Review of outcome measures used in adult critical care

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Abstract
To undertake a systematic review of the literature on the measurement properties of outcome measures that have been used with adults after discharge from critical care and to make recommendations for future research. In addition to searching five electronic databases (MEDLINE, Embase, Citation Index of the Nursing and Allied Health Literature, Psychlit, and System for Information on Grey Literature in Europe), we manually searched five journals, references in six existing reviews, and references cited in identified papers. Case series, cohort studies, and randomized trials based on adult admission to critical care that included data on outcomes after discharge for at least 20 patients and were published before August 1998 were included. Characteristics of patients (age, sex, severity of illness, diagnosis), number of patients eligible, time of follow-up, number of deaths before follow-up, number and proportion of survivors included in follow-up, method of presentation of outcome data, evidence for the validity, reliability, and responsiveness of each outcome measure were extracted. Data were synthesised by qualitative assessment and overview. Of 764 articles identified in the search, 144 met the inclusion criteria. These provided data on 161 different outcome measures although, for 123 measures there was only one reported use. The remaining 38 measures formed the basis of this review. Few of these had been subjected to rigorous assessment of their measurement properties, making it impossible to recommend, on this basis, which particular measures to use. To improve matters, the research community should select from a limited list of measures and report on some aspect of their measurement properties. We recommend the following restricted list of generic measures: physical function (Katz’s Activities of Daily Living Index, Karnofsky Index), mental function (Hospital Anxiety and Depression Scale, Profile of Mood State), measures of recovery (Glasgow Outcome Scale, return to work, return to home), and health-related quality of life (Sickness Impact Profile, Perceived Quality of Life Scale, Nottingham Health Profile, Short Form–36).