outcome Scale (23), and a scale developed by Muramaki et al (24).…”