33 PHYSICAL FUNCTIONING AFTER ICU-ADMISSION 2 able to explain 50 percent of the variability in physical functioning recovery, it also rendered the majority of baseline characteristics statistically insignificant. An additional explanation for the substantial goodness-of-fit lies in the bivariate distinction between patients who fully recover versus those who do not. This division seems to closely match the diversity in HRQoL-scores which occurs during recovery after critical illness. Evidently, future studies incorporating physical functioning at 3-months after ICU-discharge are urgently needed. In addition, it is necessary to identify factors and sub-groups not only at 12 and 3-months but also at ICU-discharge, in order to potentially facilitate multidisciplinary aftercare programs which aim to improve long-term HRQoL as early as possible. 2.4.1 Limitations Even though these findings may contribute to a further understanding of the large diversity in recovery after critical illness, there were several limitations to our study to keep in mind. First of all, the retrospective, single centre design clearly limited the potential to generalise results. The patient population per hospital can be highly diverse, especially in critical care. With regards to our physical functioning data, there was a high amount of missing data due to loss to follow-up. Furthermore, our study design lacked baseline measurements of HRQoL, identical to other studies regarding acute ICU-patients. Henceforth, methods in order to resemble baseline measurements should be considered, such as proxy measurements.29 Additionally, to take into account the pre-admission frailty of patients admitted to the ICU-ward would strengthen results. Additionally, this study reports on the physical recovery of patients who were willing and/or are able to visit the post-ICU outpatient clinic at 3 and complete the questionnaires at 12-months after ICU-discharge. Consequently, the recovery of patients who were unable to conduct the previous is unknown. It should be noted that most patients lost to follow-up indicated an overwhelming amount of appointments with health-care professionals as the main reason to decline the post-ICU clinic invitation, rather than inability to attend due to physical or mental health problems. Future studies might be able to limit the number of lost to follow-up measurements by conducting proxy or patient measurements via telephone. Additionally, due to the retrospective nature of this study and the limited financial resources of the standard care post-ICU clinic, no in-person physical tests were conducted at 12-months after discharge. This would have improved the robustness of the data and should be taken into account in future studies regarding this subject.
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