Show simple item record

dc.contributor.authorPuthucheary, ZA
dc.contributor.authorGensichen, JS
dc.contributor.authorCakiroglu, AS
dc.contributor.authorCashmore, R
dc.contributor.authorEdbrooke, L
dc.contributor.authorHeintze, C
dc.contributor.authorNeumann, K
dc.contributor.authorWollersheim, T
dc.contributor.authorDenehy, L
dc.contributor.authorSchmidt, KFR
dc.date.accessioned2020-11-17T03:53:15Z
dc.date.available2020-11-17T03:53:15Z
dc.date.issued2020-09-25
dc.identifierpii: 10.1186/s13054-020-03275-w
dc.identifier.citationPuthucheary, Z. A., Gensichen, J. S., Cakiroglu, A. S., Cashmore, R., Edbrooke, L., Heintze, C., Neumann, K., Wollersheim, T., Denehy, L. & Schmidt, K. F. R. (2020). Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors. CRITICAL CARE, 24 (1), https://doi.org/10.1186/s13054-020-03275-w.
dc.identifier.issn1466-609X
dc.identifier.urihttp://hdl.handle.net/11343/251629
dc.description.abstractBACKGROUND: Patients who survive critical illness suffer from a significant physical disability. The impact of rehabilitation strategies on health-related quality of life is inconsistent, with population heterogeneity cited as one potential confounder. This secondary analysis aimed to (1) examine trajectories of functional recovery in critically ill patients to delineate sub-phenotypes and (2) to assess differences between these cohorts in both clinical characteristics and clinimetric properties of physical function assessment tools. METHODS: Two hundred ninety-one adult sepsis survivors were followed-up for 24 months by telephone interviews. Physical function was assessed using the Physical Component Score (PCS) of the Short Form-36 Questionnaire (SF-36) and Activities of Daily Living and the Extra Short Musculoskeletal Function Assessment (XSFMA-F/B). Longitudinal trajectories were clustered by factor analysis. Logistical regression analyses were applied to patient characteristics potentially determining cluster allocation. Responsiveness, floor and ceiling effects and concurrent validity were assessed within clusters. RESULTS: One hundred fifty-nine patients completed 24 months of follow-up, presenting overall low PCS scores. Two distinct sub-cohorts were identified, exhibiting complete recovery or persistent impairment. A third sub-cohort could not be classified into either trajectory. Age, education level and number of co-morbidities were independent determinants of poor recovery (AUROC 0.743 ((95%CI 0.659-0.826), p < 0.001). Those with complete recovery trajectories demonstrated high levels of ceiling effects in physical function (PF) (15%), role physical (RP) (45%) and body pain (BP) (57%) domains of the SF-36. Those with persistent impairment demonstrated high levels of floor effects in the same domains: PF (21%), RP (71%) and BP (12%). The PF domain demonstrated high responsiveness between ICU discharge and at 6 months and was predictive of a persistent impairment trajectory (AUROC 0.859 (95%CI 0.804-0.914), p < 0.001). CONCLUSIONS: Within sepsis survivors, two distinct recovery trajectories of physical recovery were demonstrated. Older patients with more co-morbidities and lower educational achievements were more likely to have a persistent physical impairment trajectory. In regard to trajectory prediction, the PF score of the SF-36 was more responsive than the PCS and could be considered for primary outcomes. Future trials should consider adaptive trial designs that can deal with non-responders or sub-cohort specific outcome measures more effectively.
dc.languageEnglish
dc.publisherBMC
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleImplications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors
dc.typeJournal Article
dc.identifier.doi10.1186/s13054-020-03275-w
melbourne.affiliation.departmentMelbourne School of Health Sciences
melbourne.source.titleCritical Care (UK)
melbourne.source.volume24
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid1466609
melbourne.contributor.authorDenehy, Linda
melbourne.contributor.authorEdbrooke, Lara
dc.identifier.eissn1364-8535
melbourne.accessrightsOpen Access


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record