Functional independence in activities of daily living after discharge from the

Intensive Care Unit

Rannveig J. Jónasdóttir RN, CNS, PhD candidate

Health Science, University of Iceland, Reykjavík Landspitali The National University Hospital of Iceland, Reykjavik

Helga Jónsdóttir, PhD, RN, Professor, Faculty of Nursing, University of Iceland, Reykjavík

Gísli H. Sigurðsson, PhD, MD, Professor, Faculty of Medicine, University of Iceland, Reykjavík

Introduction

•  Critical illness and ICU stay

•  Physical health •  Independence in activities of daily living

(bathing, dressing, etc.) •  Structured, nurse-led follow-up

Aims

•  Measure patients´ functional independence in activities of daily living (FIADL) from ICU discharge until six months after and compare it;

– with self-reported FIADL four weeks before ICU

admission – between patients that received structured ICU-

nurse-led follow-up versus those receiving usual care

Material

•  Prospective, quasi-experimental study •  Patients ≥18 years of age and stayed ≥72 hours

in ICU; two ICUs in two separate buildings •  Intervention group

– Structured nurse-led follow-up after discharge from the ICU

•  Control group – ususal care

Structured nurse-led follow-up •  Ward stay

– Surveillance and support •  First week after discharge from general ward to

home – Phone call

•  3 months – Appointment and ICU visit

•  Usual care – Unstructured ward visits without further follow-up

Measures •  Modified Barthel Index •  10 activities of daily living •  Score 0 – 100

Modified'Barthel'Index'(MBI)'grooming'' bathing'feeding' toilet0use'

stair'climbing' dressing'bowel'control' bladder'control'

walking'/wheelchair' chair/bed'transfer'

Statistical analysis

•  Categories – Independence: 100 points on MBI – Dependence: ≥99 points on MBI

•  McNemar test: Before the ICU admission (pre) and 3 and 6 months after ICU discharge (post)

•  Chi-square: Difference between groups

Results •  Baseline characteristics

Interven4on'group'(n=69)'

Control'group'(n=75)'

Age,'yrs' 56.4''''(59.0'(19088))*' 68.9''''(70'(36083))'

APACHE'II'' 16.4'''''(15.5'(3040))' 20.2'''''(18.0'(7041))'

ICU'admission''–''surgical'–''non0surgical'

n'(%)'26'(38)'43'(62)'

n'(%)'46'(61)'29'(38)'

ICU'LOS,'days' 10.0'''''(7,0'(3046))' 12.0'''''(7.7'(3052))'

*measures presented as mean (median (range))

Results cont. •  Comparing functional independence in activites of daily living

before ICU admission and at 3 and 6 months had not reached the level before ICU (McNemars´s test)

Intervention group Control group

Time periods'

N ' Independent (score 100) '

n (%)'

Dependent (score ≤99) '

n (%)'

p"'

N ' Independent (score 100) '

n (%)'

Dependent'(score ≤99)

n (%)'

p"'

Before ICU'

69' 61 (88)' 8 (12)' 75' 58 (77)' 17 (23)'

ICU discharge'

69' 0 (0)' 69 (100)' 75' 0 (0)' 75 (100)'

Ward discharge'

69' 12 (17)' 57 (83)' 74' 15 (20)' 59 (80)'

3 months ' 69' 49 (71)' 20 (29)' 0,008 70' 40 (57)' 30 (43)' 0,006

6 months ' 62' 41 (66)' 21 (34)' 0,007 60' 38 (63)' 22 (37)' 0,041

Results cont. •  Comparison of functional independence in

activities of daily living between groups –  Independent (score 100 on MBI) and dependent (score ≥99 on MBI)

•  No difference between the groups – Before ICU (p=.12)

– Ward discharge (p=.82)

– 3 months (p=.13)

– 6 months (p=.90)

Limitations

•  RCT •  Groups different in baseline characteristics

(age, APACHE II) •  Recall bias of self-reported functional ability in

daily living before ICU •  Intervention

Conclusion

•  Functional independence in activities of daily living: –  is restricted up to six months after discharge – needs closer attention during recovery after critical

illness – should be emphasized within the ICU-nurse-led

follow-up

Thank you