The association between self-reported symptoms, rehabilitation and long-term functional disability in ICU survivors

Renato S Mesina Jr; Tone Rustøen; Milada Hagen; Jon Henrik Laake; Kristin Hofsø

doi:10.1016/j.iccn.2025.104184

The association between self-reported symptoms, rehabilitation and long-term functional disability in ICU survivors

Intensive Crit Care Nurs. 2025 Sep 19:92:104184. doi: 10.1016/j.iccn.2025.104184. Online ahead of print.

Authors

Renato S Mesina Jr¹, Tone Rustøen², Milada Hagen³, Jon Henrik Laake⁴, Kristin Hofsø⁵

Affiliations

¹ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: renmes@ous-hf.no.
² Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Department of Public Health, Faculty of Nursing Science Oslo and Akershus University College of Applied Sciences Norway, Oslo, Norway.
⁴ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway.
⁵ Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital Norway, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway.

PMID: 40974761
DOI: 10.1016/j.iccn.2025.104184

Abstract

Background: The relationship between self-reported symptoms and functional disability in ICU survivors remains unclear. Rehabilitation is considered necessary in supporting ICU survivors' recovery and functional outcomes, though evidence remains inconclusive.

Aims: To investigate the association between self-reported symptoms and the role of post-ICU rehabilitation on functional disability in ICU survivors.

Methods: Functional disability was measured using the Lawton Instrumental Activities of Daily Living (I-ADL) scale, dichotomised as "with or without disabilities" based on established threshold. Data were collected pre-ICU and at 3, 6, and 12 months post-ICU admission. To account for repeated measures over time, generalised linear model for repeated measures with a binary outcome was used to estimate possible predictive factors associated with functional disability. Separate analyses were performed for patients who did and did not receive post-ICU rehabilitation.

Results: Among 331 included ICU survivors, 165 (49.8 %) received post-ICU rehabilitation during the first year. A higher level of pain/discomfort (OR = 1.47; 95 %CI: [1.13-1.91]), higher PTSS score (OR = 1.05; 95 %CI: [1.03-1.07]), and higher depression score (OR = 1.13; 95 % CI: [1.05-1.22]) at three months were associated with functional disability during the first year. The odds of having functional disability were lower at twelve-month follow-up compared to three-month follow-up (OR = 0.46; 95 %CI: [0.26-0.83]). Patients who received rehabilitation had lower odds of having functional disability both at six months (OR = 0.42; 95 %CI: [0.18-0.95]) and at twelve months (OR = 0.36; 95 %CI: [0.16-0.82]).

Conclusions: Self-reported symptoms at three months were associated with having functional disability in ICU survivors during the first year. ICU survivors who received post-ICU rehabilitation had improved functional disability compared to those who did not receive rehabilitation.

Implications for clinical practice: Our study underscores the importance of screening self-reported symptoms during post-ICU follow-up and the potential role of post-ICU rehabilitation in improving functional disability among ICU survivors.

Keywords: Functional status; Intensive care units; Post-intensive care syndrome; Prospective studies; Rehabilitation.