195 DISCUSSION AND FUTURE PERSPECTIVES 9 Over the last decade, researchers and clinicians shifted focus from mortality after critical illness to meaningful recovery. Identifying the possible long-term consequences of Intensive Care Unit (ICU) admission as the Post-Intensive Care Syndrome (PICS) has resulted in recognition of the burden of recovery in survivors and their informal caregivers. Nevertheless, adequate aftercare remains limited due to various barriers in research and clinical practice. In this thesis, we attempt to identify patients at risk for limited recovery throughout the first year post-ICU, with a specific focus on the long-stay ICU-patient. In addition, we investigate factors that may lead to frailty before and after critical illness and evaluate the possibility of using dietary and exercise interventions to improve recovery. Finally, a new initiative using virtual reality-assisted physical therapy is introduced as a first step towards a blended aftercare program for ICU-survivors. This section reflects upon our main findings and elaborates on future perspectives in research and clinical practice. IDENTIFYING LIMITED RECOVERY One of the main challenges of outcome research in ICU-survivors is the high heterogeneity in patient characteristics and rehabilitation trajectories.1 Previous research predominantly focussed on factors like admission diagnosis, age, and the presence of comorbidities at admission, and their association with unfavourable outcomes, like prolonged ICU-admission. However, these studies did not render consistent results.2–4 Factors associated with the patient’s time in the ICU and thereafter, like newly acquired organ dysfunction and general weakness may prove more effective in predicting long-term recovery in survivors. To further investigate different pathways of recovery and assess possible markers for long-term health problems after critical illness, Chapter 2 introduces a new identification method based on patient-reported physical functioning. Assessing health-related quality of life (HRQoL) after ICU is common and provides researchers and clinical practitioners with valuable information regarding general patient-reported outcomes after ICU.5,6 Yet, it is unclear whether this approach provides sufficient information to identify non-recovery on a patient level. Using retrospective data collected in the specialised outpatient clinic, we found that 44% of survivors did not fully recover after one year, i.e. did not reach physical functioning scores of a healthy, age-adjusted control group. In addition, it seems that the patients that were unable to fully recover over the year already displayed deficits in HRQoL at their three-month clinic visit. Impaired recovery was found to be strongly correlated with objective measures of physical functioning, indicating that the proposed
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