23 PHYSICAL FUNCTIONING AFTER ICU-ADMISSION 2 2.1 INTRODUCTION Over the past decades, both hospital mortality and long-term mortality of intensive care unit (ICU) patients have declined.1,2 However, post-ICU recovery has been shown to be complex and eminently heterogeneous. Clinical evaluations of recovery after ICU-admission commonly focus on mortality and on the ability to perform basic activities of daily living (ADL). Indeed, ADL- performance seems to be a strong indicator of self-efficacy at the moment of ICU or hospital discharge and is often used to identify short-term care needs.3 However, these outcomes may be poor estimates of long-termprognosis. Thus, this short-term focus on recovery often does not equate the impact of critical illness in the long run. Long-term recovery after critical illness is often characterised by a range of physical and mental impairments, e.g. ICU-acquired weakness, cognitive decline, and emotional distress, among others.4,5 It is commonly known that persistence of impaired physical health interferes with successful rehabilitation, which is an important issue for ICU-patients and their family. Pre-ICU physical health, demographic factors and disease aetiology influence physical recovery to some extent.6 Still, ICU-admission and the highly specialised treatment that comes with it seem to play an equal role in the aetiology of long-term non-recovery. The finding that patients with a prolonged length of stay (LOS) are specifically burdened with long-term health problems illustrates the importance of this major life event as a separate risk factor for non-recovery.7 To fill this deficiency in prognostic power, recent developments have been focused on health-related quality of life (HRQoL) as an indicator for long term recovery.8 HRQoL-measurements encompass an integrative approach to physical, mental and social health of ICU-survivors. More specifically, both reduced physical health and being (partially) disabled have been shown to directly reflect on long-term HRQoL after ICU-discharge.9,10 To develop interventions which would improve HRQoL, specific target groups and risk factors with prognostic value regarding long-term non-recovery need to be determined. However, previous literature has often reported heterogenic results and were characterized by an overrepresentation of elective-surgical ICU- patients due to the ability to perform baseline tests.11 Furthermore, loss to follow-up is a serious limitation concerning the implications of results.12 These disadvantages make the generalisation of previously obtained findings troublesome.
RkJQdWJsaXNoZXIy MjY0ODMw