Beyond survival: Functionality and health-related quality of life among a cohort of ICU survivors 6 months after hospital discharge – a single-centre study in the Eastern Cape Province of South Africa

Background. New or worsened impairments in physical, cognitive and/or psychological health may persist after critical care discharge and impact negatively on survivors’ health-related quality of life (HRQOL), functionality and life roles. Objective. To describe functionality, changes in life roles and HRQOL among an Eastern Cape single-centre cohort of ICU survivors, 6 months after hospital discharge. Methods. The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape and enrolled critically ill patients who required organ support and had an ICU stay for at least 48 hours. Patients were assessed at 6 weeks and 6 months post hospital discharge. The Lawton’s Instrumental Activities of Daily Living (IADL) score and employment/educational status were determined. The Rand Short Form- 36 HRQOL questionnaire’s physical and mental component scores (PCS and MCS) were used to determine quality of life at baseline and study visits. Results. A total of 107 patients with a median age of 42, half of whom had COVID-19, completed the 6-month follow-up. At the 6-month follow-up, 17.5% of previously non-frail patients were still unable to complete at least two IADLs, and 24.3% one IADL. Overall, 34% had not returned to their life roles of home making, studying or remunerative work due to ill-health. At 6 months, 58.9% and 62.6% had significantly lower mean PCS and MCS scores, respectively. Overall, 62.6 % of survivors had either a significantly lower PCS and/or MCS at 6 months. Conclusion. This relatively young cohort of ICU survivors, with minimal previous comorbidities, demonstrated a high incidence of significantly lower HRQOL scores at the 6-month follow-up, affecting 6 out of every 10 patients. The proportion of patients who were unable to complete all IADLs at follow-up, explains the reported changes in relation to life roles, including remunerative employment. These findings have implications for the introduction or reengineering of rehabilitation resources and ICU follow-up services.