Physiotherapy - Theses

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Author: Skinner, Elizabeth Hope × Subject: physiotherapy × Subject: rehabilitation ×

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    Health-related quality of life, physical function and rehabilitation in survivors of critical illness
    Skinner, Elizabeth Hope ( 2010)
    The primary objective of the thesis was to investigate health-related quality of life and rehabilitation prescription in Australian ICU survivors. The first major component of the thesis examines the measurement of health-related quality of life in Australian ICU survivors in a prospective, longitudinal pre-post study design. Adult patients admitted to an Australian ICU for longer than 48 hours completed health-related quality of life instruments (the Short Form-36 and the Assessment of Quality of Life) at pre-admission and six months following ICU discharge. Health utilities were also calculated using the AQoL and SF-6D and the measurement properties (reliability, validity, responsiveness and sensitivity) of these two multi-attribute utility instruments were compared in the critical illness population. The second major component of the thesis examines rehabilitation prescription in Australian ICU survivors and reports the development of a physical function outcome measure (the ‘Physical Function in ICU Test’) for use in the debilitated critical illness population. The test battery was subsequently validated in 40 participants of a randomized controlled trial investigating early rehabilitation in patients admitted to ICU. Participants also underwent a pilot exercise training program in the ICU whilst mechanically ventilated and adverse events were recorded. The main findings of the investigation into health-related quality of life demonstrated that participants admitted to Australian ICUs report worse health-related quality of life than the normal population at pre-admission and follow-up. However, survivors report a return to pre-admission health-related quality of life at follow-up with improvements seen in some social functioning and psychological domains of health-related quality of life. Physical functioning health-related quality of life was most affected in comparison with the normal population. The comparison of the two health utility scores demonstrated that the utilities were not interchangeable and the SF-6D had two main problems of a lower boundary and restricted range and poor reliability which may affect its use for cost-utility analysis in the critical illness population. The main findings of the second component of the thesis were that exercise is widely prescribed by physiotherapists working in Australian ICUs. The physical functioning outcome measure that was developed was reliable and responsive to change and there was high adherence to pilot exercise training sessions with few adverse events in mechanically ventilated patients with a tracheostomy. The final study demonstrated that the outcome measure has a degree of validity in the critical illness population, however further study is required to validate the test on larger sample sizes and scoring the test battery may also provide valuable information in future studies. In conclusion, although health-related quality of life in patients admitted to Australian ICUs was worse than the general population, survivors reported improvements over time in some dimensions. Rehabilitation is widely used in the critical illness population and preliminary findings suggest that further investigation of exercise training in this population could be evaluated with larger trials. Future research should consider which specific groups of critical illness survivors to target with intervention and which multi-attribute utility instruments are most appropriate for cost-utility analysis in the critical illness population.