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Critical care
Original article
Are physical measures related to patient-centred outcomes in ARDS survivors?
  1. Kitty S Chan1,
  2. Lisa Aronson Friedman2,3,
  3. Victor D Dinglas2,3,
  4. Catherine L Hough4,
  5. Carl Shanholtz5,
  6. E Wesley Ely6,7,
  7. Peter E Morris8,
  8. Pedro A Mendez-Tellez2,9,
  9. James C Jackson6,
  10. Ramona O Hopkins10,11,12,
  11. Dale M Needham2,3,13
  1. 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Outcomes after Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
  5. 5Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, Maryland, USA
  6. 6Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  7. 7Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  8. 8Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky, USA
  9. 9Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  10. 10Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, USA
  11. 11Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, USA
  12. 12Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
  13. 13Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Kitty S Chan, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Room No 633, Baltimore, MD 21205-1901, USA; kchan10{at}jhu.edu

Abstract

Objective To inform selection of physical measures for studies of acute respiratory distress syndrome (ARDS) survivors within 12 months of ARDS.

Methods Secondary analysis of data from 6-month survivors participating in a US multicentre prospective study (ARDSNet Long-Term Outcome Study, N=134) or a multisite prospective study in Baltimore, Maryland, USA (Improving Care of Acute Lung Injury Patients, N=99). Physical measures, assessed at 6-month follow-up, were categorised according to the WHO's International Classification of Disability and Health: body functions and structures, activity and participation. Patient-centred outcomes were evaluated at 6 and 12 months: survival, hospitalisation, alive at home status and health-related quality of life. Pearson correlation, linear and logistic regression models were used to quantify associations of physical measures with patient-centred outcomes.

Main results No 6-month body functions and structures measure demonstrated consistent association with 6-month or 12-month outcomes in multivariable regression. The 6 min walk test, an activity measure, was associated with 6-month Short-Form 36 (SF-36) physical component scores (PCS, β range: 0.99 to 1.52, p<0.05). Participation measures (Functional Performance Inventory, FPI; Instrumental Activities of Daily Living, IADLs) were associated with SF-36 PCS (β range: FPI, 1.51–1.52; IADL, −1.88 to −1.32; all p<0.05) and Euro-QOL-5D utility score (β range: FPI, 2.00–3.67; IADL, −2.89 to −2.50; all p<0.01) at 6 and 12 months.

Conclusions Participation measures better reflect patient's quality of life than measures of body functions and structures within 12 months of ARDS among 6-month survivors, and are recommended for inclusion as a core measure in future studies.

  • ARDS

https://doi.org/10.1136/thoraxjnl-2016-209400

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    Footnotes

    • Contributors KSC and DMN contributed to study conception and design. VDD, CLH, CS, PEM, PAM-T, JCJ, ROH and DMN contributed data for the study. LAF conducted analyses, and all authors contributed to analysis and interpretation. KSC drafted the manuscript, and all other authors critically revised it for important intellectual content. All authors approved the submitted manuscript. KSC and DMN are responsible for the overall content and affirm that the manuscript is an accurate account of the reported study and that no important aspects of the study have been omitted.

    • Funding This research was supported by the National Heart, Lung and Blood Institute (R24 HL111895, R01HL091760, R01HL091760-02S1, R01HL096504, R01HL88045 and P050HL73994), the Johns Hopkins Institute for Clinical and Translational Research (UL1 TR 000424-06), and the ALTA and EDEN/OMEGA trials (contracts for sites participating in this study: HSN268200536170C, HHSN268200536171C, HHSN268200536173C, HHSN268200536174C, HSN268200536175C and HHSN268200536179C).

    • Competing interests None declared.

    • Ethics approval Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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