Browsing by Person "Griffith, David M."

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Determinants of Health-Related Quality of Life After ICU: Importance of Patient Demographics, Previous Comorbidity, and Severity of Illness.
(2018-04-01) Griffith, David M.; Salisbury, Lisa; Lee, Robert J.; Lone, Nazir; Merriweather, Judith L.; Walsh, Timothy S.
ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge. Nested cohort study within a previously published randomized controlled trial. Two ICUs in Edinburgh, Scotland. Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation. None. We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score _ = -1.56 [-2.44 to -0.68]; p = 0.001; Mental Component Score _ = -1.45 [-2.37 to -0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (_ = 0.33 [0.19-0.47]; p < 0.001) and lower social deprivation (_ = 1.38 [0.03-2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life. Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge
(2015-04-13) Walsh, Timothy S.; Salisbury, Lisa; Merriweather, Judith L.; Boyd, Julia A.; Griffith, David M.; Huby, G.; Kean, Susanne; Mackenzie, Simon J.; Krishan, Ashma; Lewis, Stephanie C.; Murray, Gordon D.; Forbes, John F.; Smith, Joel; Rattray, Janice; Hull, Alastair M.; Ramsay, Pamela
Importance Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P-=-.71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P-=-.96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P-=-.91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.
Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial
(2016-08-01) Ramsay, Pamela; Huby, G.; Merriweather, Judith L.; Salisbury, Lisa; Rattray, Janice; Griffith, David M.; Walsh, Timothy S.
Objectives: To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design: Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting: Two university-affiliated hospitals in Scotland.
Systemic inflammation after critical illness: relationship with physical recovery and exploration of potential mechanisms
(2016-08-12) Griffith, David M.; Lewis, Steff; Rossi, Adriano G.; Rennie, Jillian; Salisbury, Lisa; Merriweather, Judith L.; Templeton, Kate; Walsh, Timothy S.
Background Physical recovery following critical illness is slow, often incomplete and is resistant to rehabilitation interventions. We aimed to explore the contribution of persisting inflammation to recovery, and investigated the potential role of human cytomegalovirus (HCMV) infection in its pathogenesis. Methods In an a priori nested inflammatory biomarker study in a post-intensive care unit (ICU) rehabilitation trial (RECOVER; ISRCTN09412438), surviving adult ICU patients ventilated >48-h were enrolled at ICU discharge and blood sampled at ICU discharge (n=184) and 3-month follow-up (N=123). C-reactive protein (CRP), human neutrophil elastase (HNE), interleukin (IL)-1_, IL-6, IL-8, transforming growth factor _1 (TGF_1) and secretory leucocyte protease inhibitor (SLPI) were measured. HCMV IgG status was determined (previous exposure), and DNA PCR measured among seropositive patients (lytic infection). Physical outcome measures including the Rivermead Mobility Index (RMI) were measured at 3-months. Results Many patients had persisting inflammation at 3-months (CRP >3-mg/L in 59%; >10-mg/L in 28%), with proinflammatory phenotype (elevated HNE, IL-6, IL-8, SLPI; low TGF_1). Poorer mobility (RMI) was associated with higher CRP (_=0.13; p<0.01) and HNE (_=0.32; p=0.03), even after adjustment for severity of acute illness and pre-existing co-morbidity (CRP _=0.14; p<0.01; HNE _=0.30; p=0.04). Patients seropositive for HCMV at ICU discharge (63%) had a more proinflammatory phenotype at 3-months than seronegative patients, despite undetectable HMCV by PCR testing. Conclusions Inflammation is prevalent after critical illness and is associated with poor physical recovery during the first 3-months post-ICU discharge. Previous HCMV exposure is associated with a proinflammatory phenotype despite the absence of detectable systemic viraemia. Trial registration number ISRCTN09412438, post results.
The Burden of Specific Symptoms Reported by Survivors after Critical Illness
(2018-01-15) Griffith, David M.; Salisbury, Lisa; Lee, Robert J.; Lone, Nazir; Merriweather, Judith L.; Walsh, Timothy S.