Internationale Zeitschrift für Physikalische Medizin und Rehabilitation
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Abstrakt

Predicting Physical Function and Health Related Quality of Life Following Intensive Care

Kimberley Haines, Sue Berney, Stephen Warrillow and Linda Denehy

Objective: This study investigated how well the Functional Comorbity Index (FCI) predicts patient reported physical function compared with objective physical function measures, return to home and health related quality of life (HRQoL) of survivors of a general intensive care unit (ICU) cohort at 12 months post ICU discharge. This study also investigated how well ICU physiotherapists and physicians predict mortality, return to home and HRQoL of survivors at 12 months post ICU discharge. Design: Prospective observational cohort study nested within a larger trial. FCI calculated at ICU admission and compared with patient reported physical function (SF36 version 2 Physical Component Score) and objective physical function measures (Six-Minute Walk Test, Timed Up and Go) at 12 months. ICU clinicians completed a four-item questionnaire at patient discharge from ICU predicting mortality, return to home and HRQoL and these were compared with 12-month patient outcomes. Setting: 18-bed closed mixed medical/surgical, tertiary ICU in a university teaching hospital in Melbourne, Australia. Participants: 34 ICU patients. 11 ICU clinicians (5 physicians and 6 physiotherapists) who were caring for the patients on day of discharge from ICU. Results: The correlations between the FCI and 12-month objective measures of physical performance were small (6MWT rho 0. 02, TUG rho 0. 15). The FCI had a large correlation with patient reported physical function (SF36 version 2 rho -0. 60). The sensitivity of the physicians’ predictions for mortality was the highest [83% (78-91%)], whilst the physiotherapists’ predictions had the greatest specificity [100% (89-100%)]. All clinicians were comparable in their predictions of who would return home. Physicians were more accurate than physiotherapists in predicting future HRQoL (p=0. 04). Conclusions: We conclude the FCI predicts patient reported physical function better than objective physical function measures. Intensive care physiotherapists and physicians have a variable ability to predict longer term outcomes for their patients and larger studies are needed to further evaluate this.