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Recovery and Rehabilitation 59

HRQOL instruments available is large, but can be divided
Practice tip into two groups: generic to all illnesses, or specific to a
particular disease state. One limitation of generic instru-
Current clinical recommendations to limit muscle wasting ments is that, while they can be applied to a broad spec-
include: trum of populations, they may not be responsive to
● minimising patient exposure to corticosteroids and neuro- specific disease characteristics. This section discusses the
43
muscular blocking agents measurement of health outcomes, focusing on HRQOL,
● limiting excessive analgesia and sedation and the physical and psychological measures commonly
● glycaemic control may also be of value, although further used to assess survivors of a critical illness.
investigations continue
● early nutrition or specific nutritional supplements or com- As introduced earlier, reviews of numerous observational
ponents may limit loss of muscle mass or enhance muscle studies with survivors of a critical illness have demon-
recovery, but also requires further research. 25 strated a delayed recovery trajectory, highlighting particu-
larly the effect of physical function on an individual’s
usual role. Recommendations for future studies noted
that patients should be followed for at least six months,
PATIENT OUTCOMES FOLLOWING have neuropsychological testing as part of their assess-
ment, and be assessed using a HRQOL instrument that
A CRITICAL ILLNESS enables comparison across countries and languages. 3,9,44,45
Common instruments used to assess HRQOL, physical
Examination of patient outcomes beyond survival is an
important contemporary topic for critical care practice functioning and psychological functioning for cohorts of
and research. 3-5,36 Patient outcomes after a critical illness patients after a critical illness are discussed below.
or injury were traditionally measured using a number of
objective parameters (e.g. number of organ failure-free MEASURES OF HEALTH-RELATED QUALITY OF
37
days, 28-day status, or 1-year mortality). Other mea- LIFE AFTER A CRITICAL ILLNESS
sures that examined patient-centred concepts such as A generic instrument that measures baseline HRQOL and
functional status and HRQOL 38,39 have become more exhibits responsiveness in a recovering critically ill patient
prevalent in the literature. 3,4,40-42 As the recovery trajectory with demonstrated reliability and validity has been
from a critical illness may be long and incomplete, elusive, although recent review papers have identified
4,9
mapping this path is a complex process. The range of some useful instruments (see Table 4.1). SF-36 is the

TABLE 4.1 Summary of health-related quality of life (HRQOL) instruments used for patients following a critical illness

Instrument Items Concepts/domains
Medical outcomes study (SF-36) 162,163 36 physical: functioning, role limitations, pain, general health; mental: vitality, social, role
limitations, mental health; health transition; variable response levels (2–5)
EuroQol 5D 46,164 5 mobility, self-care, usual activities, pain/discomfort, anxiety/depression; 3 response
levels; cost-utility index
15D 46,165 15 mobility, vision, hearing, breathing, sleeping, eating, speech, elimination, usual
activities, mental function, discomfort, distress, depression, vitality, and sexual
activity; 5-point ordinal scale (1 = full function; 5 = minimal/no function)
Quality of life–Italian (QOL–IT) 166 5 physical activity; social life; perceived quality of life; oral communication; functional
limitation; varied response levels (4–7)
Assessment of Quality of Life (AQOL) 167 15 Illness (3 items); independent living (3 items); physical senses (3 items); social
relationships (3 items); psychological wellbeing (3 items); 4 response levels; enables
cost-utility analysis
Quality of life–Spanish (QOL–SP) 168 15 basic physiological activities (4 items); normal daily activities (8 items); emotional
state (3 items)
Sickness impact profile (SIP) 169 68 physical: somatic autonomy; mobility control; mobility range
psychosocial: psychic autonomy and communication; social behaviour; emotional
stability; developed from original 136-item 170
Nottingham Health Profile (NHP) 171 45 experience: energy, pain, emotional reactions, sleep, social isolation, physical mobility;
daily life: employment, household work, relationships, home life, sex, hobbies,
holidays
Perceived quality of life (PQOL) 172 11 satisfaction with: bodily health; ability to think/remember; happiness; contact with
family and friends; contribution to the community; activities outside work; whether
income meets needs; respect from others; meaning and purpose of life; working/
not working/retirement; each scored on 0–100 scale