title: Factors influencing physical functional status in intensive care unit survivors two years after discharge.
abstract: BACKGROUND
  Studies suggest that in patients admitted to intensive care units (ICU), physical functional status (PFS) improves over time, but does not return to the same level as before ICU admission. The goal of this study was to assess physical functional status two years after discharge from an ICU and to determine factors influencing physical status in this population.
  
  
  METHODS
  The study reviewed all patients admitted to two non-trauma ICUs during a one-year period and included patients with age ≥ 18 yrs, ICU stay ≥ 24 h, and who were alive 24 months after ICU discharge. To assess PFS, Karnofsky Performance Status Scale scores and Lawton-Instrumental Activities of Daily Living (IADL) scores at ICU admission (K-ICU and L-ICU) were compared to the scores at the end of 24 months (K-24mo and L-24mo). Data at 24 months were obtained through telephone interviews.
  
  
  RESULTS
  A total of 1,216 patients were eligible for the study. Twenty-four months after ICU discharge, 499 (41.6%) were alive, agreed to answer the interview, and had all hospital data available. PFS (K-ICU: 86.6 ± 13.8 vs. K-24mo: 77.1 ± 19.6, p < 0.001) and IADL (L-ICU: 27.0 ± 11.7 vs. L-24mo: 22.5 ± 11.5, p < 0.001) declined in patients with medical and unplanned surgical admissions. Most strikingly, the level of dependency increased in neurological patients (K-ICU: 86 ± 12 vs. K-24mo: 64 ± 21, relative risk [RR] 2.6, 95% CI, 1.8-3.6, p < 0.001) and trauma patients (K-ICU: 99 ± 2 vs. K-24mo: 83 ± 21, RR 2.7, 95% CI, 1.6-4.6, p < 0.001). The largest reduction in the ability to perform ADL occurred in neurological patients (L-ICU: 27 ± 7 vs. L-24mo: 15 ± 12, RR 3.3, 95% CI, 2.3-4.6 p < 0.001), trauma patients (L-ICU: 32 ± 0 vs. L-24mo: 25 ± 11, RR 2.8, 95% CI, 1.5-5.1, p < 0.001), patients aged ≥ 65 years (RR 1.4, 95% CI, 1.07-1.86, p = 0.01) and those who received mechanical ventilation for ≥ 8 days (RR 1.48, 95% CI, 1.02-2.15, p = 0.03).
  
  
  CONCLUSIONS
  Twenty-four months after ICU discharge, PFS was significantly poorer in patients with neurological injury, trauma, age ≥ 65 tears, and mechanical ventilation ≥ 8 days. Future studies should focus on the relationship between PFS and health-related quality of life in this population.
authors.affiliation: Postgraduate Program in Medical Science, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Jaqueline S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Medical School - Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Cassiano
authors.initials: C
authors.lastname: Teixeira
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Cabral
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Alessandra H D
authors.initials: AH
authors.lastname: Fleig
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Ana Paula R
authors.initials: AP
authors.lastname: Freitas
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Erika C
authors.initials: EC
authors.lastname: Treptow
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Márcia Ib
authors.initials: MI
authors.lastname: Rizzotto
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: André S
authors.initials: AS
authors.lastname: Machado
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Patrícia C
authors.initials: PC
authors.lastname: Balzano
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Márcio P
authors.initials: MP
authors.lastname: Hetzel
authors.affiliation: Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil.
authors.forename: Daniele M
authors.initials: DM
authors.lastname: Dallegrave
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Roselaine P
authors.initials: RP
authors.lastname: Oliveira
authors.affiliation: Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Savi
authors.affiliation: Postgraduate Program in Medical Science, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Silvia Rr
authors.initials: SR
authors.lastname: Vieira
keywords: Activities of Daily Living; Health-related Quality of Life; Intensive Care Unit; Long-term Care; Mortality; Physical Functional Status; Prognosis