Interrelationships among workload, illness severity, and function on return to work following acute respiratory distress syndrome

Han Su; Hilaire J Thompson; Kenneth Pike; Biren B Kamdar; Elizabeth Bridges; Megan M Hosey; Catherine L Hough; Dale M Needham; Ramona O Hopkins

doi:10.1016/j.aucc.2022.01.002

Interrelationships among workload, illness severity, and function on return to work following acute respiratory distress syndrome

Aust Crit Care. 2023 Mar;36(2):247-253. doi: 10.1016/j.aucc.2022.01.002. Epub 2022 Feb 21.

Authors

Han Su¹, Hilaire J Thompson², Kenneth Pike³, Biren B Kamdar⁴, Elizabeth Bridges³, Megan M Hosey⁵, Catherine L Hough⁶, Dale M Needham⁵, Ramona O Hopkins⁷

Affiliations

¹ School of Nursing, University of Washington, Seattle, WA, USA. Electronic address: rnhansu@gmail.com.
² School of Nursing, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA.
³ School of Nursing, University of Washington, Seattle, WA, USA.
⁴ Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, La Jolla, CA, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA.
⁷ Neuroscience Center and Psychology Department, Brigham Young University, Provo, Utah, USA; Pulmonary and Critical Care Medicine, Intermountain Health Care, Murray, Utah, USA; Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah, USA.

Abstract

Background: Inability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS).

Objectives: The aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS.

Methods: We conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses.

Results: Among 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: -0.51 to -0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (-0.32 to -0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months.

Conclusions: RTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients' physical, psychological, and interpersonal function.

Keywords: ARDS; Employment; Impairment; Intensive care unit; Job characteristics.

MeSH terms

Humans
Patient Acuity
Respiratory Distress Syndrome*
Return to Work* / psychology
Workload

Abstract

MeSH terms

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