Activities of daily living, physical activity, and care situation in chronic critical illness survivors one year after disease onset: A prospective cohort study.

BACKGROUND

Survivors of critical illness frequently experience long-term impairments. Chronic critical illness (CCI) affects patients requiring prolonged ICU treatment and mechanical ventilation and is often complicated by critical illness polyneuropathy/myopathy (CIP/CIM). However, long-term data on CCI and CIP/CIM-particularly regarding activities of daily living (ADL), physical activity, and care situation-are limited.

METHODS

We analyzed data from the prospective cohort study CINAMOPS, including patients with CCI and ≥ 5 days of mechanical ventilation. Participants underwent inpatient neurological rehabilitation and were followed for one year after onset of critical illness. We assessed functional independence in ADL (Barthel Index), instrumental ADL (IADL; Lawton&Brody), physical activity (IPAQ-SF), overall disability (WHODAS-12), and the care situation via telephone and postal follow-up. Pre-hospitalization and follow-up conditions were compared, and health-related quality of life (HRQoL) correlations and differences between patients with and without CIP/CIM were analyzed.

RESULTS

In our cohort (n = 204; 62 ± 13 years; 34 % women; 63 ± 42 ICU days), ADL, IADL, and physical activity were significantly reduced at one-year follow-up. The WHODAS-12 score was 39 ± 26 %, with 64 % exhibiting moderate to severe disability. Only 62 % were independent in personal care, and 36 % could manage household tasks. Disability and functional dependence correlate with HRQoL. Of those previously employed, nearly half remained on sick leave. CIP/CIM was associated with worse functional outcomes and greater therapy needs.

CONCLUSIONS

One year after CCI, most patients continued to exhibit functional impairment and substantial restrictions in independent living. The presence of CIP/CIM worsened outcomes. Intensive rehabilitation and individualized long-term support are essential to improve recovery in this population.

TRIAL REGISTRATION: German Clinical Trials Register, DRKS00021753. Registered 03 September 2020. https://drks.de/search/en/trial/DRKS00021753.