The impact of critical illness on patients’ physical function and recovery: An explanatory mixed-methods analysis

Highlights

• Function at 6-months was below population norms and did not correlate with perception of function.

• Many ICU survivors felt they had recovered 6-months from admission but still reported limitations.

• Family and friends provide essential support during the transition home from hospital-based care.

• The financial impact of critical illness continues well past discharge from acute services.

• Providing specific discharge pathways for ICU survivors may improve the recovery process.

Abstract

Objectives

To determine how the perception of physical function 6-months following critical illness compares to objectively measured function, and to identify key concerns for patients during recovery from critical illness.

Research methodology and design

A nested convergent parallel mixed methods study assessed physical function during a home visit 6-months following critical illness, with semi-structured interviews conducted at the same time.

Setting

Participants were recruited from two hospitals at one healthcare network in Melbourne, Australia from September 2017 to October 2018 with follow-up data completed in April 2019.

Main Outcome Measures

Physical function was assessed through four objective outcomes: the functional independence measure, six-minute walk test, functional reach test, and grip strength. Semi structured interviews focused on participants function, memories of the intensive care and hospital stay, assistance required on discharge, ongoing limitations, and the recovery process.

Findings

Although many participants (12/20, 60%) stated they had recovered from their critical illness, 14 (70%) had function below expected population norms. Decreased function on returning home was commonly reported, although eleven participants were described as independent and safe for discharge from hospital-based staff. The importance of family and social networks to facilitate discharge was highlighted, however participants often described wanting more support and issues accessing services. The effect of critical illness on the financial well-being of the family network was confirmed, with difficulties accessing financial support identified.

Conclusion

Survivors of critical illness perceived a better functional state than measured, but many report new limitations 6-months after critical illness. Family and friends play a crucial role in facilitating transition home and providing financial support.

Implications for clinical practice

Implementation of specific discharge liaison personnel to provide education, support and assist the transition from hospital-based care to home, particularly in those without stable social supports, may improve the recovery process for survivors of critical illness.