Age and Severity of Disease Compromising the Functional Status Recovery of Critically Ill Patients after Hospital Discharge: An Observational Study
José Marcelo e Souza Mafra
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy - University of São Paulo Medical School, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-000, São Paulo-SP, Brazil.
Janete Maria da Silva
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy - University of São Paulo Medical School, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-000, São Paulo-SP, Brazil and Physiotherapy Facility, Clinical Hospital of Medical School of University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, CEP: 05403-000, São Paulo-SP, Brazil.
Leda Tomiko Yamada da Silveira
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy - University of São Paulo Medical School, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-000, São Paulo-SP, Brazil.
Clarice Tanaka
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy - University of São Paulo Medical School, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-000, São Paulo-SP, Brazil and Physiotherapy Facility, Clinical Hospital of Medical School of University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, CEP: 05403-000, São Paulo-SP, Brazil.
Carolina Fu *
Department of Physiotherapy, Communication Science & Disorders, Occupational Therapy - University of São Paulo Medical School, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-000, São Paulo-SP, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Objective: Evaluate the functional status of critically ill patients after hospital discharge and assess the effect of age and Acute Physiology and Chronic Health Evaluation II on the questionnaire scores.
Study Design: An observational longitudinal study.
Place and Duration of Study: The study was carried out between May 2010 and January 2011, at the Clinical Hospital of the University of São Paulo, Brazil.
Methodology: 147 patients, admitted to the Intensive Care Unit, ≥18 years old, underwent at least 24 hours of Invasive Mechanical Ventilation (IMV), were eligible after hospital discharge for this study. The functional status was assessed by using the Barthel Index, Katz Index and Health Assessment Questionnaire – Disability Index (HAQ-DI), at one, three, and six months after hospital discharge.
Results: Out of 147 eligible patients, 75 and 68 responded to the initial and final evaluations, respectively. Functional status improved significantly over time in all questionnaires. The analysis with two factors (age and severity of illness) in each of the three evaluations revealed significant interaction for Katz Index in the third evaluation (p=.001), and no interaction for the Barthel Index and HAQ-DI in each of the three evaluations.
Conclusion: The functional status of critically ill patients after hospital discharge was not related to age or severity of illness or length of stay in IMV, ICU or hospital. When divided into groups of age and severity of illness, patients with less severe illness presented a higher Katz score if they were older. Yet older patients tended to present higher Katz score with more severe illness.
Keywords: Critical illness, intensive care, activities of daily living, functional status, outcome assessment