Many acute respiratory failure survivors achieve expectations for independent activities

Key takeaways:

• 71% of survivors achieved the functional expectations they hoped for at discharge in the following 6 months.
• Health expectations set at discharge were only fulfilled in 50% of survivors at 6 months.

With high expectations for independence in daily activities, 71% of survivors of acute respiratory failure achieved what they hoped for 6 months after discharge, according to results published in Annals of the American Thoracic Society.

“Despite nearly half being unable to bathe or dress independently at the time of hospital discharge, [survivor] expectations for recovery were generally optimistic,” Alison E. Turnbull, DVM, MPH, PhD, assistant professor of medicine at The Johns Hopkins University School of Medicine, and colleagues wrote. “For each instrumental activities of daily living except housekeeping and cooking, [more than] 90% of participants felt it was important to be able to perform the activity independently and expected to do so within 6 months. For the majority of participants, these functional expectations were met. However, only half of survivors perceived their overall health to be as good as they expected at discharge.”

In a multicenter, prospective and longitudinal cohort study, Turnbull and colleagues evaluated 180 adults who survived hospitalization for acute respiratory failure to understand if their expectations for recovery were met 6 months following their discharge.

To figure out a survivors’ recovery expectations, researchers collected their responses at discharge when asked about the activities and instrumental activities of daily living they hoped to be able to do on their own. If the survivor conducted the activities they described by themselves at 6 months (n = 154), researchers marked them as met.

Researchers also used a 100-point visual analogue scale to capture overall health status expectations, which were judged to be met when the 6-month status given by survivors (n = 139) did not go below more than eight points of the status they expected at discharge.

At discharge, 95% to 99% of survivors hoped to independently manage their money, shower/bathe, eat, dress, go to the bathroom, transfer, manage their medications and use the phone in 6 months. Cooking, shopping, driving/taking public transit and housekeeping were also expectations for many survivors, ranging from 87% to 93%.

Of the total cohort, 11 patients died, nine patients were lost to follow-up and 21 did not fully complete the 6-month surveys, leaving 139 patients (mean age, 53 years; 54% men; 63% white) who fully completed the 6-month assessment.

Researchers found that 71% of survivors achieved their functional expectations. At 6 months, 90% or more of survivors could eat, shower/bathe, dress, go to the bathroom, transfer, manage money, cook, manage medications and use the phone by themselves. Additionally, 81% could independently drive/take public transit, 78% could shop by themselves and 77% could do housekeeping on their own.

When comparing the percentage of patients able to do each of the activities before acute respiratory failure vs. 6 months after hospitalization, researchers found that the activity with the largest “loss of independence” was driving/taking public transit (91% vs. 81%).

In terms of survivors’ health expectations at discharge, 85 (interquartile range [IQR], 75-95) was the median number on the scale, but scores ranged widely from 30 to 100. The median was slightly lower at 6-months (80; IQR, 60-85), with scores ranging from 2 to 100, and only half of the survivors achieving their health expectations, according to researchers.

By comparing survivors with met expectations to those with unmet expectations, researchers observed the largest differences between the two in formal education (standardized difference of functional expectations, 0.88; standardized difference of health expectations, 0.41). Looking specifically at functional expectations, more survivors with a 4-year degree or more achieved vs. unachieved their expectations (47 survivors vs. 5 survivors).

In this analysis, researchers also described characteristics that were more prevalent in those with unmet expectations, including female sex (62% vs. 37%; standardized difference, 0.53), residing in areas with greater deprivation (median area deprivation index, 57 vs. 37; standardized difference, 0.47), more depression (44% vs. 25%; standardized difference, 0.4), frailty prior to hospitalization (median Clinical Frailty Scale score, 4 vs. 3; standardized difference, 0.76), less resilience (median Connor-Davidson Resilience Scale-10, 32 vs. 35; standardized difference, 0.41) and less social support (median Multidimensional Scale of Perceived Social Support, 68 vs. 73; standardized difference, 0.43).

Demographic standardized differences in health expectations between both groups were smaller than the ones outlined above, according to researchers.

“Before developing and testing interventions for expectation management, further research is needed to understand how expectations for recovery are formed and how unmet expectations impact patient outcomes, including engagement in treatment regimens and quality of life,” Turnbull and colleagues wrote.