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

doi:10.1136/bmj.b3723

Published 16 October 2009, doi:10.1136/bmj.b3723
Cite this as: BMJ 2009;339:b3723

Research

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

B H Cuthbertson, chief of critical care medicine and professor of anaesthesia¹, J Rattray, senior lecturer², M K Campbell, director and professor³, M Gager, intensive care follow-up nurse⁴, S Roughton, intensive care follow-up nurse³^,5, A Smith, intensive care follow-up nurse², A Hull, consultant pyschiatrist⁶, S Breeman, trial manager³, J Norrie, professor of biomedical statistics⁷, D Jenkinson, statistician³, R Hernández, health psychologist³^,8, M Johnston, professor of health psychology⁹, E Wilson, consultant in anaesthesia and intensive care ¹⁰, C Waldmann, consultant in anaesthesia and intensive care⁴, on behalf of the PRaCTICaL study group

¹ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ² School of Nursing and Midwifery, University of Dundee, Dundee, ³ Health Services Research Unit, University of Aberdeen, Aberdeen AB32, ⁴ Intensive Care Unit, Royal Berkshire and Battle Hospital, Reading, ⁵ Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, ⁶ Department of Mental Health, Murray Royal Hospital, Perth, ⁷ Robertson Centre for Biostatistics, University of Glasgow, Glasgow, ⁸ Health Economics Research Unit, University of Aberdeen, ⁹ Health Psychology Unit, University of Aberdeen, ¹⁰ Department of Anaesthesia and Intensive Care Medicine, Ninewells Hospital and Medical School, Dundee

Correspondence to: B H Cuthbertson brian.cuthbertson{at}sunnybrook.ca

Objectives To test the hypothesis that nurse led follow-up programmesare effective and cost effective in improving quality of lifeafter discharge from intensive care.

Design A pragmatic, non-blinded, multicentre, randomised controlledtrial.

Setting Three UK hospitals (two teaching hospitals and one districtgeneral hospital).

Participants 286 patients aged $≥$ 18 years were recruited afterdischarge from intensive care between September 2006 and October2007.

Intervention Nurse led intensive care follow-up programmes versusstandard care.

Main outcome measure(s) Health related quality of life (measuredwith 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 yearfollow-up. At 12 months, there was no evidence of a differencein the SF-36 physical component score (mean 42.0 (SD 10.6) v40.8 (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 significantdifferences in secondary outcomes or subgroup analyses. Follow-upprogrammes were significantly more costly than standard careand are unlikely to be considered cost effective.

Conclusions A nurse led intensive care follow-up programme showedno evidence of being effective or cost effective in improvingpatients’ quality of life in the year after dischargefrom intensive care. Further work should focus on the rolesof early physical rehabilitation, delirium, cognitive dysfunction,and relatives in recovery from critical illness. Intensive careunits should review their follow-up programmes in light of theseresults.

Trial registration ISRCTN 24294750

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