Activities of daily living (Barthel Index) at discharge from the intensive care unit

Introduction

In order to continue optimal and adequate rehabilitation care in the nursing ward, information about the functional status of patients at discharge from the ICU is needed [1]. The Barthel Index is a simple index of independence to score the ability of a patient to care for itself. It measures the patient's daily functioning, specifically the activities of daily living (ADL) and mobility [2]. The objectives of the present study were to assess the ADL of ICU patients at discharge to the ward, and to identify explanatory factors of functional status.

Methods

A prospective, observational, cohort study was conducted with patients who stayed in a six-bed mixed (predominantly medical) ICU for longer than 48 hours. We used the Danish-language version of the Barthel-20 Index, which is a validated and reliable generic instrument, to measure ADL. The Barthel Index measures the capacity to perform 10 basic ADL and gives a quantitative estimation of the patient's level of dependency, with scoring from 0 (totally dependent) to 20 (totally independent). All assessments were carried out by critical care nurses with an experienced physiotherapist. Patient characteristics and outcome measures were analyzed with descriptive statistics. The data are expressed as medians and interquartile ranges.

Results

At discharge from the ICU, functional status (as primary outcome) was assessed in 73 patients. The overall functional status was poor (median Barthel Index 2; 0 to 9). In their ability to perform basic ADL, 63% were severely dependent, 25% were moderately dependent, and 10% were slightly dependent on other people. The transfer from bed to wheelchair and return with major help was the ADL component that was noted in the great majority of the patients. Duration of mechanical ventilation (median 5 days; 1 to 12 days) was associated with poorer functional status at ICU discharge.

Conclusions

This study provides information that is important for the planning of rehabilitation of patients at ICU discharge. After transfer to the ward, the physical resilience of critically ill patients is severely limited. This implies that prior assessment of any care needed after discharge from the ICU is very important.