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      Pre-existing disease: the most important factor for health related quality of life long-term after critical illness: a prospective, longitudinal, multicentre trial

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          Abstract

          Introduction

          The aim of the present multicenter study was to assess long term (36 months) health related quality of life in patients after critical illness, compare ICU survivors health related quality of life to that of the general population and examine the impact of pre-existing disease and factors related to ICU care on health related quality of life.

          Methods

          Prospective, longitudinal, multicentre trial in three combined medical and surgical intensive care units of one university and two general hospitals in Sweden. By mailed questionnaires, health related quality of life was assessed at 6, 12, 24 and 36 months after the stay in ICU by EQ-5D and SF-36, and information of pre-existing disease was collected at the 6 months measure. ICU related factors were obtained from the local ICU database. Comorbidity and health related quality of life (EQ-5D; SF-36) was examined in the reference group. Among the 5306 patients admitted, 1663 were considered eligible (>24 hrs in the intensive care unit, and age ≥ 18 yrs, and alive 6 months after discharge). At the 6 month measure 980 (59%) patients answered the questionnaire. Of these 739 (75%) also answered at 12 month, 595 (61%) at 24 month, and 478 (47%) answered at the 36 month measure. As reference group, a random sample (n = 6093) of people from the uptake area of the hospitals were used in which concurrent disease was assessed and adjusted for.

          Results

          Only small improvements were recorded in health related quality of life up to 36 months after ICU admission. The majority of the reduction in health related quality of life after care in the ICU was related to the health related quality of life effects of pre-existing diseases. No significant effect on the long-term health related quality of life by any of the ICU-related factors was discernible.

          Conclusions

          A large proportion of the reduction in the health related quality of life after being in the ICU is attributable to pre-existing disease. The importance of the effect of pre-existing disease is further supported by the small, long term increment in the health related quality of life after treatment in the ICU. The reliability of the conclusions is supported by the size of the study populations and the long follow-up period.

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          Quality of life in adult survivors of critical illness: a systematic review of the literature.

          David Dowdy, Mark P Eid, Artyom Sedrakyan … (2005)
          To determine how the quality of life (QOL) of intensive care unit (ICU) survivors compares with the general population, changes over time, and is predicted by baseline characteristics. Systematic literature review including MEDLINE, EMBASE, CINAHL and Cochrane Library. Eligible studies measured QOL > or = 30 days after ICU discharge using the Medical Outcomes Study 36-item Short Form (SF-36), EuroQol-5D, Sickness Impact Profile, or Nottingham Health Profile in representative populations of adult ICU survivors. Disease-specific studies were excluded. Of 8,894 citations identified, 21 independent studies with 7,320 patients were reviewed. Three of three studies found that ICU survivors had significantly lower QOL prior to admission than did a matched general population. During post-discharge follow-up, ICU survivors had significantly lower QOL scores than the general population in each SF-36 domain (except bodily pain) in at least four of seven studies. Over 1-12 months of follow-up, at least two of four studies found clinically meaningful improvement in each SF-36 domain except mental health and general health perceptions. A majority of studies found that age and severity of illness predicted physical functioning. Compared with the general population, ICU survivors report lower QOL prior to ICU admission. After hospital discharge, QOL in ICU survivors improves but remains lower than general population levels. Age and severity of illness are predictors of physical functioning. This systematic review provides a general understanding of QOL following critical illness and can serve as a standard of comparison for QOL studies in specific ICU subpopulations.
          Article 0 comments Cited 153 times – based on 0 reviews     Review now
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            The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden.

            Matthew Ware, Timothy J. Sullivan, Fridrik J. Karlsson (1995)
            We document the applicability of the SF-36 Health Survey, which was translated into Swedish using methods later adopted by the International Quality of Life Assessment (IQOLA) Project procedures. To test its appropriateness for use in Sweden, it was administered through mail-out/mail-back questionnaires in seven general population studies with an average response rate of 68%. The 8930 respondents varied by gender (48.2% men), age (range 15-93 years, mean age 42.7), marital status, education, socio-economic status, and geographical area. Psychometric methods used in the evaluation of the SF-36 in the U.S. were replicated. Over 90% of respondents had complete items for each of the eight SF-36 scales, although more missing data were observed for subjects 75 years and over. Scale scores could be computed for the vast majority of respondents (95% and over); slightly fewer in the oldest subgroup. Item-internal consistency was consistently high across socio-demographic subgroups and the eight scales. Most reliability estimates exceeded the 0.80 level. The highest reliability was observed for the Bodily Pain Scale where all subgroups met the 0.90 level recommended for individual comparisons; coefficients at or above 0.90 were also observed in most subgroups for the Physical Functioning Scale. Tests of scaling assumptions including hypothesized item groupings, which reflect the construct validity of scales, were consistently favorable across subgroups, although lower rates were noted in the oldest age group. In conclusion, these studies have yielded empirical evidence supporting the feasibility of a non-English language reproduction of the SF-36 Health Survey. The Swedish SF-36 is ready for further evaluation.
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              Test-retest reliability of health state valuations collected with the EuroQol questionnaire.

              Gouke J. Bonsel, Thea Vliet Vlieland, Brian Bot … (1994)
              This study is a contribution by the Dutch participants to the research programme of the EuroQol Group. This collaborative group of researchers engaged in outcome measurement is working towards the development of a standardized, non-disease-specific instrument for describing and particularly valuing health-related quality of life. The present article analyses the test-retest reliability of the valuations collected with the EuroQol questionnaire in a population survey (n = 208). The choice of the appropriate method for test-retest analysis is discussed and the results of several approaches with the EuroQol data are shown. Generalizability Theory is proposed as the most suitable method. This method is the most comprehensive, giving distinct information about the relative contributions of different sources of variance. The EuroQol valuations appear to have good test-retest reliability.
              Article 0 comments Cited 66 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2010
                Publication date (Electronic): 15 April 2010
                Volume: 14
                Issue: 2
                Page: R67
                Affiliations
                [1 ]Departments of Intensive Care Linköping University Hospital, Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Garnisonsvägen, Linköping, 581 85, Sweden
                [2 ]TFS Trial Form Support AB, Ruben Rausings gata 11B, Lund, 223 55, Sweden
                [3 ]Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping, 551 85, Sweden
                [4 ]Department of Anaesthesia and Intensive Care, Vrinnevi Hospital, Gamla Övägen 25, Norrköping, 601 82, Sweden
                [5 ]Department of Intensive Care, Linköping University Hospital, Garnisonsvägen, Linköping, 581 85, Sweden
                [6 ]Department of Intensive Care Linköping University Hospital, Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Garnisonsvägen, Linköping, 581 85, Sweden
                Article
                Publisher ID: cc8967
                DOI: 10.1186/cc8967
                PMC ID: 2887189
                PubMed ID: 20398310
                SO-VID: b7411b18-a989-4f26-9847-704155688f90
                Copyright © Copyright ©2010 Orwelius et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 October 2009
                Date revision received : 4 February 2010
                Date accepted : 15 April 2010
                Categories
                Subject: Research

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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