COSMIN database

Outcome measures for adult critical care: a systematic review

Hayes, J. A., Black, N. A., Jenkinson, C., Young, J. D., Rowan, K. M., Daly, K., and Ridley, S.
OBJECTIVES: 1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care.


DATA SOURCES: Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified.

STUDY SELECTION: Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care.

DATA EXTRACTION AND SYNTHESIS: If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported outcomes were also extracted.


MEASURES USED IN CRITICAL CARE: Measures of impairment were largely confined to the respiratory system so are almost certainly not appropriate for many critical care survivors. They can be categorised as respiratory volumes (e.g. vital capacity), gas flow within the respiratory system (e.g. forced expiratory volume in 1 second (FEV1)), pulmonary diffusing capacity (e.g. carbon monoxide diffusing capacity) and visualisation of the upper airway (e.g. bronchoscopy). Multiple tests are often performed. Eight measures of physical functional status were used, five generic and three disease-specific. The most frequently used generic measures were multi-item scales. Two single-item global measures attempted to capture a person's overall activity level or functional status. Five multi-item measures of mental functional status were used, four generic and one specific to trauma patients. The generic measures were either confined to assessing depressive symptoms or also encompassed a measure of anxiety. Measures of neuropsychological functioning relate to a person's cognition, attention, ability to process information and memory. Apart from one single-item measure, which focused on communication level, six multi-item measures were used with critical care survivors. Such measures are particularly appropriate for use with survivors of head injury or other neurological insult and, in that sense, they are disease-specific rather than generic measures. Single item measures of recovery were frequently used but researchers often invented their own, so there was little consistency in the wording. These measures had five principal foci - return to work, return to own home, degree of recovery, productivity and chronic health status. One multi-item scale was also used. (ABSTRACT TRUNCATED)
Health Technol Assess
1366-5278 (Print)
Publication year:
Functional status:
Physical functioning
General health perceptions / HRQoL:
Health-related quality of life
Adults (18-65)
Seniors (65+)
Certain conditions originating in the perinatal period and related symptoms
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the digestive system
Diseases of and symptoms related to the ear and mastoid process
Diseases of and symptoms related to the eye and adnexa
Diseases of and symptoms related to the genitourinary system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Diseases of and symptoms related to the respiratory system
Diseases of and symptoms related to the skin and subcutaneous tissue
Endocrine, nutritional and metabolic diseases and related symptoms
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
Pregnancy, childbirth and puerperium and related symptom
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
8 - Imaging tests
9 - Laboratory tests
12MinWT - 12 Minute Walk Test [alias; 12MWT]   
1MWT - 1-Minute Walk Test
6MWT - 6-Minute Walk Test    | 
Activity levels
ATS respiratory disease questionnaire
BDI - Beck Depression Inventory   
Bentons’ Visual Retention Test
BI - Barthel Index   
CES-D - Centre for Epidemiologic Studies-Depression Scale   
DDI - Disability and Distress Index (often referred to as the Rosser Index)
Fernandez’s questionnaire
FEV - Forced Expiration Volume
FIV1 - timed forced inspiratory volume
FRC - functional residual capacity
FVC - Forced Vital Capacity
GOS - Glasgow Outcome Scale
HADS - Hospital Anxiety and Depression Scale   
IES - Impact of Event Scale
Katz ADL - Katz’ Index Of Independence In Activities Of Daily Living    | 
KPS - Karnofsky Performance Scale (of: Status)
MMSE - Mini-Mental State Examination   
NHP - Nottingham Health Profile   
NYHA (functional class) - New York Heart Association functional class questionnaire   
PASAT - Paced Auditory Serial Additions Test
PEF - peak expiratory flow
PEFR - peak expiratory flow rate
PGWBI - Psychological General Well-Being index [alias: PGWB] (Also: PGWBI-S - short form)
POMS - Profile of Mood States
PQOL - Perceived Quality of Life
RV - Residual Volume
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SIP - Sickness Impact Profile   
Spitzer Quality of Life Index
TLC - Total Lung Capacity
TMT - Trail Making Test
VC - Vital Capacity
WCST - Wisconsin Card Sorting Test
Wechsler Memory Scales - (WMS-R, WMS-III, WMS-IV)
Whiston Hospital questionnaire