Quality of life after intensive care--evaluation with EQ-5D questionnaire.
ABSTRACT To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU).
Intensive care unit (ICU), tertiary care hospital, Oporto, Portugal.
Of all the patients discharged over a 2 year period, 355 were considered eligible and 275 completed the study.
Patients were interviewed 6 months after ICU discharge using EuroQol 5-D (EQ-5D). At the interview only 29% reported feeling worse than 6 months before ICU admission. The proportions of those reporting moderate to extreme problems in the five dimensions studied were as follows: mobility (37%), self-care (22%), usual activities (46%), pain/discomfort (45%) and anxiety/depression (54%). Although 77% of patients reported a problem in at least one dimension, 44% referred to no problems or only moderate problems regarding pain or anxiety. EQ visual analogue scale (VAS) and EQ Index medians were 60 and 81, respectively.
Intensive care unit variables (e.g., diagnosis, length of stay and severity of disease) and patient's background data (e.g., age, gender, education, main activity, smoking habits, experience with serious illness and previous health status) may be significant determinants of HR-QOL. However, when adjusted for background data, most ICU variables are no longer associated with EQ-5D. This should cause attention to be paid to the role of a patient's background in the evaluation of HR-QOL and to a careful interpretation of EQ-5D results when comparing ICUs.
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ABSTRACT: Health-related quality of life (HR-QoL) is a subjective concept, reflecting the overall mental and physical state of the patient, and their own sense of well-being. Estimating current and future QoL has become a major outcome in the evaluation of critically ill patients. The aim of this study is to enhance the inference process of 6 weeks and 6 months prognosis of QoL after intensive care unit (ICU) stay, using the EQ-5D questionnaire. The main outcomes of the study were the EQ-5D five main dimensions: mobility, self-care, usual activities, pain and anxiety depression. For each outcome, three Bayesian classifiers were built and validated with 10-fold cross-validation. Sixty and 473 patients (6 weeks and 6 months, respectively) were included. Overall, 6 months QoL is higher than 6 weeks, with the probability of absence of problems ranging from 31% (6 weeks mobility) to 72% (6 months self-care). Bayesian models achieved prognosis accuracies of 56% (6 months, anxiety depression) up to 80% (6 weeks, mobility). The prognosis inference process for an individual patient was enhanced with the visual analysis of the models, showing that women, elderly, or people with longer ICU stay have higher risk of QoL problems at 6 weeks. Likewise, for the 6 months prognosis, a higher APACHE II severity score also leads to a higher risk of problems, except for anxiety depression where the youngest and active have increased risk. Bayesian networks are competitive with less descriptive strategies, improve the inference process by incorporating domain knowledge and present a more interpretable model. The relationships among different factors extracted by the Bayesian models are in accordance with those collected by previous state-of-the-art literature, hence showing their usability as inference model.2014 IEEE 27th International Symposium on Computer-Based Medical Systems (CBMS); 05/2014
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ABSTRACT: Objective: An evaluation is made of lung function and quality of life 6 months after discharge from the Intensive Care Unit (ICU) among survivors of acute respiratory distress syndrome (ARDS) due to pandemic 2009 influenza A H1N1, based on studies of lung function and the EQ-5D health questionnaire. Design: Case series. Setting: The ICU of Dr. Leónidas Lucero Acute Cases Municipal Hospital, Bahía Blanca, Argentina. Patients: Patients discharged from the ICU who had been admitted with ARDS in 2009 due to influenza A H1N1. Results: Eleven patients were studied. Seven were positive for influenza H1N1 and four were negative. The mean age was 37±9.5 years, and 73% were males. Quality of life, as measured by the EQ-5D, showed changes in the 5 components in all patients, particularly in the pain/discomfort dimension 1.55±0.52; health status (EQ%health) was 70%±24. The indices adjusted for Argentina were Time Trade Off(TTO) 0.903±0.085 and Visual Analog Scale (VAS) 0.827±0.153. In all patients, spirometry and the study of pulmonary diffusion (DLCO) showed values of >80%. There was no correlation between lung diffusion and quality of life (%DLCO and EQ%health). A correlation was observed between quality of life and TTO (EQ%health and TTO), and between quality of life and the VAS score (EQ%health and VAS). Conclusion: Although the sample is small, our results suggest that patients with ARDS due to influenza A H1N1 evaluated 6 months after discharge from the ICU show no deterioration of lung function, and the impact on quality of life is moderate-in contrast to the situation found in patients with ARDS of other etiologies.Medicina Intensiva 02/2012; 36(1):15-23. DOI:10.1016/j.medin.2011.09.007 · 1.24 Impact Factor
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ABSTRACT: Abstract Purpose: To investigate the mortality, quality of life and functional limitations of intensive care unit (ICU) patients with and without joint contractures 3.3 years after discharge from the hospital. Methods: 155 consecutive patients admitted to a primary care referral centre ICU for 2 or more weeks with information on joint range of motion formed a retrospective cohort. The EuroQol and a Joint Contracture Questionnaire were administered to the cohort survivors. Results: Fifty patients returned the questionnaires, 57 did not return the questionnaire, and 48 were deceased. The patients who had died presented significantly more joint contractures in the ICU than the respondents and the non-respondents (p = 0.003 and p = 0.006, respectively). More respondents who reported limitations in their mobility on the EuroQol had joint contractures in ICU 13/18 (72.2%) compared to respondents who did not have contractures 7/21 (33.3%; p = 0.02). Conclusions: Joint contractures in ICU were associated with higher mortality. Patients who spent 2 weeks or more in ICU and developed joint contractures identified more difficulty with mobility 3.3 years after discharge; joint contractures may impose irreversible disability. A strategy to identify and treat joint contractures in ICU may prevent long-term functional limitations. Implications for Rehabilitation The presence of joint contractures was associated with higher mortality more than 3 years after discharge. Joint contractures that developed in ICU were associated with disability for mobility more than 3 years after ICU discharge. Monitoring, detection and early rehabilitation may be critical in treating joint contractures before they become irreversible. These results support prospectively tracking contractures of large joints in the continuum from ICU to hospital to home.Disability and Rehabilitation 05/2014; DOI:10.3109/09638288.2014.913707 · 1.84 Impact Factor