- Study protocol
- Open Access
- Open Peer Review
Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study
© Jeitziner et al; licensee BioMed Central Ltd. 2011
- Received: 21 March 2011
- Accepted: 2 September 2011
- Published: 2 September 2011
Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1) to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2) to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use), living situation, and survival after discharge and at 6 and 12 months of follow-up.
A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group). Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group.
Little research has focused on long term consequences after ICU admission in older critically ill patients. The present study is specifically focussing on long term consequences of stress factors experienced during ICU admission.
- General Practitioner Visit
- Confusion Assessment Method
- Behavioural Pain Scale
- Physical Role Function
- Important Stress Factor
Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes . It is generally recognized that survival alone is not the only important outcome following an ICU stay. Various stress factors experienced in the ICU and the severity of illness or injury have long-term consequences [2–4]. Over the long term, discomfort experienced in the ICU and stressful memories of an ICU stay have been associated with the development of acute posttraumatic stress disorder-related syndromes, anxiety, depression, and impaired health-related quality of life (HR-QOL) [5–9]. For some patients these symptoms are chronic and cause lasting personality changes. Other studies focus on outcomes such as functional status, ability to live at home, influence on the social network, and the burden on the family, all of which can, at times, be more important than the length of survival [10–12]. Recent research has indicated that there may be significant cognitive and emotional dysfunction following critical illness [13–15]. Another study shows that survivors of critical illnesses have increased health care system needs. Continuing hospital care, and/or rehabilitation, community support services or other healthcare services after the ICU stay were needed. In addition, there was an increase in the use of medication and of doctor visits . An increasing proportion of critically ill patients are aged (65 years and older). Older patients with severe injuries are at risk of poor outcome . Mortality rates are almost 22% in older surgical patients , and yet age alone does not appear to be a reliable predictor of outcome after ICU admission [19, 20]. Older patients express preferences for longer life under compromised health conditions more frequently than healthy persons . Until now, few studies have examined long-term outcomes after ICU admissions in older critically ill patients [17, 22, 23]. Pain, anxiety and agitation are important stress factors for many critically ill patients, yet these symptoms are difficult to distinguish from one another. Pain, anxiety and agitation can have consequences for the health-related quality of life . In addition, pain, anxiety, and agitation, and their consequences for long-term outcomes, have rarely been examined in older critically ill patients in the ICU [24–26]. In contrast to other studies [22, 23], the present study examines the relationship between the ICU stay and post-hospital pain, anxiety and agitation in older critically ill patients, and addresses whether acute experiences in the ICU can cause more serious chronic conditions after discharge. This article describes a longitudinal study in which older critically ill patients are followed one year after their discharge from the hospital. Under investigation were their pain experiences, levels of anxiety and agitation, health-related quality of life, and use of the health care system, in order to detect relationships between these main outcomes and their ICU experiences.
The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. The study addresses the following research questions: (1) Does an ICU stay influence the pain, anxiety, and agitation experienced by older critically ill patients after discharge, and at 6- and 12-month follow-up? (2) Do the pain, anxiety and agitation experienced by older critically ill patients during an ICU stay affect their experiences of these symptoms after discharge, and at 6- and 12-month follow-up? (3) Does an ICU stay affect the health-related quality of life (HR-QOL) of older critically ill patients after discharge, and at 6-and 12-month follow-up? (4) What is the relation between the ICU stay and subsequent use of the health care system (readmissions, general practitioner visits, rehabilitation, length of hospital stay), medication use, living situation, and survival as experienced by older critically ill patients after discharge, and at 6- and 12-month follow-up?
Participants and Setting
The study will be conducted in the interdisciplinary ICU of a Swiss university hospital, where approximately 4000 patients with surgical procedures, illnesses, and trauma are treated each year, as well as at 12 follow-up clinics. From this ICU, 150 older critically ill patients (age 65 years and older) will be recruited, to be followed until 1 year after discharge from the hospital (the ICU group). A sample of 100 patients will be needed, based on a power analysis; with a 95% confidence interval for an estimated prevalence of pain between 0.30-0.50 and a total of 0.20, a sample size of 81-96 is needed. In order to ensure a large enough sample, and to counteract the potential loss of participants through mortality, relocation, attrition, or other problems, an additional 50 participants will be recruited (150 total). In order to be able to interpret trends in scores in the ICU group for the outcome variables pain, anxiety, agitation, HRQOL, use of the health care system (readmissions, GP visits, rehabilitation, length of hospital stay), medication use, living situation, and survival, we decided to collect similar data in a comparison group. Participants of the comparison group are a convenience sample of older people from the Swiss population, who have not been admitted to an ICU for the last 15 years. Through matching of age and gender, an attempt is made to increase the comparability of the groups at baseline.
Inclusion and exclusion criteria
To participate in this study, the participants must have a minimum age of 65 years, have had an ICU stay of at least 48 hours (ICU group) or no stay for the last 15 years (comparison group), be able to speak and read either German or French, and live in Switzerland. Excluded were participants because of temporary tracheostomies, chronic mechanical ventilation, illness-related cognitive impairment (dementia), or psychotic illnesses including delusions and changes in mental state, and potentially terminal illnesses such as lung or heart diseases and cancer.
Demographic data include age, gender and marital status. Furthermore, health-related data including Activities of Daily Living (ADL) and co-morbidities will be collected at baseline for all participants. The severity of the patient's condition will be determined using the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Simplified Acute Physiology Score (SAPS II) . The performance of ADL will be measured using items querying the need for assistance with daily activities (home health care, home food delivery, residence in a retirement home or nursing home) and various quality-of-life dimensions such as physical function, physical role function, vitality and social role function (Short Form 36 Health Survey [SF-36]). A scale developed for this study will be used to assess the need for assistance with daily activities (completely dependent; needs support by caregivers and special medical equipment; needs caregivers; independent with medical equipment; completely independent). Co-morbidities will be measured using the International Classification of Diseases (ICD), Version 10 .
Pain, anxiety and agitation during an ICU stay
During the ICU stay, pain, anxiety and agitation will be measured in the ICU group. In patients unable to express pain themselves verbally, pain intensity will be measured using a behavioural pain scale employing three behavioural parameters--mimic, body movement, and muscle tone. The intensity of the behavioural parameters will be assessed on the basis of a four-point Likert scale: each characteristic will be rated as weak or absent, moderately severe, severe, or very severe. The validity of the scale has been determined to be adequate, and its interrater reliability is high (kappa value 0.80) (Jeitziner MM. et al. Assessment of pain in sedated and mechanically ventilated patients: an observational study, submitted). Furthermore, potentially painful procedures will be recorded. The painful procedures include: intratracheal suctioning, dressing changes, repositioning in bed, and insertion of a central venous catheter . Anxiety will be assessed using a numeric rating scale (0-10) (0 = no anxiety to 10 = worst possible anxiety) . Agitation during the ICU stay will be measured using the German version of the Richmond Agitation-Sedation Scale (RASS), which has 10 levels, ranging from -5: unarousable (no response) to +4: combative (danger to staff). This scale has proven reliable for the assessment of critically ill patients in the ICU, with strong interrater reliability and criterion, construct, and face validity [31, 32]. The Confusion Assessment Method for the ICU (CAM-ICU) will be used to assess delirium in the ICU , as well as general cognitive abilities, focusing on the following factors: a) acute onset or fluctuating course, b) inattention, c) disorganized thinking, and d) altered level of consciousness. This scale has been proven reliable and valid, with an interrater reliability kappa value of 0.96. Its sensitivity was 100% and 93%, with 98% and 100% specificity .
Outcome indicators after discharge
Measurements during ICU stay
Pain (intensity, frequency)
Agitation (intensity, frequency)
Reasons for ICU admission (cause)
APACHE: diagnosis at admission
Severity of illness
APACHE II, SAPS II
Measurements in the ICU group and the comparison group (Follow-up)
Time of Measurement
Baseline/1 week after discharge ICU
Pain (intensity, frequency)
Anxiety (intensity, frequency)
Agitation (intensity, frequency)
International classification of diseases, version 10
Quality of life (HR-QOL)1
Background data will be gathered via medical records and questionnaires. Medical and nursing staff will gather daily routine data regarding pain, anxiety, and agitation, along with any other information relevant to usual care in the ICU. Collection of data concerning pain, anxiety and agitation will be carried out by the staff who regularly care for the patients. For this study these caregivers have received special training. Data about the outcome indicators will be collected using questionnaires 1 week, 6 months and 12 months after discharge. It should be emphasized that participants in the ICU group will be asked one week after discharge to make an assessment of both their current HR-QOL and their HR-QOL, pain, anxiety and agitation intensity, before admission to the ICU. One week after ICU discharge, patients in the ICU group will be contacted and interviewed. The interviews will be carried out only if the patients are physically and psychologically fit to be interviewed. If necessary, help will be provided in filling out the questionnaire. All data will be collected using face-to-face (baseline) and telephone (follow-up) interviews and will be collected by 4 trained interviewers. The baseline interviews with all critically ill patients will take place in the hospital. All other interviews for both groups will take place by telephone. The SF36 and HADS-D will be mailed to all participants. In order for them to prepare themselves for the interview, both groups will be informed of the general nature of the questions ahead of time. Because unanswered questions would affect the evaluation of the questionnaires, an interviewer will check to ensure that all questions have been answered, and follow up in cases where information is lacking. If questionnaires are not returned, reminders will be sent to the participants.
The study protocol was approved by the Cantonal Ethics Commission of Bern. For the patient interviews during the first week (5 to 10 days) after the ICU stay, patients will be contacted, comprehensively informed about the study--verbally and in writing--and invited to participate. The participants in the comparison group will receive the same information. Study participants agree to participate via a written informed consent form. To ensure confidentiality, all data will be coded, and all personal data will be documented, archived, and analyzed anonymously, making it impossible to determine the identity of the individual participants.
The statistical analysis will be performed using the R Project for Statistical Computing. Descriptive statistical analyses (mean, median, interquartile range) will be used to describe and characterize the data. To indicate the strength and direction of relationships between variables, Spearman's rank correlation coefficient for ordinal data and Pearson's product-moment coefficient will be conducted, depending on measurement levels and data dispersion. The Mann-Whitney U Test will be used for continuous data when comparing groups, and random effects models will be used for the longitudinal data. Attrition (i.e., missing data) during the follow-up will be reported.
This article presents the design of a prospective longitudinal study investigating the associations between admission to the ICU and pain, anxiety, agitation, health-related quality of life, and use of the health care system in later life. Previous longitudinal studies have examined ICU patients' health-related quality of life [4, 7–9] or traumatic memories of postoperative treatment [2, 5]. The present study specifically assesses situations involving pain, anxiety and agitation in older patients, as well as their consequences. These symptoms can influence the long-term outcomes of older critically ill patients. The study will be conducted over a period of two years. Data on health-related quality of life are time dependent and related to the life situation of the participant. Changes that take place during the follow-ups, such as modifications in therapy or accidents, were integrated into the analysis, based on the various measurement techniques. The instruments used for the study represent a limitation.
Various studies have attempted to explain ICU stay-related variables by using identical generic instruments to compare critically ill patients' health-related quality of life with that of comparison groups from the general population [4, 9, 41, 42].
Apparently, illness-specific influences on health-related quality of life are not identified by these generic instruments. Various studies assessed HR-QOL with a variety of instruments [19, 43] In addition, the effort required for older people to fill out multiple questionnaires is not negligible. Some studies on critically ill patients have questioned the patients' families regarding their health-related quality of life [44, 45]. However, due to the subjective nature of quality of life, the current study uses only interview and questionnaire data provided by the patients themselves, in order to more accurately describe the patients' own perception of their ICU stay. Until now, little research has focused on the short- and long-term consequences of pain, anxiety, and agitation in older patients, including the effect on the patients' use of the health care system. Because inadequate pain assessment and management may needlessly increase hospital readmissions and the use of the health care system, this topic should be of broad interest. This study will provide the first data on the situation in Switzerland.
We thank Dr. Stephen O'Connor, Dr. Erik van Rossum, and Ottilia Rohrer, RN, for their valuable feedback in the preparation of this manuscript. We would like to thank Jeannie Wurz and Linda Bolzern for carefully editing the manuscript.
- Williams TA, Dobb GJ, Finn JC, Webb SA: Long-term survival from intensive care: a review. Intensive Care Med. 2005, 31: 1306-1315. 10.1007/s00134-005-2744-8.View ArticlePubMedGoogle Scholar
- Novaes MA, Aronovich A, Ferraz MB, Knobel E: Stressors in ICU: patients' evaluation. Intensive Care Med. 1997, 23: 1282-1285. 10.1007/s001340050500.View ArticlePubMedGoogle Scholar
- Williams TA, Dobb GJ, Finn JC, Knuiman MW, Geelhoed E, Lee KY, Webb SA: Determinants of long-term survival after intensive care. Crit Care Med. 2008, 36: 1523-1530. 10.1097/CCM.0b013e318170a405.View ArticlePubMedGoogle Scholar
- Schelling G, Richter M, Roozendaal B, Rotenhäusler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M, Kapfhammer HP: Exposure to high stress in the intensive care unit may have negative effects on health-related quality of life outcomes after cardiac surgery. Crit Care Med. 2003, 31: 1971-1980. 10.1097/01.CCM.0000069512.10544.40.View ArticlePubMedGoogle Scholar
- Jones C, Griffiths RD, Humphris G, Skirrow PM: Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001, 29: 573-580. 10.1097/00003246-200103000-00019.View ArticlePubMedGoogle Scholar
- Rattray JE, Johnston M, Wildsmith JA: Predictors of emotional outcomes of intensive care. Anaesthesia. 2005, 60: 1085-1092. 10.1111/j.1365-2044.2005.04336.x.View ArticlePubMedGoogle Scholar
- Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A: Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care. 2005, 9: R96-109. 10.1186/cc3026.View ArticlePubMedPubMed CentralGoogle Scholar
- Ulvik A, Kvale R, Wentzel-Larsen T, Flaatten H: Quality of life 2-7 years after major trauma. Acta Anaesthesiol Scand. 2008, 52: 195-201. 10.1111/j.1399-6576.2007.01533.x.View ArticlePubMedGoogle Scholar
- Hofhuis JG, Spronk PE, van Stel HF, Schrijvers GJ, Rommes JH, Bakker J: The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest. 2008, 133: 377-385. 10.1378/chest.07-1217.View ArticlePubMedGoogle Scholar
- Lee BO, Chaboyer W, Wallis M: Predictors of health-related quality of life 3 months after traumatic injury. J Nurs Scholarsh. 2008, 40: 83-90. 10.1111/j.1547-5069.2008.00210.x.View ArticlePubMedGoogle Scholar
- Richter JC, Pajonk FG, Waydhas C, Bregenzer T: Lebensqualität nach chirurgischer Langzeitintensivtherapie. Anästhesist. 2000, 49: 822-828.View ArticleGoogle Scholar
- Chaboyer W, Grace J: Following the path of ICU survivors: a quality-improvement activity. Nurs Crit Care. 2003, 8: 149-155. 10.1046/j.1478-5153.2003.00020.x.View ArticlePubMedGoogle Scholar
- Jackson JC, Girard TD, Gordon SM, Thompson JL, Shintani AK, Thomason JW, Pun BT, Canonico AE, Dunn JG, Bernard GR, Dittus RS, Ely EW: Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med. 2010, 182: 183-191. 10.1164/rccm.200903-0442OC.View ArticlePubMedPubMed CentralGoogle Scholar
- Jackson JC, Obremskey W, Bauer R, Greevy R, Cotton BA, Anderson V, Song Y, Ely EW: Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. J Trauma. 2007, 62: 80-88. 10.1097/TA.0b013e31802ce9bd.View ArticlePubMedGoogle Scholar
- Rattray J, Crocker C, Jones M, Connaghan J: Patients' perceptions of and emotional outcome after intensive care: results from a multicentre study. Nurs Crit Care. 2010, 15: 86-93. 10.1111/j.1478-5153.2010.00387.x.View ArticlePubMedGoogle Scholar
- Williams TA, Leslie GD, Brearley L, Dobb GJ: Healthcare utilisation among patients discharged from hospital after intensive care. Anaesth Intensive Care. 2010, 38: 732-739.PubMedGoogle Scholar
- Aitken LM, Burmeister E, Lang J, Chaboyer W, Richmond TS: Characteristics and outcomes of injured older adults after hospital admission. J Am Geriatr Soc. 2010, 58: 442-449. 10.1111/j.1532-5415.2010.02728.x.View ArticlePubMedGoogle Scholar
- Arenal JJ, Bengoechea-Beeby M: Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003, 46: 111-116.PubMedPubMed CentralGoogle Scholar
- Chelluri L, Pinsky MR, Donahoe MP, Grenvik A: Long-term outcome of critically ill elderly patients requiring intensive care. JAMA. 1993, 269: 3119-3123. 10.1001/jama.269.24.3119.View ArticlePubMedGoogle Scholar
- Kleinpell RM, Ferrans CE: Factors influencing intensive care unit survival for critically ill elderly patients. Heart Lung. 1998, 27: 337-343. 10.1016/S0147-9563(98)90054-1.View ArticlePubMedGoogle Scholar
- Winter L, Lawton MP, Ruckdeschel K: Preferences for prolonging life: a prospect theory approach. Int J Aging Hum Dev. 2003, 56: 155-170. 10.2190/4G9A-UT53-ENVK-CC3N.View ArticlePubMedGoogle Scholar
- Noseworthy TW, Gibney RT, Konopad E, Shustack A, Stollery D, Johnston R, Grace M: One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med. 1993, 21: 687-691. 10.1097/00003246-199305000-00011.View ArticlePubMedGoogle Scholar
- Kaarlola A, Tallgren M, Pettilä V: Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med. 2006, 34: 2120-2126. 10.1097/01.CCM.0000227656.31911.2E.View ArticlePubMedGoogle Scholar
- Valdix SW, Puntillo KA: Pain, pain relief and accuracy of their recall after cardiac surgery. Prog Cardiovasc Nurs. 1995, 10: 3-11.PubMedGoogle Scholar
- Moser DK, Dracup K, McKinley S, Yamasaki K, Kim CJ, Riegel B, Ball C, Doering LV, An K, Barnett M: An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosom Med. 2003, 65: 511-516. 10.1097/01.PSY.0000041543.74028.10.View ArticlePubMedGoogle Scholar
- Inouye SK: The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994, 97: 278-288. 10.1016/0002-9343(94)90011-6.View ArticlePubMedGoogle Scholar
- Janssens U, Jordan A, Graf C, Graf J, Grenner H, Hanrath P: Vergleich von APACHE II, SAPS und TISS im täglichen Einsatz bei Patienten einer kardiologischen Intensivstation. Intensivmed. 2000, 37: 31-43. 10.1007/s003900050005.View ArticleGoogle Scholar
- Schweizerische Eidgenossenschaft: Statistik Schweiz. Normenklaturen 2011, Internationale Klassifikation der Krankenheiten (ICD-10). [http://www.bfs.admin.ch]
- Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR: Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med. 2004, 32: 421-427. 10.1097/01.CCM.0000108875.35298.D2.View ArticlePubMedGoogle Scholar
- Li DT, Puntillo K: A pilot study on coexisting symptoms in intensive care patients. Appl Nurs Res. 2006, 19: 216-219. 10.1016/j.apnr.2006.01.003.View ArticlePubMedGoogle Scholar
- Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002, 166: 1338-1344. 10.1164/rccm.2107138.View ArticlePubMedGoogle Scholar
- Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003, 289: 2983-2991. 10.1001/jama.289.22.2983.View ArticlePubMedGoogle Scholar
- Putensen C, Guenther U: Die Confusion Assessment Method (CAM) für Intensivstationen (CAM-ICU). Übungsleitfaden. Vanderbilt University. 2002, [http://www.mc.vanderbilt.edu/icudelirium/docs/CAM_ICU_training_German.pdf]Google Scholar
- Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R: Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001, 286: 2703-2710. 10.1001/jama.286.21.2703.View ArticlePubMedGoogle Scholar
- Herrmann Ch, Buss U, Snaith RP: HADS-D: Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Testdokumentation und Handanweisung. 1995, Bern: Hans HuberGoogle Scholar
- Bickel H: Deutsche Version der Confusion Assessment Method (CAM) zur Diagnose des Delirs. Psychosom Konsiliarpsychiatr. 2007, 1: 224-228. 10.1007/s11800-007-0041-9.View ArticleGoogle Scholar
- Marcantonio ER, Michaels M, Resnick NM: Diagnosing delirium by telephone. J Gen Intern Med. 1998, 13: 621-623. 10.1046/j.1525-1497.1998.00185.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990, 113: 941-948.View ArticlePubMedGoogle Scholar
- Bullinger M, Kirchberger I, Ware J: Der deutsche SF-36 Health Survey. Übersetzung und psychometrische Testung eines krankheitsübergreifenden Instruments zur Erfassung der gesundheitsbezogenen Lebensqualität. Zeitschrift für Gesundheitswissenschaften. 1995, 1: 21-36.Google Scholar
- Bullinger M: Erfassung der gesundheitsbezogenen Lebensqualität mit dem SF-36-Health Survey. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2000, 43: 190-197. 10.1007/s001030050034.View ArticleGoogle Scholar
- Ringdal M, Plos K, Lundberg D, Johansson L, Bergbom I: Outcome after injury: memories, health-related quality of life, anxiety, and symptoms of depression after intensive care. J Trauma. 2009, 66: 1226-1233. 10.1097/TA.0b013e318181b8e3.View ArticlePubMedGoogle Scholar
- Boyle M, Murgo M, Adamson H, Gill J, Elliott D, Crawford M: The effect of chronic pain on health related quality of life amongst intensive care survivors. Aust Crit Care. 2004, 17: 104-106. 10.1016/S1036-7314(04)80012-2. 108-113View ArticlePubMedGoogle Scholar
- Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J: Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med. 2000, 28: 3389-3395. 10.1097/00003246-200010000-00002.View ArticlePubMedGoogle Scholar
- de Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E: Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc. 2008, 56: 816-822. 10.1111/j.1532-5415.2008.01671.x.View ArticlePubMedGoogle Scholar
- Hofhuis J, Hautvast JL, Schrijvers AJ, Bakker J: Quality of life on admission to the intensive care: can we query the relatives?. Intensive Care Med. 2003, 29: 974-979.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2318/11/52/prepub
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