Comparison of Functional Recovery with Pre-hospitalization Functional Status among ICU Survivors at a Tertiary Care Hospital in South India

INTRODUCTION: Survivors of critical illness often experience new or worsening physical, cognitive, and mental health impairments after hospital discharge, collectively termed Post-Intensive Care Unit Syndrome (PICS).(1) Among these, physical impairments significantly affect their ability to perform basic and instrumental activities of daily living (BADLs and IADLs), which are vital for independent living.(2) Functional evaluation using tools like the PaciFIC scale, quantifies physical functioning in ICU survivors across the continuum of care.(3) Many ICU survivors face challenges with daily activities and social reintegration.(4) Inpatient rehabilitation aims to restore pre-hospitalization functional status.(5) Despite research on PICS, the long-term impact of functional deficits and their relationship with post-discharge outcomes remains poorly understood. OBJECTIVES: To compare the functional recovery of ICU survivors at one- and three-months following hospital discharge with their pre-hospitalization functional status and to determine the impact of physical function at hospital discharge on functional recovery. MATERIALS AND METHODS: Ethical approval was obtained from the Institutional Ethics Committee, and the study was registered in the Clinical Trial Registry-India. Participants were screened at ICU discharge, and informed consent was obtained. Pre-hospitalization functional status was assessed using self-report questionnaires for ADL (Barthel Index; BI and Lawton Brody IADL scale; LB-IADL) from patients/caregivers. At hospital discharge along with these outcomes, physical function was assessed using the PaciFIC Tool. Functional recovery was assessed at 30- and 90-days post-discharge using BI and LB-IADL scales through telephonic follow-up. The statistical analysis of the study included descriptive and inferential statistics to evaluate functional outcomes in ICU survivors. Correlation was performed using Pearson's correlation coefficient. All analysis were performed using Jamovi 2.6.19. MATERIALS AND METHODS: Ethical approvals were obtained from the Institutional Research and Ethics Committees, and the study was registered in the Clinical Trial Registry-India. Participants were screened at ICU discharge, and informed consent was obtained. Pre-hospitalization functional status was assessed at hospital discharge using reports and assessments (PaciFIC Tool, Barthel Index and Lawton Brody IADL scales) from patients/caregivers. Functional outcomes were evaluated using Barthel Index and Lawton Brody IADL scales through telephonic follow-ups at 30- and 90-days post-discharge. RESULTS: Analysis was performed using Jamovi 2.6.19. The statistical analysis of the study included descriptive and inferential statistics to evaluate functional outcomes in ICU survivors. The cohort (n=50) had a mean age ± SD (59.1 ± 13.1) almost equal distribution of male (n=24), and female (n=26). The mean ICU and hospital length of stay (LOS) was (6.16 ± 2.62) days, and (11.8 ± 4.72) days respectively with APACHE II scores of (6.74 ± 3.70). Functional outcomes, assessed using the Barthel Index (BI) and Instrumental Activities of Daily Living (IADL), showed significant variation over time. BI scores declined from discharge (96.6± 10.3) to 30 days (76.4± 20.2) and partially recovered by 90 days (84.8± 17.0). (Repeated Measures ANOVA, F = 42.4, p < 0.001). Similarly, IADL scores varied significantly over time (F = 11.1, p < 0.001), declining from discharge (5.40 ± 2.02) to 30 days (4.38 ± 2.18) and improving by 90 days (4.98 ± 2.11). Subgroup analysis revealed that patients with higher PaciFIC Scores (>11) had significantly better BI and IADL recovery trajectories compared to those with lower scores (<11), with significant interaction effects (F=25.8, p<0.001).(6) CONCLUSIONS: A notable proportion of ICU survivors demonstrated improvements toward achieving functional recovery within one- and three-months post-discharge, with many approaching their pre-hospitalization functional status. The significant correlation between the PaciFIC scores and the functional assessment points highlights the importance of physical function evaluations as predictors of long-term recovery in ICU-survivors.