You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
over the past 10 years we have learned that some icu patients remain at elevated risk for many problems in the months following critical illness .
these problems may occur in the first few months , or even the first year after a critical illness , but what about in the longer - term ? in this issue of critical care , cuthbertson and colleagues   provide data from an ambitious single - center study in scotland that followed critical care survivors for 5 years , measuring physical and mental quality of life at various time - points .
these are precious data as few studies have managed to follow patients for such an extended period of time . using the established sf-36 and eq-5d questionnaires , as well as general survey questions , they found that icu admission was associated with poor physical quality of life and low quality adjusted life - years after 5 years .
encouragingly , they did find that the mean mental scores after 6 months were similar to population norms .
because of the overall lower quality of life in comparison to age - adjusted norms , the authors suggest that surviving an admission to the icu may warrant acknowledgement of its long - term physical impact on patients , along the lines of other ' true ' chronic medical conditions .
it is important to note that this study did not include a specific control population . instead , the authors compared outcomes in their icu cohort to known age - adjusted norms for the set of standard quality of life questionnaires employed . for cohort studies ,
the ideal is to have information not only on quality of life post - icu , but also information on pre - icu functional status , and an appropriate matched control group for comparison - a tall order .
studies of morbidity and mortality after critical care are also difficult due to the frequent ' loss to follow - up ' .
this study was only able to provide data on 195 out of 300 patients enrolled ( 65% ) for the entire 5 years .
the authors provide imputed data to suggest that the findings would not substantially change with the additional survivors , but most methods to adjust for loss - to - follow - up are least robust when potentially informative censoring is occurring , which is very likely in studies of icu survivors .
data from cohort studies examining mortality after critical illness are mixed with regard to whether or not there is a residual long - term risk of death [ 2 - 4 ] . but taken together with other studies , primarily of subgroups of patients such as those with the acute respiratory distress syndrome , and severe sepsis , the data of cuthbertson and colleagues provide a consistent picture of the risk of morbidity , demonstrating that many icu survivors continue to struggle with decreased quality of life .
these post - icu sequelae include inability to work , post - traumatic stress disorder , cognitive dysfunction , depression , and other alterations in lifestyle associated with physical disability .
the questions become what , exactly , are the cause of these decrements , whether these factors are specific to all icu patients or are only seen in specific subgroups , and whether some of these factors are modifiable with the ultimate goal of interventions to improve these outcomes . while standard measures of quality of life , such as the sf-36 , are important because they are well validated , they are limited in that they do not provide information that allows us to understand the mechanisms leading to these decrements in quality of life . to identify these factors
, we need to improve our understanding of the interplay among pre - existing conditions , specific events and care provided within the icu , and both short- and long - term functional status .
assessing the changes in quality of life associated with critical illness is a uniquely frustrating venture .
critical illness combines ( often ) unplanned admission with illness severe enough that patients are not able to provide information themselves , sometimes causing intensivists to liken their work to that of pediatricians or veterinarians , gathering information from charts and family members .
how , then , to establish the physical and mental quality of life of a patient prior to admission ?
one option would be to follow a cohort of patients , measuring quality of life , and waiting for critical illness to occur .
unfortunately , the low frequency of critical illness in the population makes this a difficult study design .
the alternative , chosen by cuthbertson and colleagues , was to use estimates of pre - illness quality of life generated by family members .
while this approach certainly represents a good option , it is still a proxy for true measures , and we know from other work that family members often underestimate reported quality of life of patients when the two measures are compared .
further studies that involve long - term follow - up are clearly needed , and data from longer than 1 year seem essential .
a few studies have been able to leverage other pre - existing data sources to supplement icu - specific data .
such research requires enormous foresight , to allow for appropriate data collection , as well as integration with other data systems . to ultimately provide answers that can lead to improvements , research in this area
should involve reaching well beyond traditional boundaries of intensive care to out - patient settings , and making use of other rich clinical data sources , to gain a clearer picture of the lives of all critically ill patients pre and post - icu .
data continue to emerge demonstrating the poor quality of life of icu survivors in the months and years following critical illness . in this issue of critical care , cuthbertson and 
 colleagues present new data on quality of life from a cohort of icu survivors who were followed for 5 years . 
 they found that survivors had poor physical quality of life and low quality adjusted life - years in comparison to age - adjusted norms , describing the long - term impact of critical illness as similar to a co - morbidity . 
 studies are now needed that seek to identify potentially modifiable factors both during and following an icu admission to allow for eventual improvement in long - term morbidity . 
 such studies will likely need to incorporate extensive planning for data collection , as well as coordinated linkage with other available datasets that include substantial amounts of patient information from outside of the icu .