69 HRQOL, HEALTHCARE UTILISATION AND BACK-TO-WORK ACTIVITIES IN ICU-SURVIVORS 4 adjusted reference values.16 However, some differences need to be addressed. In a follow-up study conducted in 156 post-ICU patients, severity of illness was associated with physical recovery at the six months follow-up.17 Interestingly, in our data set, patients with physical non-recovery did not have higher severity of illness scores. This dissimilarity may be due to group allocation based on physical recovery rather than ICU-characteristics. In conclusion, despite current rehabilitation options, critical illness survivors demonstrate long-term non-recovery in physical functioning. Due to these long-termhealth problems, ICU-survivors requiremore healthcare during and after hospital discharge compared to non-ICU patients, the latter reflected in a higher number of emergency room visits and hospital readmissions.7 In a recent Dutch cohort study, ICU-survivors were found to have up to five times higher healthcare costs compared to a healthy control group.18 Our study shows that physical NR-patients may contribute more to this extreme increase in costs over the first year after admission with a primary focus on the need for home care and assistance in daily living. Targeting this patient group in future interventions may have a positive impact on healthcare costs. Furthermore, the inability to return-to-work of ICU-survivors is one of the most prevalent personal and social consequences of a long-term ICU-admission. In a recent systematic review and meta-analysis of 52 studies, roughly one-third of the ICU-survivors that were employed prior to ICU-admission were jobless up to five years after ICU-admission.19 A prospective study in the north of the Netherlands indicated that the work rate (percentage of full-time) of a long-stay ICU-cohort was only 32.2% at six months after ICU-discharge.20 As disturbing as these results already are for all ICU-survivors, return-to-work in NR-patients seems to be even worse, as not even 15% of patients participate in work activities twelve months after admission. The dire situation of this specific group warrants more extensive and elaborate aftercare interventions to ensure that these people have a higher chance of societal reintegration and regain a sense of purpose. This study provides valuable information regarding pre-ICU health status, with in-depth assessment of HRQoL before admission in the acute setting, and recovery after critical illness. Yet, our study is limited by the number of patients and the heterogeneous origin of ICU-admission. Despite the in-depth information provided due to the longitudinal follow-up design with several time points, the findings represent a select patient group in the northern part of
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