60 CHAPTER 4 patients a year, with close to half of these admissions following elective surgery.8 All adult patients admitted to the ICU between May 20 and November 27 of 2019, with a length of stay (LOS) ICU of ≥48 hours, who were able to read and understand the Dutch language, were included in this study. The cut-off value on LOS ICU of 48 hours was used as a large proportion of patients in this ICU-ward with a shorter LOS are admitted per protocol and will be discharged within two days without mayor complications. It is commonly known that these patients have a lower risk of long-term health problems. Sample size was based on the average number of long-stay patients admitted to the local ICU-ward in six months due to the explorative nature of this study. The follow-up measurements were conducted throughout the first year after ICU-admission. Participating patients who did not survive until the one-year follow-up, did not complete the end-of-study HRQoL-measurement, or were lost to follow-up were excluded from analysis. This study, including a deferred consent procedure for patients that were not able to provide consent at baseline, has been evaluated and approved by the local research ethics committee of the Medical Centre Leeuwarden (Regionale Toetsingscommissie Patiëntgebonden Onderzoek, Leeuwarden, The Netherlands; METC-number: RTPO 1055). The study protocol was registered online (ClinicalTrials. gov identifier: NCT04154995). All patients provided written informed consent. A deferred consent procedure was instated to make sure baseline measurements could be performed if the patient was unable to give consent due to, for instance, sedation or delirium. When clinical evaluation showed that the patient was able to give an informed response, official consent was obtained. As a consequence, patients with severe cognitive problems after awakening, e.g. post-anoxic coma, or with inevitable ICU-mortality were excluded. 4.2.2 Data collection At baseline (LOS ICU ≤72h), a proxy of the patient was asked to complete the RAND-36, in order to evaluate the patient’s HRQoL prior to ICU-admission.9 This questionnaire, which is very similar to the Medical Outcome Study Short-Form-36 (MOS SF-36), consists of nine domains, as described in the previously conducted retrospective study.10 Higher scores indicate better subjective health status. Patients were asked to complete the RAND-36 again at three, six and twelve months after ICU-admission. In line with the previously applied identification method, all patients with a physical functioning (PF) domain score below age-adjusted reference value -based on a Dutch healthy
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