Beyond survival: Functionality and health-related quality of life among a cohort of ICU survivors 6 months after hospital discharge - a single-centre study in the Eastern Cape Province of South Africa.

Background: New or worsened impairments in physical, cognitive and/or psychological health may persist after critical care discharge and impact negatively on survivors' health-related quality of life (HRQOL), functionality and life roles. Objectives: To describe functionality, changes in life roles and HRQOL among an Eastern Cape single-centre cohort of ICU survivors, 6 months after hospital discharge. Methods: The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape and enrolled critically ill patients who required organ support and had an ICU stay for at least 48 hours. Patients were assessed at 6 weeks and 6 months post hospital discharge. The Lawton's Instrumental Activities of Daily Living (IADL) score and employment/educational status were determined. The Rand Short Form 36 HRQOL questionnaire's physical and mental component scores (PCS and MCS) were used to determine quality of life at baseline and study visits. Results: A total of 107 patients with a median age of 42, half of whom had COVID-19, completed the 6-month follow-up. At the 6-month follow-up, 17.5% of previously non-frail patients were still unable to complete at least two IADLs, and 24.3% one IADL. Overall, 34% had not returned to their life roles of home making, studying or remunerative work due to ill-health. At 6 months, 58.9% and 62.6% had significantly lower mean PCS and MCS scores, respectively. Overall, 62.6 % of survivors had either a significantly lower PCS and/or MCS at 6 months. Conclusion: This relatively young cohort of ICU survivors, with minimal previous comorbidities, demonstrated a high incidence of significantly lower HRQOL scores at the 6-month follow-up, affecting 6 out of every 10 patients. The proportion of patients who were unable to complete all IADLs at follow-up, explains the reported changes in relation to life roles, including remunerative employment. These findings have implications for the introduction or reengineering of rehabilitation resources and ICU follow-up services. Contribution of the study: This study adds to the limited body of evidence on post-ICU outcomes in South Africa by documenting high rates of impaired functionality, reduced HRQOL, and disrupted life roles at 6 months after hospital discharge. These findings support the need for context-appropriate ICU follow-up and rehabilitation strategies.