IMPROVE: Evaluation of a combined lifestyle intervention program to improve quality of life in long-term ICU-survivors

Survival rates of patients with critical illness have increased due to improved
facilities and treatment methods in the intensive care unit (ICU). However,
surviving critical illness does not mean these patients are cured. In general,
ICU-admission is associated with decreased physical and mental health,
reflecting in an impaired long-term recovery and decreased quality of life
(QoL). Long-term health problems can partly be contributed to prolonged muscle
weakness and malnutrition. Mono-interventions focusing on improving physical
performance or nutritional intake have limited effect on long term functioning
and QoL. A lifestyle intervention encompassing physical therapy and
optimisation of caloric and protein intake may improve wellbeing and QoL in
these patients. Previous studies found that interventions focused on
mobilization and physical rehabilitation are feasible within the ICU and
outpatient programs. Additionally, promising results were found in personalized
healthcare and lifestyle programs for other patient groups with long-term
health problems, such as cancer survivors and patients with diabetes or mental
health problems. Based on this, we hypothesize that a lifestyle intervention
program may improve wellbeing and quality of life in long-term ICU-survivors.

Evaluation of the effects of a integrative lifestyle intervention program on
health related quality of life after ICU-admission.

Randomised controlled trial

The intervention group will be part of a 12-week combined lifestyle
intervention encompassing group physical therapy twice a week and improvement
of dietary caloric and protein intake by means of nutritional advice and, if
applicable, caloric and/or protein supplementation. The control group will be
subject to follow up meetings with research staff to assess physical and mental
health and quality of life.

All participants have two additional appointments where they participate in an
interview and perform physical tests (bioimpedance measurements, ultrasound of
the upper thigh muscles, hand grip strength test, Morton mobility index test,
and the six-minute walking test with pulse oximetry). At baseline and week 12
of the program, all participants complete a combination of questionnaires on
mental health and quality of life. The intervention group will additionally be
subject to supervised group training sessions twice a week for the duration of
the intervention (12 weeks). Further, two meetings with a professional about
their diet will be organised. If a patient has a deficit in caloric and/or
protein intake, dietary supplements with daily intake instructions will be
provided. The risks and disadvantages of this intervention are minimal.
However, this study requires considerable time investment and physical and
mental effort. The extent of this study is crucial to clarify the effect of a
combined intervention program on recovery after critical illness. *