[show abstract][hide abstract] ABSTRACT: To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care.
A pragmatic, non-blinded, multicentre, randomised controlled trial.
Three UK hospitals (two teaching hospitals and one district general hospital).
286 patients aged >or=18 years were recruited after discharge from intensive care between September 2006 and October 2007.
Nurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed.
286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI -1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (-3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective.
A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.
[show abstract][hide abstract] ABSTRACT: Negative emotional outcomes (anxiety, depression and post-traumatic stress) have been identified in patients discharged from intensive care. The aims of this prospective, longitudinal study were to assess levels of and changes in emotional outcome after intensive care, and to explore how these relate to objective and subjective indicators of the intensive care experience. Emotional outcome was assessed using the Hospital Anxiety and Depression and Impact of Event Scales. Anxiety (p = 0.046) and depression (p = 0.001) were reduced subsequently, but not avoidance (p = 0.340) or intrusion (p = 0.419). Most objective (age, gender, length of ICU and hospital stay) and subjective indicators (as measured by the Intensive Care Experience Questionnaire) of the intensive care experience were related to negative emotional outcome. Subjective interpretation of the intensive care experience emerged as a consistent predictor of adverse emotional outcome, in both the short- and the long-term.
[show abstract][hide abstract] ABSTRACT: Quality of life is a dynamic, multi-dimensional concept, the essence of which is its individuality. In this study quality of life six to 12 months after intensive care was not significantly lower than quality of life prior to intensive care, assessed retrospectively. Family, leisure activities and people were seen as more important than health as a main determinant of quality of life after intensive care. Quality of life assessment after intensive care should combine generic measures of health status and individual measures.
Nursing in Critical Care 3(5):220-6. · 0.95 Impact Factor