Health-related quality of life and return to work after critical illness in general intensive care unit patients: a 1-year follow-up study

Abstract

Objective: To study how health-related quality of life of intensive care unit survivors compares with the general population, changes over time, and association with an optimistic personality trait and posttraumatic stress. Further, to explore differences in health-related quality of life between medical, trauma, and surgical patients and to assess return to work/school at 1 yr.

Design: Prospective 1-yr follow-up study.

Setting: University-affiliated trauma center hospital.

Patients: At 1-yr, 194 patients participated. Mean age was 49 yrs and 60% were males.

Measurements and main results: Health-related quality of life was assessed by the Short Form 36, which measures health-related quality of life in eight separate dimensions (0=worst health state, 100=best health state). At 1 yr, significantly lower scores compared to the general population were seen in all eight scales (p<.001). The decrease in Short Form 36 scores between before intensive care unit and 1-yr measurements was significant for all eight dimensions (p<.01). The multivariate regression analyses adjusted for gender, age (beta, -0.3), optimism (beta, 0.9), medical disease (beta, 12.2), length of stay in intensive care unit (beta, -0.4), being employed/student/retired before intensive care unit stay (beta, 12.5), and posttraumatic stress symptoms (beta, -9.1; all p<.05) were independent predictors of the dimension physical functioning (adjusted r=.22). For mental health, adjusted for age and gender, independent predictors were optimism (beta, 1.4), being employed/student/retired before intensive care unit stay (beta, 14.9), and posttraumatic stress symptoms (beta, -11.6; all p<.001; adjusted r=.35). Before intensive care unit admission, 122 (63%) patients were students/working, among these, 67 (55%) had returned to work/school at 1-yr follow-up.

Conclusion: Intensive care unit survivors had significantly lower health-related quality of life at 1 yr compared to the general population and significantly reduced compared to their states before intensive care unit admission. Less posttraumatic stress and optimism were predictors of higher health-related quality of life and return to work/school. Trauma patients had the largest decrease in both physical and mental scores. Only half of the patients had returned to work/school.