Changes in biopsychosocial outcomes for a mixed cohort of ICU survivors

Abstract

BackgroundProlonged 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.ObjectivesTo determine changes in biopsychosocial outcomes for a mixed cohort of ICU survivors in hospital and at 1 month and 6 months after discharge.MethodA 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.ResultsParticipants (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.ConclusionClinically 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 implicationsIntensive 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.

Investigation of physical and functional impairments experienced by people with active tuberculosis infection: A feasibility pilot study

“…Roos et al (2013), when screening physical activity levels and physical activity preferences of relatively healthy HIV individuals attending an HIV roll-out centre in Johannesburg, observed a dropout rate of 27.3%. In contrast, Van Aswegen et al (2010), when evaluating the effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge, noted a dropout rate of 46% in their study participants who required less than 5 days of mechanical ventilation during hospital stay. Van Aartsen and Van Aswegen (2018) reported a 54.2% dropout rate over a 6-month period while investigating changes in biopsychosocial outcomes in a mixed cohort of ICU survivors in South Africa.…”

“…In contrast, Van Aswegen et al (2010), when evaluating the effect of penetrating trunk trauma and mechanical ventilation on the recovery of adult survivors after hospital discharge, noted a dropout rate of 46% in their study participants who required less than 5 days of mechanical ventilation during hospital stay. Van Aartsen and Van Aswegen (2018) reported a 54.2% dropout rate over a 6-month period while investigating changes in biopsychosocial outcomes in a mixed cohort of ICU survivors in South Africa. The reasons for participant dropout listed by the abovementioned authors are similar to those experienced in this feasibility study.…”

“…High loss to follow-up experienced in rehabilitation-based trials in Gauteng Province of South Africa is not unusual (Roos et al 2013; Van Aartsen & Van Aswegen 2018; Van Aswegen et al 2010). Roos et al (2013), when screening physical activity levels and physical activity preferences of relatively healthy HIV individuals attending an HIV roll-out centre in Johannesburg, observed a dropout rate of 27.3%.…”

“…There was only a 10-m distance of relatively open free space available at the back of the ward over which the walk test could be performed. This might have led to sub-optimal participant performance because of the frequent turning enforced by the shorter track (Van Aartsen & Van Aswegen 2018). Consideration should, thus, be given to using an alternative test to assess participants’ exercise capacity in hospital such as the 3-min step test.…”

“…Understanding and quantifying the level of physical (level of breathlessness, muscle architecture and mass, muscle power, balance) and functional (exercise capacity) impairments that patients with active TB infection present with at the time of disease diagnosis may be useful to physiotherapists in developing appropriate rehabilitation programmes for these patients during their hospital stay and after discharge to optimise their recovery to a comparable level with that of a healthy general population at the time of completion of anti-TB therapy. Clinical trials, using a longitudinal design, are often limited by high patient dropout rates after hospital discharge (Abshire et al 2017; Roos, Myezwa & Van Aswegen 2013; Van Aswegen et al 2010). This feasibility study was, therefore, conducted to assess the acceptability, implementation and practicality (Bowen et al 2009) of conducting a prospective, observational and longitudinal trial in an urban setting of a developing country to describe physical and functional impairments of patients at the time of active TB diagnosis and to evaluate changes in these outcomes over the 6-month period of anti-TB therapy.…”