Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge

Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review

INTRODUCTION

Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised.

OBJECTIVE

The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia.

INCLUSION CRITERIA

Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness.

METHODS

The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022.

RESULTS

There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved.

CONCLUSIONS

Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.

Perceptions of adult intensive care unit patients regarding nursing presence and their intensive care experiences: A descriptive-correlational study

AIMS AND OBJECTIVES

This study aims to determine the relationship between perceptions of nursing presence and intensive care experiences in adult intensive care unit patients'.

BACKGROUND

Intensive care units (ICUs) are settings where patients have many negative emotions and experiences, which affect both treatment and post-discharge outcomes. The holistic presence of nurses may help patients turn their negative emotions and experiences into positive ones.

DESIGN

A descriptive-correlational design was used and reported according to the STROBE checklist.

METHODS

The sample consisted of 182 participants. Data were collected using a personal information form, the Glasgow Coma Scale (GCS), the Intensive Care Experience Scale (ICES), and the Presence of Nursing Scale (PONS).

RESULTS

A strong positive correlation existed between total ICES and PONS scores (r = 0.889, p < 0.001). There was a strong positive correlation between PONS total score and ICES subscales (awareness of surroundings (r = 0.751, p < 0.001), frightening experiences (r = 0.770, p < 0.001), recall of experience (r = 0.774, p < 0.001), and satisfaction with care (r = 0.746, p < 0.001)). Males (β = -0.139, p < 0.05), and patients who were university and higher education graduate (β = 0.137, p < 0.05) had higher positive ICU experiences. It was also found length of ICU stay was correlated with ICU experiences and nursing presence.

CONCLUSIONS

The more positively the patients perceive nurses, the better ICU experiences they have. Gender and education level were found determinants of adult ICU patients' experiences. ICU length of stay predicted what kind of experience patients have and how much they feel the presence of nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses should make their presence felt completely and holistically by using their communication skills for patients have more positive intensive care experiences. Nurses should consider variables which affects patients' ICU experiences and nursing presence.

Health-related quality of life among critically ill patients after discharge from the ICU-A systematic review protocol

The impact of critical illness on patients is profound, resulting in physical, mental, and social consequences and poor health-related quality of life (HRQOL). Several studies investigated HRQOL among patients discharged from the intensive care unit (ICU). However, few systematic reviews cover studies conducted in the last decade or using valid instruments for measuring HRQOL in general ICU survivor populations. Herein, we conduct a systematic review of these studies that followed PRISMA guidelines. We will search PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Open Grey for papers. We will search for articles reporting the HRQOL of ICU survivors that were written in English and published from 01 January 2012 onward from the date of this protocol's publication. We will also extract HRQOL data and analyze associate factors. The risk of bias will be measured with a standard quality assessment tool. The strength of the results will depend on the number of studies and the consistency of their results. Trial registration number: PROSPERO CRD 42022304279.

Health-related quality of life measured with the EQ-5D-5L in critical care survivors: A cross-sectional study

OBJECTIVES

The aim of this study was to investigate health-related quality of life (HRQOL) and related factors in intensive care unit survivors one-12 months after discharge.

RESEARCH METHODOLOGY/DESIGN

This cross-sectional survey included survivors who had been admitted to an intensive care unit for ≥48 hours.

MAIN OUTCOME MEASURES

HRQOL was measured using the EQ-5D-5L profile, which evaluates five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) on five levels (no, slight, moderate, severe, and extreme problems), EQ-VAS (score range 0-100, 100 indicating best health) and EQ values (score range -0.066-1, 1 indicating best health). The factors influencing HRQOL were analyzed by Tobit regression.

SETTING

Survivors treated in an intensive care unit at six institutions in Korea.

RESULTS

Only 7.9% of the 534 participants had self-reported profiles of no health problems in all five dimensions. The proportion of participants with slight problems was highest in pain/discomfort with 85.0%. The proportion with severe problems was highest in usual activities with 21.7%, followed by mobility with 21.0%. The median and interquartile range of the EQ-VAS and EQ values were 60.00 (45.00 to 75.00) and 0.72 (0.52 to 0.80), respectively. Negative impact factors on HRQOL included older age, women, residing in a long term care facility, unemployment, emergency intensive care admission, and intensive care stay ≥ 7 days.

CONCLUSION

HRQOL among Korean intensive care survivors is low. The level of problems in physical dimensions is more severe than that in mental health dimensions. Early rehabilitation in the intensive care unit should be provided to facilitate long-term recovery.

Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit

AIM

(a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge.

DESIGN

A mixed-methods approach will be applied.

METHODS

In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.

Health-related quality of life after injury: examining the roles of perceived daily-life stress and injury perceptions

PURPOSE

The present study aimed to examine the effects of injury perceptions and perceived daily stress on health-related quality of life (HRQL) of individuals affected by a physical injury.

METHODS

Two hundred and forty injured individuals completed questionnaires assessing HRQL (Medical Outcome Health Survey short-form 36), perceived daily-life stress (Perceived Stress Scale), and injury perceptions (Brief-InjPQ).

RESULTS

The direct effects of stress on HRQL scores were not moderated by gender. Emotional representation of the injury significantly mediated the links between PSS and all HRQL subscales only among women, but not among men. However, the mediation of the HRQL total score by emotional representations was significant for both genders. In addition, treatment control perceptions of the injury mediated the link between PSS and self-assessed health among men but not women, and injury-self perceptions mediated the link between PSS and physical functioning among men but not women.

CONCLUSION

These findings underscore the importance of perceived daily stress, gender, and injury perceptions as key factors for explaining variance in HRQL following injury. In addition to their conceptual contributions, the findings have clinical implications for treating injured populations.

Cross-Cultural Validation of the Intensive Care Experience Questionnaire in Korean Critical Care Survivors

PURPOSE

The purpose of this study was to culturally adapt the Intensive Care Experience Questionnaire (ICEQ) for Korean patients and evaluate its validity and reliability.

METHODS

This cross-sectional study comprised two phases. The first phase involved the cultural adaptation of the ICEQ. In the second phase, the psychometric properties of the adapted measure were evaluated. Cultural adaptation was conducted in accordance with the World Health Organization's process. The adapted questionnaire was administered to 200 Korean patients who had received treatment in an intensive care unit within the past six months. Model fit was assessed through confirmatory factor analysis, and convergent validity and discriminant validity of the items were assessed. Known-groups validity was evaluated using the t test and Cohen's effect size. Cronbach's α was used to examine internal consistency reliability.

RESULTS

The Korean version of the ICEQ (K-ICEQ) consists of 26 items and four subscales: Frightening Experiences, Awareness of Surroundings, Satisfaction with Care, and Recall of Experiences. The model fit indices, convergent validity, and discriminant validity of the K-ICEQ were all satisfactory. According to the results of the test of known-groups validity, intensive care unit (ICU) experience varied according to gender, planned ICU admission, mechanical ventilation, and restraints application. Cronbach's α of the K-ICEQ subscales ranged from .74 to .93.

CONCLUSION

The validity and reliability of the K-ICEQ reflecting the characteristics of Korean ICU patients were satisfactory. The K-ICEQ can be used to evaluate the experience of Korean ICU patients and contribute to the development of interventions to improve the ICU experience.

Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study

BACKGROUND

Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life.

METHODS

A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed.

RESULTS

Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life.

CONCLUSIONS

Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.

Using wearable technology to predict health outcomes: a literature review

Objective

To review and analyze the literature to determine whether wearable technologies can predict health outcomes.

Materials and methods

We queried Ovid Medline 1946 -, Embase 1947 -, Scopus 1823 -, the Cochrane Library, clinicaltrials.gov 1997 – April 17, 2018, and IEEE Xplore Digital Library and Engineering Village through April 18, 2018, for studies utilizing wearable technology in clinical outcome prediction. Studies were deemed relevant to the research question if they involved human subjects, used wearable technology that tracked a health-related parameter, and incorporated data from wearable technology into a predictive model of mortality, readmission, and/or emergency department (ED) visits.

Results

Eight unique studies were directly related to the research question, and all were of at least moderate quality. Six studies developed models for readmission and two for mortality. In each of the eight studies, data obtained from wearable technology were predictive of or significantly associated with the tracked outcome.

Discussion

Only eight unique studies incorporated wearable technology data into predictive models. The eight studies were of moderate quality or higher and thereby provide proof of concept for the use of wearable technology in developing models that predict clinical outcomes.

Conclusion

Wearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology.

The relationship between stressors and intensive care unit experiences

BACKGROUND

Patients in intensive care units (ICUs) face many physical and psychological stressors because of the environment of these units and their own critical conditions and experience stress in various degrees. Each stressor may affect patients' experiences in ICUs differently.

AIM AND OBJECTIVES

This study aimed to examine the relationship between stressors and patients' experiences in an ICU.

METHODS

This descriptive, cross-sectional study was conducted between September 2014 and June 2015 in a university hospital and included 116 patients who were admitted to the general ICU for at least 24 hours. Data were collected using the Intensive Care Experience Scale and a questionnaire that included questions about socio-demographic and disease-related characteristics of patients and their stressors.

RESULTS

The mean age of the patients was 57.81 ± 13.81 years, and the mean duration of ICU stay was 2.28 ± 3.88 days. There was a moderate positive relation between the stressors noise (r = .534; P < .01), thirst (r = .438; P < .01), loneliness (r = .410; P < .01), and pain (r = .404; P < .01) and the subscale frightening experiences. However, there was a moderate, negative relation between the stressors inability to speak (r = -.444; P < .01), surrounding speeches (r = -.458; P < .01), equipment noise (r = -.490; P < .01), and physical exercise (r = -.546; P < .01) and the subscale satisfaction with care.

CONCLUSIONS

The patients associated stressors with satisfaction and frightening experiences in the early period of their discharge from the ICU. As stressors increases, so do frightening experiences, and satisfaction with care is affected negatively.

RELEVANCE TO CLINICAL PRACTICE

Currently, stressors to which patients discharged from ICU are exposed during their admission to wards are not evaluated in practice. This study is important in that it can help health professionals be aware of effects of stressors on patients in the early period of their discharge.

Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors

Background

Sleep disturbances in critically ill patients are associated with poorer long-term clinical outcomes and quality of life. Studies are needed to better characterize associations and risk factors for persistent sleep disturbances after intensive care unit (ICU) discharge. Psychiatric disorders are frequently associated with sleep disturbances, but the role of psychiatric symptoms in sleep disturbances in ICU survivors has not been well-studied.

Objective

To examine the association between psychiatric symptoms and sleep disturbances in ICU survivors.

Methods

112 adult ICU survivors seen from July 2011 to August 2016 in the Critical Care Recovery Center, an ICU survivor clinic at the Eskenazi Hospital in Indianapolis, IN, USA, were assessed for sleep disturbances (insomnia, hypersomnia, difficulty with sleep onset, difficulty with sleep maintenance, and excessive daytime sleepiness) and psychiatric symptoms (trauma-related symptoms and moderate to severe depressive symptoms) 3 months after ICU discharge. A multivariate logistic regression model was performed to examine the association between psychiatric symptoms and sleep disturbances. Analyses were controlled for age, hypertension, history of depression, and respiratory failure.

Results

ICU survivors with both trauma-related and depression symptoms (OR 16.66, 95% CI 2.89–96.00) and trauma-related symptoms alone (OR 4.59, 95% CI 1.11–18.88) had a higher likelihood of sleep disturbances. Depression symptoms alone were no longer significantly associated with sleep disturbances when analysis was controlled for trauma-related symptoms.

Conclusion

Trauma-related symptoms and trauma-related plus moderate to severe depressive symptoms were associated with a higher likelihood of sleep disturbances. Future studies are needed to determine whether psychiatric symptoms are associated with objective changes on polysomnography and actigraphy and whether adequate treatment of psychiatric symptoms can improve sleep disturbances.

Relationship of symptoms associated with ICU-survivorship: An integrative literature review

BACKGROUND

The number of adults who survive a critical illness involving admission to an intensive care unit is increasing. These survivors have an increased risk of developing impairments in cognition, physical function and psychological health.

OBJECTIVE

This integrative literature review examined the literature for studies exploring the relationships among two or more of the variables of interest, i.e. cognitive, physical, and psychological symptoms (depressive, anxiety, or posttraumatic stress) in intensive care unit survivors post-hospital discharge.

METHODS

A literature search was conducted using PubMed, CINHAL and PsycINFO databases.

FINDINGS

While all 13 studies included in the review explored some aspect of a relationship among the variables of interest, none explored associations among all three variables. Five studies explored physical function and psychological symptoms, four studies explored cognitive impairment and psychological symptoms and five studies explored the association among different psychological symptoms. Inconsistencies were found in the study designs, follow-up time frames, patient populations and measures used.

CONCLUSIONS

Further research using well-designed methodologies and standardized instruments is warranted. Gaining a better understanding of the relationships among these impairments has the potential to contribute to the development of screening guidelines, preventative strategies, and treatments.

Changes in health-related quality of life after discharge from an intensive care unit: a systematic review

Quality of life after critical illness is becoming increasingly important as survival improves. Various measures have been used to study the quality of life of patients discharged from intensive care. We systematically reviewed validated measures of quality of life and their results. We searched PubMed, CENTRAL, CINAHL, Web of Science and Open Grey for studies of quality of life, measured after discharge from intensive care. We categorised studied populations as: general; restricted to level‐3 care or critical care beyond 5 days; and septic patients. We included quality of life measured at any time after hospital discharge. We identified 48 studies. Thirty‐one studies used the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) and 19 used the EuroQol‐5D (EQ‐5D); eight used both and nine used alternative validated measures. Follow‐up rates ranged from 26–100%. Quality of life after critical care was worse than for age‐ and sex‐matched populations. Quality of life improved for one year after hospital discharge. The aspects of life that improved most were physical function, physical role, vitality and social function. However, these domains were also the least likely to recover to population norms as they were more profoundly affected by critical illness.

The provision of nurse-led follow-up at Norwegian intensive care units

AIMS AND OBJECTIVES

To describe the prevalence, content and administration of intensive care unit diaries and follow-up practices offered to patients and their families in Norway.

BACKGROUND

Intensive care treatment has been associated with risks for new or increased health impairments affecting both patients and their families. These impairments have the potential of continuing beyond the acute phase of treatment. In parallel, preventive actions have gradually become an integrated part of critical care nursing, and in Norway, national recommendations for the use of intensive care unit diaries have been established.

DESIGN AND METHODS

A survey was conducted in Norwegian intensive care units offering care for adult patients, using a questionnaire asking about the frequency, administration and content of the follow-up offered to patients, their relatives, as well as bereaved family members.

RESULTS

Thirty-nine of 66 (59.1%) invited intensive care units answered the questionnaire. The majority (n = 33, 84.6%) of the responding units had follow-up routines. The provision of diaries was the most frequent follow-up activity (n = 24, 61.5%), and consultations postdischarge formed an integrated part of the diary practice. Consultations with bereaved were conducted in 21 (53.8%) of the intensive care units. About one quarter of the responding intensive care units had positions for follow-up nursing staff.

CONCLUSION

Nurse-led follow-up after critical care was a common activity in Norwegian intensive care units, comprising diaries and consultations offered to patients and family members. The follow-up was mainly driven by bottom-up processes conducted by dedicated nurses motivated by the patients' and their families' situation and feedback.

RELEVANCE TO CLINICAL PRACTICE

Adherence to recommendations, as well as the availability of defined positions for aftercare nurses or teams, may improve the implementation of follow-up practices and reduce suffering after discharge from Norwegian intensive care units.

Changes in biopsychosocial outcomes for a mixed cohort of ICU survivors

Background

Prolonged inflammation and infection associated with being critically ill and the ensuing physical inactivity has proven negative effects on the recovery of physical function, psychological health and reintegration into society for intensive care unit (ICU) survivors. Limited evidence is available on changes in biopsychosocial outcomes for South Africans recovering from an episode of critical illness.

Objectives

To determine changes in biopsychosocial outcomes for a mixed cohort of ICU survivors in hospital and at 1 month and 6 months after discharge.

Method

A prospective, observational, longitudinal study was conducted. Severity of illness, mechanical ventilation (MV) duration and ICU and hospital length of stay (LOS) were recorded. Physical function in ICU test-scored (PFIT-s) was performed at discharge from ICU and hospital. At 1 month and 6 months, peripheral muscle strength, exercise endurance, health-related quality of life (HRQOL), depression status and return to work were assessed. Descriptive and inferential statistics were used.

Results

Participants (n = 24) had a median age of 51.5 years, majority were male (n = 19; 79%) and most were employed before admission (n = 20; 83%). At 6 months, 11 participants (n = 11) were part of the final sample. Median PFIT-s changed significantly (0.3 points; p = 0.02) between ICU and hospital discharge. Peripheral muscle strength improved significantly for upper and lower limbs over 6 months (p = 0.00–0.03) but change in median 6-minute walk test distance (65m) was not significantly different. Significant improvements occurred in mean Medical Outcomes Short Form-36 (SF-36) physical health component scores (8.8 ± 7.6; p = 0.00). Mean SF-36 mental health component scores had a strong negative relationship with MV duration (r = −0.7; p = 0.01), LOS (r = −0.56; p = 0.04) and Patient Health Questionnaire 9 scores (r = −0.72; p = 0.01). Six participants (55%) returned to employment.

Conclusion

Clinically important improvements in biopsychosocial outcomes related to physical function and social factors were observed. Limitations in mental aspects of HRQOL were present at 6 months and some reported mild depressive symptoms.

Clinical implications

Intensive care unit survivors with a history of prolonged MV duration and hospital LOS who exhibit limitations in mental HRQOL, and signs of depressive symptoms should be referred to a psychologist for evaluation.

Psychological recovery after intensive care: Outcomes of a long-term quasi-experimental study of structured nurse-led follow-up

OBJECTIVES

To compare psychological recovery of patients receiving structured nurse-led follow-up and patients receiving usual care after intensive care discharge.

DESIGN

Quasi-experimental study.

SETTING

Single centre, university hospital, mixed intensive care patient population.

MAIN OUTCOME MEASURES

Symptoms of post-traumatic stress disorder, anxiety and depression measured three and four times over 12 months after intensive care discharge. Disturbing memories of the intensive care stay and psychological reactions (that one's life was in danger, threat to physical integrity, intense fear, helplessness, horror) three months after intensive care. A mixed effect model tested differences between the groups over time and regression model predicted post-traumatic stress at three months.

RESULTS

The experimental group had significantly more symptoms of post-traumatic stress and anxiety than the control group over the 12 months. Patients from both groups had severe symptoms of post-traumatic stress. Patients with post-traumatic stress at three months had disturbing memories and psychological reactions.

CONCLUSION

The structured nurse-led follow-up did not improve patients' measured outcomes of psychological recovery after intensive care. Patients with severe symptoms of post-traumatic stress are of concern. Emphasis needs to be placed on disturbing memories of the intensive care stay and psychological reactions when constructing intensive care nurse-led follow-up.