The impact of musculoskeletal ill health on quality of life and function after critical care: a multicentre prospective cohort study

Author:

Gustafson O. D.1ORCID,King E. B.1ORCID,Schlussel M. M.2,Arnold A.3,Wade C.4,Nicol P. S.5,Rowland M. J.6ORCID,Dawes H.7ORCID,Williams M. A.8ORCID

Affiliation:

1. Clinical Academic Physiotherapist, Oxford Allied Health Professions Research and Innovation Unit Oxford University Hospitals NHS Foundation Trust Oxford UK

2. Senior Medical Statistician, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK

3. Clinical Specialist Physiotherapist, Intensive Care Unit, Great Western Hospitals NHS Foundation Trust Swindon UK

4. Lead Physiotherapist, Intensive Care Unit Milton Keynes University Hospital NHS Foundation Trust Milton Keynes UK

5. Senior Physiotherapist, Intensive Care Unit Royal Berkshire NHS Foundation Trust Reading UK

6. Honorary Professor, Wellcome‐Wolfson Institute for Experimental Medicine Queen's University Belfast Belfast UK

7. Professor, College of Medicine and Health University of Exeter Exeter UK

8. Reader, Oxford Institute of Applied Health Research, Faculty of Health and Life Sciences Oxford Brookes University Oxford UK

Abstract

SummaryPhysical disability is a common component of post‐intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health‐related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392–0.589); anxiety, rs = ‐0.433 (95%CI ‐0.538 to ‐0.315); and depression, rs = ‐0.537 (95%CI ‐0.631 to ‐0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0–3.25 [0–7]) vs. 4 (1–7 [0–7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high‐risk groups to target in future interventional studies.

Funder

Research Trainees Coordinating Centre

NIHR Exeter Clinical Research Facility

Publisher

Wiley

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