Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program

Abstract

IntroductionSignificant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery.MethodsA multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge.ResultsOf the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores.ConclusionsThis individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention.Trial registrationAustralia and New Zealand Clinical Trials Register ACTRN12605000166673

Avaliação funcional de pacientes internados na Unidade de Terapia Intensiva adulto do Hospital Universitário de Canoas

“…According to a study conducted by Elliott et al 18 , the patients of the intervention group who received early mobilization traveled a greater distance in the 6MWT in all the assessments conducted in comparison with the control group. In general, participants of the intervention group improved the distance of the 6MWT in 27% at 8 weeks and 39% at 26 weeks of the initial assessment.…”

“…A mediana do tempo de internação na UTI foi de 5 (3)(4)(5)(6)(7)(8)(9) dias, e de internação hospitalar de 13 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) …”

“…The most frequent hospitalization diagnosis was Acute Myocardial Infarction. The median of the length of stay in ICU was 5 (3-9) days and, in the hospital, 13 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days.…”

The Burden of Specific Symptoms Reported by Survivors after Critical Illness

“…At 12 months, there remained a significant proportion of patients experiencing symptoms at the most severe end of each symptom scale (table 1) Previous investigators have shown that HRQoL is reduced following critical illness and that spontaneous improvement is limited, sometimes over many years (1). Some (but not all) rehabilitation trials have demonstrated improved functional outcomes, but have not necessarily improved HRQoL (4,5). In this analysis, we have shown that symptoms that influence daily life are prevalent following ICU discharge, are highly correlated with HRQoL, and frequently worsen in their severity over time.…”

“…Patients who survive critical illness sometimes report poor health-related quality of life (HRQoL) (1), but rehabilitation trials have mostly found no effect on this and other measures of health status (2)(3)(4)(5). Most critical care research has employed tools such as the Medical Outcomes Study Short Form questionnaires (SF12/SF36) or EuroQol (EQ-5D) to measure HRQoL.…”