ICU Discharge Function Predicts Poor Hospital Discharge Outcomes: Lessons from the CYCLE Research Program
CCCF ePoster library. Kho M. Oct 3, 2017; 198155; 63
Dr. Michelle Kho
Dr. Michelle Kho
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ICU Discharge Function Predicts Poor Hospital Discharge Outcomes: Lessons from the CYCLE Research Program

Kho, Michelle E1,2; Heels-Ansdell, Diane3; Thabane, Lehana3; Cook, Deborah J3,4 and the TryCYCLE and CYCLE Pilot RCT investigators

 

1Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton ON, Canada, L8S 1C7

2Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton ON, Canada

3Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Center, Room HSC-2C, 1200 Main Street West, Hamilton ON, Canada, L8N 3Z5

4Department of Medicine, McMaster University, Health Sciences Center, Room 3W10, 1200 Main Street West, Hamilton ON, Canada, L8N 3Z5

 


INTRODUCTION: Physical function 7 days post-ICU can predict function 1 year later(1), however the relationship between physical function at ICU discharge and more proximal outcomes is unknown. The Physical Function ICU Test-scored (PFIT-s) is a reliable and valid measure of function in patients with critical illness.  It includes 4 items (shoulder and knee extensor strength, amount of assistance required to stand, stepping cadence), and scores range from 0 to 10, with higher scores reflecting better function.(2, 3)  While studies from Australia(4) and the United States(5) identified positive relationships between higher PFIT-s scores and better hospital discharge disposition, the generalizability of these findings in Canada are unknown.
 
OBJECTIVES: To predict the relationship between PFIT-s scores at ICU discharge and outcomes at hospital discharge in a cohort of Canadian ICU survivors.
 
METHODS: This is a secondary analysis of 2 studies from the CYCLE Research Program: TryCYCLE (NCT01885442), a single-centre, 33-patient prospective cohort study of early in-bed cycling(
6), and CYCLE Pilot (NCT02377830), a 7-centre, 66 patient RCT of early in-bed cycling and routine physiotherapy interventions versus routine physiotherapy interventions alone(7).  Both of these studies included adult patients within the first 4 days of mechanical ventilation and first 7 days of ICU admission who could ambulate independently pre-hospital with or without a gait aid, and had no other exclusions.  At ICU discharge, trained physiotherapists collected the PFIT-s. We prospectively identified whether ICU survivors with PFIT scores met any of 3 conditions comprising a composite outcome of poor health status at hospital discharge:  1) mortality, 2) readmission to ICU, or 3) discharge requiring paid assistance (e.g., home care, rehabilitation, assisted living, etc.). For continuous variables, we calculated the mean and standard deviation (SD); for binary variables, we calculated counts and percentages.  We conducted a logistic regression to predict the association of PFIT-s score and poor health status at hospital discharge. We conducted all analyses with SAS version 9.4 for Windows, Cary NC.
 
RESULTS: We included 74 patients with PFIT-s scores at ICU discharge (26 patients from TryCYCLE and 48 from the CYCLE Pilot RCT).  The mean (SD) PFIT-s score was 5.7 (2.2).  At hospital discharge, 46 (62.2%) of patients had poor health status (11 (14.5%) died, 8 (10.8%) were readmitted to ICU, 35 (47.3%) required paid assistance at hospital discharge; numbers total >46 because a patient could experience >1 outcome).  Using logistic regression, we found that higher PFIT-s scores (better function) were significantly associated with a lower odds of developing poor health status (odds ratio 0.59, 95% confidence interval (0.43, 0.81)). 
 
CONCLUSION: A 1-point increase in PFIT score (out of 10) at ICU discharge significantly decreased the odds of developing poor health status at hospital discharge (mortality, readmission to ICU, or requirement for paid assistance) by 40%. This analysis underscores the prognostic value of physical functional disability after ICU discharge and its potential use predicting poor health status at hospital discharge. These findings may be useful in the evaluation of rehabilitation interventions designed to optimize patients’ function and independence after hospitalization.

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