Article

Oeyen SG, Vandijck DM, Benoit DD, et al. Quality of life after intensive care: A systematic review of the literature

Department of Intensive Care Medicine, Ghent University Hospital, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Critical care medicine (Impact Factor: 6.31). 12/2010; 38(12):2386-400. DOI: 10.1097/CCM.0b013e3181f3dec5
Source: PubMed

ABSTRACT

To evaluate quality of life at least 12 months after discharge from the intensive care unit of adult critically ill patients, to evaluate the methodology used to assess long-term quality of life, and to give an overview of factors influencing quality of life.
EMBASE-PubMed, MEDLINE (OVID), SCI/Web of Science, the Cochrane Library, Google Scholar, and personal files.
Data extraction was performed independently and cross-checked by two reviewers using a predefined data extraction form. Eligible studies were published between 1999 and 2009 and assessed quality of life ≥12 months after intensive care unit discharge by means of the Medical Outcomes Study 36-Item Short Form Health Survey, the RAND 36-Item Health Survey, EuroQol-5D, and/or the Nottingham Health Profile in adult intensive care unit patients.
Fifty-three articles (10 multicenters) were included, with the majority of studies performed in Europe (68%). The Medical Outcomes Study 36-Item Short Form Health Survey was used in 55%, and the EuroQol-5D, the Nottingham Health Profile, the RAND 36-Item Health Survey, or a combination was used in 21%, 9%, 8%, or 8%, respectively. A response rate of ≥80% was attained in 26 studies (49%). Critically ill patients had a lower quality of life than an age- and gender-matched population, but quality of life tended to improve over years. The worst reductions in quality of life were seen in cases of severe acute respiratory distress syndrome, prolonged mechanical ventilation, severe trauma, and severe sepsis. Study quality criteria, defined as a baseline quality of life assessment, the absence of major exclusion criteria, a description of nonresponders, and a comparison with a reference population were met in only four studies (8%). Results concerning the influence of severity of illness, comorbidity, preadmission quality of life, age, gender, or acquired complications were conflicting.
Quality of life differed on diagnostic category but, overall, critically ill patients had a lower quality of life than an age- and gender-matched population. A minority of studies met the predefined methodologic quality criteria. Results concerning the influence of the patients' characteristics and illnesses on long-term quality of life were conflicting.

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Available from: Dominique M Vandijck
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    • "Hard clinical work, pioneering research and intensive follow-up have improved the prognosis and health-related quality of life of critically ill patients over time (Oeyen et al., 2010; Vincent et al., 2010). Nowadays, innovation is considered to constitute new opportunities for further improvement of care and, above, to provide economic incentives to be returned to patients, institutions, and society (Vandijck and Stärkel, 2014). "

    Full-text · Article · May 2015 · Nursing in Critical Care
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    • "Following discharge from the ICU, patients often suffer from reduced physical function, exercise capacity, health-related quality of life and social functioning which may continue for up to 5 years following discharge home from hospital [1-5]. In a systematic review of 53 studies (10 multicentre) reporting health-related quality of life outcomes at least 12 months after discharge from the ICU, critically ill patients had a lower health-related quality of life than an age- and gender-matched population [6]. The worst reductions in quality of life were seen in cases of severe acute respiratory distress syndrome, prolonged mechanical ventilation, severe trauma, and severe sepsis. "
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    ABSTRACT: Following discharge home from the ICU, patients often suffer from reduced physical function, exercise capacity, health-related quality of life and social functioning. There is usually no support to address these longer term problems, and there has been limited research carried out into interventions which could improve patient outcomes. The aim of this study is to investigate the effectiveness and cost-effectiveness of a 6-week programme of exercise on physical function in patients discharged from hospital following critical illness compared to standard care. The study design is a multicentre prospective phase II, allocation-concealed, assessor-blinded, randomised controlled clinical trial. Participants randomised to the intervention group will complete three exercise sessions per week (two sessions of supervised exercise and one unsupervised session) for 6 weeks. Supervised sessions will take place in a hospital gymnasium or, if this is not possible, in the participants home and the unsupervised session will take place at home. Blinded outcome assessment will be conducted at baseline after hospital discharge, following the exercise intervention, and at 6 months following baseline assessment (or equivalent time points for the standard care group). The primary outcome measure is physical function as measured by the physical functioning subscale of the Short-Form-36 health survey following the exercise programme. Secondary outcomes are health-related quality of life, exercise capacity, anxiety and depression, self efficacy to exercise and healthcare resource use. In addition, semi-structured interviews will be conducted to explore participants' perceptions of the exercise programme, and the feasibility (safety, practicality and acceptability) of providing the exercise programme will be assessed. A within-trial cost-utility analysis to assess the cost-effectiveness of the intervention compared to standard care will also be conducted. If the exercise programme is found to be effective, this study will improve outcomes that are meaningful to patients and their families. It will inform the design of a future multicentre phase III clinical trial of exercise following recovery from critical illness. It will provide useful information which will help the development of services for patients after critical illness.Trial registration: ClinicalTrials.gov NCT01463579.
    Full-text · Article · Apr 2014 · Trials
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    • "First, and in line with our starting hypothesis, we found that after stratifying for coexisting disease, no differences were found in HRQoL between patients who had been in an ICU and those in a control group matched for age and sex [1,2]. These conclusions are supported by our previous findings that, after adjusting for coexisting conditions, only minor effects on HRQoL could be related to specific events in ICU, such as high APACHE II score, longer duration of stay, and time spent on a ventilator [3]. "
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    ABSTRACT: Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterise the ICU patients with the lowest HRQoL within these strata. We did a cross-sectional comparison of scores of the short form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each strata patients with low scores (below - 2 SD of the control group) were identified and characterised. After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (- 2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived shorter after being in ICU. After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had however a poor quality of life as compared to the controls (-2 SD). This group, which more often consisted of singles, men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.
    Full-text · Article · Oct 2013 · Critical care (London, England)
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