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The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness : a pragmatic randomised controlled trial

By Brian Cuthbertson, Marion Kay Campbell, John David Norrie, David James Jenkinson, Rodolfo Andrés Hernández, Marie Johnston, PRaCTICaL Study Group, J Rattray, M Gager, S Roughton, A Smith, A Hull, S Breeman, E Wilson and C Waldman


Objectives To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving\ud quality of life after discharge from intensive care. Design A pragmatic, non-blinded, multicentre, randomised controlled trial. Setting Three UK hospitals (two teaching hospitals and one district general hospital). Participants 286 patients aged ≥18 years were recruited after discharge from intensive care between September 2006 and October 2007. Intervention Nurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed. Results 286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI −1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (−3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective. Conclusions A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients’ quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.The study is supported by a research grant from the Chief Scientist Office of the Scottish Government Health Directorates. The Health Services Research Unit is also funded by the Chief Scientist Office of the Scottish Government Health Directorates. The researchers are completely independent of the funders, and the views expressed are those of the authors alone. The study sponsor was the University of Aberdeen, which had no role in the study design; collection, analysis, and interpretation of data; writing of the article; or the decision to submit it for publication. The researchers are completely independent of the sponsors in their research activities.Peer reviewedPublisher PD

Topics: Cost-benefit analysis, Critical illness, Intensive care, Nurses, Randomised controlled trial, RT Nursing
Publisher: BMJ
Year: 2009
DOI identifier: 10.1136/bmj.b3723
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