Huvudintresseområde: Hälsorelaterad livskvalitet
Medicine doktor, Intensivvårdssjuksköterska
Institutionen för klinisk och experimentell medicin
Intensivvårdskliniken, Universitetssjukhuset i Linköping
telefon 070-322 13 21
mobil 010-103 3651
Utvidgat intresseområde: Uppföljning efter intensivvård, PostIVA mottagning ; PROM (Patient Reported Outcome Measures); Post traumatisk stress; Sömn; Minnesstörning; Coping/empowerment; Kvalitetsuppföljning mha Q-register
Akademisk nivå: Medicine doktor
Doctoral thesis/ ph.d. , titel , abstract : Health related quality of life in adult former intensive care unit patients
Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co-morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health-related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients.
Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical-surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5-Dimensions (EQ-5D) and Medical Outcome Short Form (SF-36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre-existing diseases was collected by self-reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group.
Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ-5D and in SF-36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre-existing diseases were found to be the factor that had the largest influence on HRQoL in both the short- and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC -related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay.
Conclusions: This multicenter study shows that pre-existing diseases influence the HRQoL short- and long-term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre-existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.
1. Ph.D. Thesis in Anestesiology and Intensive Care “Health related quality of life in adult former intensive care unit patients” Linköping Medical dissertations, no 1117
2. Orwelius L. Nordlund A. Nordlund P. Simonsson E. Bäckman C. Samuelsson A. Sjöberg F. Pre-existing disease: the most important factor for health related quality of life long-term after critical illness: a prospective, longitudinal, multicentre trial. Critical Care 2010 14:R67
3. Orwelius L. Bäckman C. Fredrikson M. Simonsson E. Nordlund P. Samuelsson A. Sjöberg F. Social integration: an important factor for health-related quality of life after critical illness. Intensive Care Medicine 2011 Online 2 february 2011
4. Book chapter “Hälsofrämjande möten i vården”, Studentlitteratur 2013 Red. Margareta Kristensson och Anna Hertting.
5. Book chapter “Omvårdnadens grunder” advanced level. Studentlitteratur 2013 Red. Helle Wijk och Anna-Karin Edberg.
Under 2012 och 2013 har jag i perioder varit som Post-doc vid universitetet i Porto, Portugal och där arbetet i ett forskningsteam under ledning av professor Cristina Granja. Huvudtemat har varit uppföljning av hälsorelaterad livskvalitet efter intensivvård med speciell fokus på patienter vårdade för sepsis (HRQoL), samtliga diagnoser (HRQoL, PTSS och Minnesstörning) och multitrauma (HRQoL och GOSE).
Arbetar vid PROMcenter vilket har i uppdrag av Sveriges Kommuner och landsting (SKL) att utgöra en nationell resurs avseende PROM (Patient Reported Outcome Measures) inom Nationella Kvalitetsregister. Mätning med PROM är bland annat ett verktyg för att öka patientmedverkan i vården och bättre ta tillvara patienternas kunskaper och erfarenheter i utvecklingsarbeten. www.promcenter.se
Arbetar med SIR (Svenska intensivvårdsregistret) med huvudansvarsområde PostIVA uppföljning. www.icuregswe.org