Joint contractures in the intensive care unit: quality of life and function 3.3 years after hospital discharge

Abstract

Purpose: To investigate the mortality, quality of life and functional limitations of intensive care unit (ICU) patients with and without joint contractures 3.3 years after discharge from the hospital. Methods: 155 consecutive patients admitted to a primary care referral centre ICU for 2 or more weeks with information on joint range of motion formed a retrospective cohort. The EuroQol and a Joint Contracture Questionnaire were administered to the cohort survivors. Results: Fifty patients returned the questionnaires, 57 did not return the questionnaire, and 48 were deceased. The patients who had died presented significantly more joint contractures in the ICU than the respondents and the non-respondents (p = 0.003 and p = 0.006, respectively). More respondents who reported limitations in their mobility on the EuroQol had joint contractures in ICU 13/18 (72.2%) compared to respondents who did not have contractures 7/21 (33.3%; p = 0.02). Conclusions: Joint contractures in ICU were associated with higher mortality. Patients who spent 2 weeks or more in ICU and developed joint contractures identified more difficulty with mobility 3.3 years after discharge; joint contractures may impose irreversible disability. A strategy to identify and treat joint contractures in ICU may prevent long-term functional limitations.

Implications for Rehabilitation

• The presence of joint contractures was associated with higher mortality more than 3 years after discharge.

• Joint contractures that developed in ICU were associated with disability for mobility more than 3 years after ICU discharge.

• Monitoring, detection and early rehabilitation may be critical in treating joint contractures before they become irreversible.

• These results support prospectively tracking contractures of large joints in the continuum from ICU to hospital to home.

• Contracture
• immobility
• joint
• prolonged ICU

Acknowledgements

We would like to thank Dr. Hans Uhthoff and Dr. Paul Hébert for their helpful comments on the manuscript, as well as Gloria Baker for her careful editing.

Declaration of interest

The authors report no declarations of interest. This study was funded by the Canadian Institute of Health Research grant # MOP 97831. The Canadian Institute of Health Research had no input in either the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, nor in the decision to submit the manuscript for publication.