68 CHAPTER 4 4.4 DISCUSSION In this prospective twelve month observational period, more than half of the long-term ICU-survivors showed no significant sign of physical recovery. These results substantiate the findings of our previously published retrospective study on recovery in an ICU-outpatient clinic cohort.6 In addition, after ICU- admission this was associated with shortcomings in self-efficacy and societal participation. Persistent physical NR was a marker for impairment in (almost) all domains of HRQoL. Ultimately, proxy-derived HRQoL at baseline helped to identify patients at risk for non-recovery. It is commonly known that age, pre-admission health status, and frailty impact recovery after critical illness. Although there was an imbalance in age between groups in our study, we believe it is unlikely to be the sole cause of the observed lack of recovery. At first glance, CFS at baseline did not differ up to the point of clinical risk identification, despite there being a statistically significant difference. However, a closer look at baseline HRQoL revealed marked differences between groups. Specifically in the physical HRQoL domains, patients that did not recover after 12-months experienced more health-related impairments before admission. These findings may represent the rehabilitation potential of this patient group. However, as these patients also had a higher LOS in ICU and more days on mechanical ventilation and there was only a modest difference in frailty before admission, contributing the lack of recovery solely to pre- admission health seems inappropriate. Nevertheless, proxy-derived HRQoL may help to perform an adequate risk assessment for non-recovery, and could potentially be simplified by an isolated PF-domain score in the acute hospital setting. In addition, a subsequent assessment at three months after discharge has added value in the identification of long-term non-recovery, and can be a trigger for further rehabilitation. This adds to the existing literature, since pre-ICU data on quality of life and physical functioning comes from studies in the elective surgical group.14,15 In general, our findings are consistent with previously reported impaired recovery of physical functioning and HRQoL in ICU-survivors. Firstly, in a study by Hofhuis et al. (2021), physical functioning domain scores varied between 6 and 59 from baseline to 10 years after ICU-discharge. This patient cohort never reached the age-adjusted reference value for the physical functioning domain. Secondly, in a follow-up study investigating physical functioning between three and twelve months after ICU-discharge, researchers observed that the physical component score (PCS) remained far below age-
RkJQdWJsaXNoZXIy MjY0ODMw