• B H Cuthbertson, J Rattray, M K Campbell, M Gager, S Roughton, A Smith, A Hull, S Breeman, J Norrie, D Jenkinson, R Hernández, M Johnston, E Wilson, C Waldmann, and PRaCTICaL study group.
• Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto. brian.cuthbertson@sunnybrook.ca
• BMJ. 2009 Jan 1;339:b3723.

ObjectivesTo test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care.DesignA pragmatic, non-blinded, multicentre, randomised controlled trial.SettingThree UK hospitals (two teaching hospitals and one district general hospital).Participants286 patients aged >or=18 years were recruited after discharge from intensive care between September 2006 and October 2007.InterventionNurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed.Results286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI -1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (-3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective.ConclusionsA nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.Trial RegistrationISRCTN 24294750.

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