Health-related quality of life in intensive care survivors: Associations with social support, comorbidity, and pain interference

Anne Kathrine Langerud, Tone Rustøen, Milada Cvancarova Småstuen, Ulf Kongsgaard, Audun Stubhaug, Anne Kathrine Langerud, Tone Rustøen, Milada Cvancarova Småstuen, Ulf Kongsgaard, Audun Stubhaug

Abstract

Background: Experiences during a stay in the intensive care unit (ICU), including pain, delirium, physical deterioration, and the critical illness itself, may all influence survivors' health-related quality of life (HRQOL). However, few studies have examined the influence of social support, comorbidity, and pain interference on ICU survivors' HRQOL.

Objectives: To investigate possible associations between social support, number of comorbidities, and pain interference on HRQOL in ICU survivors.

Methods: ICU survivors responded to a survey 3 months (n = 118) and 1 year (n = 89) after ICU discharge. HRQOL was measured using the Short Form Health Survey-12 (v1), social support using the revised Social Provision Scale, pain interference using the Brief Pain Inventory-Short Form, and comorbidities using the Self-Administered Comorbidity Questionnaire.

Results: Physical and mental HRQOL were reduced at both 3 months and 1 year in ICU survivors compared with the general population. This reduction was more pronounced at 3 months for physical HRQOL, while a small reduction in mental HRQOL was not clinically relevant. Social support was statistical significantly positively associated with mental HRQOL at 3 months, while number of comorbidities was statistical significantly associated with a reduction in physical HRQOL at 3 months and 1 year and mental HRQOL at 1 year. Lastly pain interference was significantly associated with a reduction in physical HRQOL at 3 months and 1 year.

Conclusions: ICU survivors primarily report reduced physical HRQOL. Social support was positively associated with mental HRQOL, while number of comorbidities, and pain interference were all significantly associated with a reduction in HRQOL. Pain interference was associated with the largest reduction in HRQOL.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Brinkman S, Abu-Hanna A, de Jonge E, de Keizer NF. Prediction of long-term mortality in ICU patients: model validation and assessing the effect of using in-hospital versus long-term mortality on benchmarking. Intensive Care Med. 2013;39(11):1925–31. doi: .
    1. Boyko Y, Ording H, Jennum P. Sleep disturbances in critically ill patients in ICU: how much do we know? Acta Anaesthesiol Scand. 2012;56(8):950–8. doi: .
    1. Elliott R, McKinley S. The development of a clinical practice guideline to improve sleep in intensive care patients: a solution focused approach. Intensive Crit Care Nurs. 2014;30(5):246–56. doi: .
    1. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF. Sleep in the intensive care unit. Am J Respir Crit Care Med. 2015;191(7):731–8. doi: .
    1. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306. doi: .
    1. Berntzen H, Bjork IT, Woien H. "Pain relieved, but still struggling"-Critically ill patients experiences of pain and other discomforts during analgosedation. J Clin Nurs. 2017;15:15 doi: .
    1. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Interventions for preventing critical illness polyneuropathy and critical illness myopathy (Review) The Cochrane Libary. 2014;2014(1). doi: .
    1. Cuthbertson BH, Scott J, Strachan M, Kilonzo M, Vale L. Quality of life before and after intensive care. Anaesthesia. 2005;60(4):332–9. doi: .
    1. Myhren H, Ekeberg O, Stokland O. Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study. Crit Care Med. 2010;38(7):1554–61. doi: .
    1. Stricker KH, Sailer S, Uehlinger DE, Rothen HU, Zuercher Zenklusen RM, Frick S. Quality of life 9 years after an intensive care unit stay: a long-term outcome study. J Crit Care. 2011;26(4):379–87. doi: .
    1. Angus DC, Carlet J, Brussels RP. Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med. 2003;29(3):368–77. doi:
    1. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A, et al. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care. 2005;9(2):R96–109. doi:
    1. Soliman IW, de Lange DW, Peelen LM, Cremer OL, Slooter AJ, Pasma W, et al. Single-center large-cohort study into quality of life in Dutch intensive care unit subgroups, 1 year after admission, using EuroQoL EQ-6D-3L. J Crit Care. 2015;30(1):181–6. doi: .
    1. Timmers TK, Verhofstad MH, Moons KG, Leenen LP. Long-term survival after surgical intensive care unit admission: fifty percent die within 10 years. Ann Surg. 2011;253(1):151–7. doi: .
    1. Flaatten H, Kvale R. Survival and quality of life 12 years after ICU. A comparison with the general Norwegian population. Intensive Care Med. 2001;27(6):1005–11. .
    1. Svenningsen H, Langhorn L, Agard AS, Dreyer P. Post-ICU symptoms, consequences, and follow-up: an integrative review. Nurs Crit Care. 2017;22(4):212–20. doi: .
    1. Orwelius L, Nordlund A, Edell-Gustafsson U, Simonsson E, Nordlund P, Kristenson M, et al. Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care. Crit Care Med. 2005;33(7):1557–64. .
    1. Orwelius L, Nordlund A, Nordlund P, Simonsson E, Backman C, Samuelsson A, et al. Pre-existing disease: the most important factor for health related quality of life long-term after critical illness: a prospective, longitudinal, multicentre trial. Crit Care. 2010;14(2):R67 doi: ; PubMed Central PMCID: PMC2887189.
    1. Boyle M, Murgo M, Adamson H, Gill J, Elliott D, Crawford M. The effect of chronic pain on health related quality of life amongst intensive care survivors. Aust Crit Care. 2004;17(3):104–6. .
    1. Ferrans CE. Quality of life: conceptual issues. Semin Oncol Nurs. 1990;6(4):248–54. .
    1. Chaboyer W, Elliott D. Health-related quality of life of ICU survivors: review of the literature. Intensive Crit Care Nurs. 2000;16(2):88–97. doi: .
    1. Ferrans CE. Conceptualizations of quality of life in cardiovascular research. Prog Cardiovasc Nurs. 1992;7(1):2–6. .
    1. Varricchio CG, Ferrans CE. Quality of life assessments in clinical practice. Semin Oncol Nurs. 2010;26(1):12–7. doi: .
    1. Shen BJ, Wachowiak PS, Brooks LG. Psychosocial factors and assessment in cardiac rehabilitation. Eura Medicophys. 2005;41(1):75–91. .
    1. Johansen C. Rehabilitation of cancer patients—research perspectives. Acta Oncol. 2007;46(4):441–5. doi: .
    1. Hui DS, Wong KT, Ko FW, Tam LS, Chan DP, Woo J, et al. The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest. 2005;128(4):2247–61. doi: .
    1. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;371(3):287–8. doi: .
    1. Hough CL, Herridge MS. Long-term outcome after acute lung injury. Curr Opin Crit Care. 2012;18(1):8–15. doi: .
    1. Griffiths RD, Jones C. Recovery from intensive care. BMJ. 1999;319(7207):427–9. .
    1. Griffiths RD, Jones C. Recovering lives: the follow-up of ICU survivors. Am J Respir Crit Care Med. 2011;183(7):833–4. doi: .
    1. Tilburgs B, Nijkamp MD, Bakker EC, van der Hoeven H. The influence of social support on patients' quality of life after an intensive care unit discharge: A cross-sectional survey. Intensive Crit Care Nurs. 2015;31(6):336–42. doi: .
    1. Le Gall JR., Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.
    1. Schuster HP, Schuster FP, Ritschel P, Wilts S, Bodmann KF. The ability of the Simplified Acute Physiology Score (SAPS II) to predict outcome in coronary care patients. Intensive Care Med. 1997;23(10):1056–61. .
    1. Vincent JL, Moreno R, Takala J, Willatts S, De MA, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10. .
    1. Vincent JL, De MA, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800. .
    1. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003;49(2):156–63. doi: .
    1. Ware J, A. Kosinski M, D. Keller S. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales 1998.
    1. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998. .
    1. Ware J, Snoww K, Ma K, Bg G. SF36 Health Survey: Manual and Interpretation Guide 1993.
    1. Russell D, Cutrona CE, Rose J, Yurko K. Social and emotional loneliness: an examination of Weiss's typology of loneliness. J Pers Soc Psychol. 1984;46(6):1313–21. .
    1. Cutrona CE. Objective determinants of perceived social support. J Pers Soc Psychol. 1986;50(2):349–55. .
    1. Cutrona CE, Russell D.W. The Provisions of Social Relationships and Adaptaton to Stress. Advances in Personal Relationships. 1987;1:37–67.
    1. Bondevik M. The life of the oldest old: studies concerning loneliness, social contacts, activities of daily living, purpose in life and religiousness [Bergen: ]: Department of Public Health and Primary Health Care, Division for Nursing Science, University of Bergen; 1997.
    1. Constable JF, Russell DW. The effect of social support and the work environment upon burnout among nurses. J Human Stress. 1986;12(1):20–6. doi: .
    1. Cutrona CE. Social support and stress in the transition to parenthood. J Abnorm Psychol. 1984;93(4):378–90. .
    1. Russell DW, Altmaier E, Van Velzen D. Job-related stress, social support, and burnout among classroom teachers. J Appl Psychol. 1987;72(2):269–74. .
    1. Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain. 1983;17(2):197–210. .
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129–38. .
    1. Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S. The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage. 2002;24(5):517–25. .
    1. Kroenke K, Theobald D, Wu J, Tu W, Krebs EE. Comparative responsiveness of pain measures in cancer patients. J Pain. 2012;13(8):764–72. doi: .
    1. Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Ann Intern Med. 1993;119(2):121–6. .
    1. Wu JS, Beaton D, Smith PM, Hagen NA. Patterns of pain and interference in patients with painful bone metastases: a brief pain inventory validation study. J Pain Symptom Manage. 2010;39(2):230–40. doi: .
    1. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20(5):309–18. .
    1. Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the Brief Pain Inventory for chronic nonmalignant pain. J Pain. 2004;5(2):133–7. doi: .
    1. Astrup GL, Rustoen T, Miaskowski C, Paul SM, Bjordal K. Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain. 2015;156(5):967–79. doi: .
    1. Christensen VL, Holm AM, Kongerud J, Bentsen SB, Paul SM, Miaskowski C, et al. Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease. Pain Manag Nurs. 2016;17(2):107–18. doi: .
    1. Langerud AK, Rustoen T, Brunborg C, Kongsgaard U, Stubhaug A. Prevalence, Location, and Characteristics of Chronic Pain in Intensive Care Survivors. Pain Manag Nurs. 2017. doi: In press
    1. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31(5):611–20. doi: .
    1. Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Bakker J, Spronk PE. Health-related quality of life in critically ill patients: how to score and what is the clinical impact? Curr Opin Crit Care. 2009;15(5):425–30. doi: .
    1. Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Spronk PE. ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med. 2015;41(3):495–504. doi: .
    1. Sprangers MA, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999;48(11):1507–15. .
    1. Cella D, Bullinger M, Scott C, Barofsky I, Clinical Significance Consensus Meeting G. Group vs individual approaches to understanding the clinical significance of differences or changes in quality of life. Mayo Clin Proc. 2002;77(4):384–92. doi: .
    1. Battle CE, Davies G, Evans PA. Long term health-related quality of life in survivors of sepsis in South West Wales: an epidemiological study. PLoS One. 2014;9(12):e116304 doi: .
    1. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82. doi: .
    1. Langerud AK, Rustoen T, Smastuen MC, Kongsgaard U, Stubhaug A. Intensive care survivor-reported symptoms: a longitudinal study of survivor symptoms. Nurs in Crit Care. December 2017. doi:
    1. Ratzer M, Brink O, Knudsen L, Elklit A. Posttraumatic stress in intensive care unit survivors—a prospective study. Health psychology and behavioral medicine. 2014;2(1):882–98. doi: .
    1. Duggan MC, Wang L, Wilson JE, Dittus RS, Ely EW, Jackson JC. The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: Results from the BRAIN-ICU investigation. J Crit Care. 2016;37:72–9. doi: .

Source: PubMed

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