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Fourie M, van Aswegen H. Physical function and activity of patients after open abdominal surgery: a prospective cohort study comparing the clinimetric properties of two outcome measures. Physiotherapy 2024; 123:142-150. [PMID: 38490073 DOI: 10.1016/j.physio.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To measure and compare the clinimetric properties of the Chelsea Critical Care Physical Assessment (CPAx) and Physical Function in Intensive Care Test-scored (PFIT-s) for assessment of physical function and activity. DESIGN Prospective cohort design using crossover-randomisation of the sequence in which participants were assessed with CPAx and PFIT-s. SETTING Surgical and transplant intensive care units (ICU) in an academic hospital. PARTICIPANTS Adults who underwent elective open abdominal surgery. Consecutive sampling was used to enrol 69 participants. INTERVENTIONS Physical function and activity were assessed on ICU days one, three, five and at ICU discharge using the CPAx and PFIT-s in random order. MAIN OUTCOME MEASURES Responsiveness to change, minimal clinically important difference (MCID), floor and ceiling effect, and convergent validity. RESULTS CPAx demonstrated a large responsiveness (effect size index (ESI)= 0.83) and PFIT-s moderate responsiveness (ESI=0.73) to change in scores. MCID for CPAx was 2.1 (standard error of measurement (SEM) 1.1) and for PFIT-s 0.6 (SEM=0.3). CPAx had no floor effect and a small ceiling effect (9%, n = 6) at ICU discharge compared to 2% (n = 1) floor and 48% (n = 32) ceiling effects of PFIT-s. Moderate convergent validity was found for both tools at ICU admission (n = 67, r = 0.62, p < 0.001) and discharge (n = 67, r = 0.51, p < 0.001). CONCLUSION CPAx is most responsive to changes in physical function and activity scores, has no floor and limited ceiling effects and moderate convergent validity, and is recommended for similar cohorts. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Marelee Fourie
- Michele Carr Physiotherapists, Wits Donald Gordon Medical Centre, 21 Eton Road, Parktown, Johannesburg 2193, South Africa; Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg 2193, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg 2193, South Africa.
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Paranhos DB, Annoni R, Schujmann DS, Fernandes LFRM. Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals with COVID-19: A Prospective Observational Study. J Intensive Care Med 2024; 39:439-446. [PMID: 37915228 DOI: 10.1177/08850666231211754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Objectives: To determine whether low functional capacity (FC) prior to intensive care unit (ICU) admission due to coronavirus disease 2019 (COVID-19) might be associated with worse clinical outcomes. To monitor FC until discharge from the ICU. To identify associations between physical outcomes and decreased FC at discharge from the ICU. Design: Prospective observational study conducted from March to August 2021. Setting: ICU for adult patients with COVID-19. Participants: Adults (≥18 years) with COVID-19. Interventions: Not applicable. Main outcome measures: Clinical and demographic data were obtained from medical records. At ICU admission, evaluation was made of FC using the Barthel index (BI), and of the level of mobility using the ICU mobility scale. At ICU discharge, FC and mobility level were reassessed, and muscle strength was measured using the Medical Research Council (MRC) scale and the handgrip test. Results: The study was performed with 108 individuals. At the initial assessment, 73.1% of the patients were functionally independent. Length of hospital stay (odds ratio [OR] = 1.05; 95%confidence interval [CI] = 1.00-1.10) and death (OR = 5.27; 95%CI = 1.37-20.28) were related to functional status prior to ICU admission. Between ICU admission and discharge, the BI evaluation indicated a functional decline of 22.5 points. Low mobility level (P = .003) and low muscle strength assessed by the MRC scale (P < .001), measured at ICU discharge, were associated with a greater decrease of FC during the ICU stay. Conclusions: Patients with COVID-19 who were functionally dependent prior to ICU admission presented worse clinical outcomes, with low functional status being associated with longer hospitalization and higher mortality. However, irrespective of the initial functionality status, the surviving individuals suffered from functional decline at ICU discharge. Greater functional decline during the ICU stay was associated with lower muscle strength and lower mobility level at ICU discharge.
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Affiliation(s)
- Darlisson B Paranhos
- Master's Program in Physiotherapy, Federal University of Triângulo Mineiro and Federal University of Uberlândia, Uberaba, Brazil
| | - Raquel Annoni
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Debora S Schujmann
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Luciane F R M Fernandes
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Woodbridge HR, McCarthy CJ, Jones M, Willis M, Antcliffe DB, Alexander CM, Gordon AC. Assessing the safety of physical rehabilitation in critically ill patients: a Delphi study. Crit Care 2024; 28:144. [PMID: 38689372 PMCID: PMC11061934 DOI: 10.1186/s13054-024-04919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical rehabilitation of critically ill patients is implemented to improve physical outcomes from an intensive care stay. However, before rehabilitation is implemented, a risk assessment is essential, based on robust safety data. To develop this information, a uniform definition of relevant adverse events is required. The assessment of cardiovascular stability is particularly relevant before physical activity as there is uncertainty over when it is safe to start rehabilitation with patients receiving vasoactive drugs. METHODS A three-stage Delphi study was carried out to (a) define adverse events for a general ICU cohort, and (b) to define which risks should be assessed before physical rehabilitation of patients receiving vasoactive drugs. An international group of intensive care clinicians and clinician researchers took part. Former ICU patients and their family members/carers were involved in generating consensus for the definition of adverse events. Round one was an open round where participants gave their suggestions of what to include. In round two, participants rated their agreements with these suggestions using a five-point Likert scale; a 70% consensus agreement threshold was used. Round three was used to re-rate suggestions that had not reached consensus, whilst viewing anonymous feedback of participant ratings from round two. RESULTS Twenty-four multi-professional ICU clinicians and clinician researchers from 10 countries across five continents were recruited. Average duration of ICU experience was 18 years (standard deviation 8) and 61% had publications related to ICU rehabilitation. For the adverse event definition, five former ICU patients and one patient relative were recruited. The Delphi process had a 97% response rate. Firstly, 54 adverse events reached consensus; an adverse event tool was created and informed by these events. Secondly, 50 risk factors requiring assessment before physical rehabilitation of patients receiving vasoactive drugs reached consensus. A second tool was created, informed by these suggestions. CONCLUSIONS The adverse event tool can be used in studies of physical rehabilitation to ensure uniform measurement of safety. The risk assessment tool can be used to inform clinical practise when risk assessing when to start rehabilitation with patients receiving vasoactive drugs. Trial registration This study protocol was retrospectively registered on https://www.researchregistry.com/ (researchregistry2991).
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Affiliation(s)
- Huw R Woodbridge
- Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | | | | | - David B Antcliffe
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anthony C Gordon
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Uhlig SE, Rodrigues MK, Oliveira MF, Tanaka C. Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice. Physiother Theory Pract 2024; 40:865-873. [PMID: 36562697 DOI: 10.1080/09593985.2022.2160680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there was scarce data about clinical/functional conditions during hospitalization or after hospital discharge. Little was known about COVID-19 repercussions and how to do early mobilization in intensive care unit (ICU). OBJECTIVE Identify the time to the initiation of out-of-bed mobilization and the levels of mobility (sitting over the edge of the bed, sitting in a chair, standing, and ambulating) reached by critically ill patients with COVID-19 during hospitalization and the factors that could impact early mobilization. METHODS This was a retrospective observational study of patients with COVID-19 in the ICU. RESULTS There were 157 surviving COVID-19 patients included in the study (median age: 61 years; median ICU length of stay: 12 days). The median time to initiate out-of-bed mobilization in the ICU was 6 days; between patients who received mechanical ventilation (MV) compared with those who did not, this time was 8 vs. 2.5 days (p < .001). Most patients who used MV were mobilized after extubation (79.6%). During ICU stays, 88.0% of all patients were mobilized out of bed, and 41.0% were able to ambulate either with assistance or independently. The time to initiate out-of-bed mobilization is associated with sedation time and MV time. CONCLUSION Despite the pandemic scenario, patients were quickly mobilized out of bed, and most of the patients achieved higher mobility levels in the ICU and at hospital discharge. Sedation time and MV time were associated with delays in initiating mobilization.
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Affiliation(s)
- Suélen E Uhlig
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Miguel K Rodrigues
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Mayron F Oliveira
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Clarice Tanaka
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
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Ji HM, Won YH. Early Mobilization and Rehabilitation of Critically-Ill Patients. Tuberc Respir Dis (Seoul) 2024; 87:115-122. [PMID: 38228092 PMCID: PMC10990608 DOI: 10.4046/trd.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
Post-intensive care unit (ICU) syndrome may occur after ICU treatment and includes ICU-acquired weakness (ICU-AW), cognitive decline, and mental problems. ICU-AW is muscle weakness in patients treated in the ICU and is affected by the period of mechanical ventilation. Diaphragmatic weakness may also occur because of respiratory muscle unloading using mechanical ventilators. ICU-AW is an independent predictor of mortality and is associated with longer duration of mechanical ventilation and hospital stay. Diaphragm weakness is also associated with poor outcomes. Therefore, pulmonary rehabilitation with early mobilization and respiratory muscle training is necessary in the ICU after appropriate patient screening and evaluation and can improve ICU-related muscle weakness and functional deterioration.
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Affiliation(s)
- Hye Min Ji
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Ohland PLS, Jack T, Mast M, Melk A, Bleich A, Talbot SR. Continuous monitoring of physiological data using the patient vital status fusion score in septic critical care patients. Sci Rep 2024; 14:7198. [PMID: 38531955 DOI: 10.1038/s41598-024-57712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Accurate and standardized methods for assessing the vital status of patients are crucial for patient care and scientific research. This study introduces the Patient Vital Status (PVS), which quantifies and contextualizes a patient's physical status based on continuous variables such as vital signs and deviations from age-dependent normative values. The vital signs, heart rate, oxygen saturation, respiratory rate, mean arterial blood pressure, and temperature were selected as input to the PVS pipeline. The method was applied to 70 pediatric patients in the intensive care unit (ICU), and its efficacy was evaluated by matching high values with septic events at different time points in patient care. Septic events included systemic inflammatory response syndrome (SIRS) and suspected or proven sepsis. The comparison of maximum PVS values between the presence and absence of a septic event showed significant differences (SIRS/No SIRS: p < 0.0001, η2 = 0.54; Suspected Sepsis/No Suspected Sepsis: p = 0.00047, η2 = 0.43; Proven Sepsis/No Proven Sepsis: p = 0.0055, η2 = 0.34). A further comparison between the most severe PVS in septic patients with the PVS at ICU discharge showed even higher effect sizes (SIRS: p < 0.0001, η2 = 0.8; Suspected Sepsis: p < 0.0001, η2 = 0.8; Proven Sepsis: p = 0.002, η2 = 0.84). The PVS is emerging as a data-driven tool with the potential to assess a patient's vital status in the ICU objectively. Despite real-world data challenges and potential annotation biases, it shows promise for monitoring disease progression and treatment responses. Its adaptability to different disease markers and reliance on age-dependent reference values further broaden its application possibilities. Real-time implementation of PVS in personalized patient monitoring may be a promising way to improve critical care. However, PVS requires further research and external validation to realize its true potential.
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Affiliation(s)
- Philipp L S Ohland
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hanover, Germany
| | - Marcel Mast
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hanover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany
| | - André Bleich
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Steven R Talbot
- Hannover Medical School, Institute for Laboratory Animal Science, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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Ramos IR, Santos JS, Pires Dos Santos MC, da Silva DF, Alves IGN, Neto MG, Martinez BP. Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob). Braz J Phys Ther 2024; 28:101047. [PMID: 38522390 PMCID: PMC10973779 DOI: 10.1016/j.bjpt.2024.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/03/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.
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Affiliation(s)
- Isis Resende Ramos
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Joice Sousa Santos
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | | | | | - Iura Gonzalez Nogueira Alves
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Medicine, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Bruno Prata Martinez
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Physical Therapy, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil.
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Sawadogo A, Sogbossi ES, Everard GJ, Kpadonou T, Batcho CS. Use of standardised outcome measures among physiotherapists in French-speaking sub-Saharan Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1981. [PMID: 38322653 PMCID: PMC10839157 DOI: 10.4102/sajp.v80i1.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/19/2023] [Indexed: 02/08/2024] Open
Abstract
Background The use of standardised assessment tools is a fundamental aspect of good clinical practice. However, to our knowledge, no study has documented the use of standardised assessment tools in physiotherapy in French-speaking sub-Saharan Africa. Objectives Documenting the use of standardised outcome measures in physiotherapy in French-speaking sub-Saharan Africa. Method Our cross-sectional survey used an online self-questionnaire on facilitators and barriers to the use of standardised outcome measures, distributed to physiotherapists in French-speaking sub-Saharan Africa. Results A total of 241 physiotherapists working in French-speaking sub-Saharan Africa responded to the survey. The most represented countries were Benin (36.9%), Cameroon (14.1%), and Burkina Faso (10.8%). Although 99% of participants reported using standardised outcome measures, only 27% of the respondents used them systematically (all the time). The most reported facilitators included the recognition that standardised outcome measures help to determine whether treatment is effective, help to guide care, and improve communication with patients. The most significant barriers were the lack of time, unavailability of the standardised outcome measures, and non-sensitivity of measures to patients' cultural and ethnic concerns. There was a higher proportion of use in the middle age group (30-40) (p = 0.02) and a lower proportion of use in physiotherapists simultaneously working in public and private sectors (p = 0.05). Conclusion Standardised outcome measures are still not widely used by physiotherapists in French-speaking sub-Saharan Africa. Clinical implications The perceived barriers and facilitators could help to develop strategies to improve the systematic use of outcome measures in French-speaking sub-Saharan Africa.
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Affiliation(s)
- Abdoulaye Sawadogo
- School of Physiotherapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Emmanuel Segnon Sogbossi
- School of Physiotherapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- University Clinic of Physical Medicine and Rehabilitation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Gauthier J. Everard
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, Quebec, Canada
- Department of Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, UCLouvain, Brussels, Belgium
| | - Toussaint Kpadonou
- University Clinic of Physical Medicine and Rehabilitation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Charles Sèbiyo Batcho
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, Quebec, Canada
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Luo W, Cao L, Wang C. Low body temperature and mortality in critically ill patients with coronary heart disease: a retrospective analysis from MIMIC-IV database. Eur J Med Res 2023; 28:614. [PMID: 38124189 PMCID: PMC10731844 DOI: 10.1186/s40001-023-01584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study was aimed to investigate the correlation between low body temperature and outcomes in critically ill patients with coronary heart disease (CHD). METHODS Participants from the Medical Information Mart for Intensive Care (MIMIC)-IV were divided into three groups (≤ 36.5 ℃, 36.6-37.4 ℃, ≥ 37.5 ℃) in accordance with body temperature measured orally in ICU. In-hospital, 28-day and 90-day mortality were the major outcomes. Multivariable Cox regression, decision curve analysis (DCA), restricted cubic splines (RCS), Kaplan-Meier curves (with or without propensity score matching), and subgroup analyses were used to investigate the association between body temperature and outcomes. RESULTS A total of 8577 patients (65% men) were included. The in-hospital, 28-day, 90-day, and 1-year overall mortality rate were 10.9%, 16.7%, 21.5%, and 30.4%, respectively. Multivariable Cox proportional hazards regression analyses indicated that patients with hypothermia compared to the patients with normothermia were at higher risk of in-hospital [adjusted hazard ratios (HR) 1.23, 95% confidence interval (CI) 1.01-1.49], 28-day (1.38, 1.19-1.61), and 90-day (1.36, 1.19-1.56) overall mortality. For every 1 ℃ decrease in body temperature, adjusted survival rates were likely to eliminate 14.6% during the 1-year follow-up. The DCA suggested the applicability of the model 3 in clinical practice and the RCS revealed a consistent higher mortality in hypothermia group. CONCLUSIONS Low body temperature was associated with increased mortality in critically ill patients with coronary heart disease.
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Affiliation(s)
- Weiran Luo
- The Six Clinical Medical School, Capital Medical University, Beijing, China
| | - Lixue Cao
- Department of Medical Genetics and Developmental Biology, Capital Medical University School of Basic Medical Sciences, Beijing, China
| | - Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Beijing, 100029, China.
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Mayer KP, Kosmac K, Wen Y, Parry SM, Dhar S, Foster S, Starck J, Montgomery-Yates AA, Dupont-Versteegden EE, Kalema AG. Construct and criterion validity of muscle ultrasonography for assessment of skeletal muscle in patients recovering from COVID-19. Front Physiol 2023; 14:1231538. [PMID: 37936579 PMCID: PMC10625915 DOI: 10.3389/fphys.2023.1231538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Background: The purpose was to investigate the content, construct, and criterion validity of muscle ultrasound in a mixed cohort of participants recovering from mild and critical COVID-19. Methods: A secondary analysis of a prospective cross-sectional study was conducted on data obtained from a battery of muscle and physical function assessments including a muscle biopsy and muscle ultrasonography (US). Rectus femoris (RF) muscle thickness (mT), quadricep complex (QC) mT, RF muscle cross-sectional area (CSA) using 2D freeform trace and estimated from Feret's diameter, and RF echo intensity (EI) were assessed with US. Muscle fiber CSA, fiber type, protein content in muscle fibers, extracellular matrix content (ECM; wheat-germ agglutin), and percent area of collagen in ECM (picrosirius red) were examined from vastus lateralis muscle biopsies. Spearman rho correlations (r) were performed to assess validity of ultrasound parameters. Results: Thirty-three individuals participated including 11 patients surviving critical COVID-19, 15 individuals recovering from mild-COVID, and 7 controls. There were several significant correlations between RF mT, QC mT, RF CSA, and RF EI with age, comorbid burden, body-mass index, and measures of muscle strength, muscle power, and physical function (range r = 0.35-0.83). RF Feret's CSA correlated to CSA of type II muscle fibers (r = 0.41, p = 0.022) and the average size of all muscle fibers (r = 0.39, p = 0.031). RF EI was correlated with collagen in muscle ECM (r = 0.53, p = 0.003) and protein content in muscle tissue (r = -0.52, p = 0.012). Conclusion: Muscle size and quality measured using US has moderate content and construct validity, and to lesser extent, fair to moderate criterion validity in a mixed cohort of individuals recovering from COVID. Muscle ultrasound quality (EI) appears to be sensitive at detecting muscle dysfunction as it is associated with strength, power, physical function, and collagen distribution in a mixed group of individuals recovering from COVID-19.
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Affiliation(s)
- Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Kate Kosmac
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Yuan Wen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Selina M. Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sanjay Dhar
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Sarah Foster
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
| | - Jonathan Starck
- Department of Biology, College of Arts and Sciences, University of Kentucky, Lexington, KY, United States
| | - Ashley A. Montgomery-Yates
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Esther E. Dupont-Versteegden
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, United States
- Center for Muscle Biology, University of Kentucky, Lexington, KY, United States
| | - Anna G. Kalema
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
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Broadley T, Higgins A, Hodgson C. Physical rehabilitation, mobilization and patient-centred outcomes: what is new? Curr Opin Crit Care 2023; 29:505-512. [PMID: 37641507 DOI: 10.1097/mcc.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Physical rehabilitation and mobilization interventions aim to reduce the incidence of intensive care unit (ICU)-acquired weakness and subsequently reduce morbidity in critically ill patients. This chapter will explore the evidence for physical rehabilitation and mobilization with an emphasis on patient-centred outcomes selected in randomized controlled trials. This is particularly pertinent at a time when clinicians are deciding how to implement physical rehabilitation and mobilization into the treatment of critically ill patients. RECENT FINDINGS Multiple trials of physical rehabilitation and mobilization were published in 2022 and 2023 with conflicting results. Analysing the complexities of physical rehabilitation research provides an insight into these results and will aid in the interpretation of trials of physical rehabilitation and mobilization. SUMMARY Patient-centred outcomes are often utilized in physical rehabilitation and mobilization research, but this does not automatically correspond to an increase in research quality. Improving consistency in trials of physical rehabilitation will aid in the interpretation and translation of physical rehabilitation research.
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Affiliation(s)
- Tessa Broadley
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
| | - Alisa Higgins
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- The George Institute for Global Health, Sydney
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
- The George Institute for Global Health, Sydney
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
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12
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Dos Santos JSF, Silva GAG, Lima NMFV, Gualdi LP, Dantas DDS, Lima ÍNDF. Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach. BMC Health Serv Res 2023; 23:871. [PMID: 37587469 PMCID: PMC10433595 DOI: 10.1186/s12913-023-09787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/05/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients. METHODS Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient. RESULTS The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832). CONCLUSIONS This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.
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Affiliation(s)
- Juliana S F Dos Santos
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Gabriely A G Silva
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal, 59078-970, Brasil.
| | - Nubia M F V Lima
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Lucien P Gualdi
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Diego de S Dantas
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Brasil
| | - Íllia N D F Lima
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
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13
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Schanke CM, Brekka AK, Rimehaug SA, Klokkerud M, Andersen TM. Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability. J Clin Med 2023; 12:5033. [PMID: 37568435 PMCID: PMC10419396 DOI: 10.3390/jcm12155033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. METHOD CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. RESULTS The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983-0.994) and at "B" 0.994 (0.990-0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996-0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland-Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. CONCLUSION CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.
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Affiliation(s)
- Charlotte Marie Schanke
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
| | - Anne Kristine Brekka
- Department of Physiotherapy, Sorlandet Hospital, 4838 Arendal, Norway;
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Stein Arne Rimehaug
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
| | - Mari Klokkerud
- Regional Rehabilitation Knowledge Center in South East Norway, 1453 Nesodden, Norway; (S.A.R.); (M.K.)
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Tiina Maarit Andersen
- Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway;
- Faculty of Health and Social Sciences, Bergen University College, 5063 Bergen, Norway
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14
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Nascimento MS, Talerman C, Eid RAC, Brandi S, Gentil LLS, Semeraro FM, Targa FB. Application of the Perme Score to assess mobility in patients with COVID-19 in inpatient units. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:167-174. [PMID: 37781351 PMCID: PMC10540155 DOI: 10.29390/001c.84263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
Abstract
Objective To evaluate the ability of the Perme Score to detect changes in the level of mobility of patients with COVID-19 outside the intensive care unit. Method A retrospective cohort study was conducted in inpatient units of a private hospital. Patients older than 18, diagnosed with COVID-19, who were discharged from the intensive care unit and remained in the inpatient units were included. The variables collected included demographic characterization data, length of hospital stay, respiratory support, Perme Score values at admission to the inpatient unit and at hospital discharge and the mobilization phases performed during physical therapy. Result A total of 69 patients were included, 80% male and with a mean age of 61.9 years (SD=12.5 years). The comparison of the Perme Score between the times of admission to the inpatient unit and at hospital discharge shows significant variation, with a mean increase of 7.3 points (95%CI:5.7-8.8; p<0.001), with estimated mean values of Perme Score at admission of 17.5 (15.8; 19.3) and hospital discharge of 24.8 (23.3; 26.3). There was no association between Perme Score values and length of hospital stay (measure of effect and 95%CI 0.929 (0.861; 1.002; p=0.058)). Conclusion The Perme Score proved effective for assessing mobility in patients diagnosed with COVID-19 with prolonged hospitalization outside the intensive care setting. In addition, we demonstrated by the value of the Perme Score that the level of mobility increases significantly from the time of admission to inpatient units until hospital discharge. There was no association between the Perme Score value and length of hospital stay.
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Affiliation(s)
| | - Claudia Talerman
- Department of Clinical Medicine - Surgical Hospital Israelita Albert Einstein
| | - Raquel A C Eid
- Department of Critical Care Medicine Hospital Israelita Albert Einstein
| | - Simone Brandi
- Department of Assistance Practice Hospital Israelita Albert Einstein
| | - Luana L S Gentil
- Department of Clinical Medicine - Surgical Hospital Israelita Albert Einstein
| | - Fernanda M Semeraro
- Department of Clinical Medicine - Surgical Hospital Israelita Albert Einstein
| | - Fabiano B Targa
- Department of Clinical Medicine - Surgical Hospital Israelita Albert Einstein
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15
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Rousseau AF, Dardenne N, Kellens I, Bornheim S, Misset B, Croisier JL. Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures. Intensive Care Med Exp 2023; 11:39. [PMID: 37394577 DOI: 10.1186/s40635-023-00523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one. METHODS AND RESULTS Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland-Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59-0.94) and the bias was - 0.49 N/Kg (limits of agreement: - 1.76-0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24-0.78), and the bias was - 0.53 N/Kg (limits of agreement: - 1.01-2.07 N/kg). CONCLUSIONS As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.
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Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium.
| | - Nadia Dardenne
- Biostatistics Center (B-STAT), University Hospital and University of Liège, Liège, Belgium
| | - Isabelle Kellens
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium
| | - Stephen Bornheim
- Department of Sport Sciences and Rehabilitation, University of Liège, Liège, Belgium
| | - Benoit Misset
- Intensive Care Department and Burn Center, University Hospital, University of Liège, Sart-Tilman B35, Hippocrate Avenue 1, 4000, Liège, Belgium
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, Liège, Belgium
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Kenji Nawa R, Luiz Ferreira De Camillis M, Buttignol M, Machado Kutchak F, Chaves Pacheco E, Rodrigues Gonçalves LH, Correa Garcia LM, Tavares Timenetsky K, Forgiarini LA. Clinimetric properties of the Perme Intensive Care Unit Mobility Score -a multicenter study for minimum important difference and responsiveness analysis. Colomb Med (Cali) 2023; 54:e2005580. [PMID: 38089826 PMCID: PMC10714681 DOI: 10.25100/cm.v54i3.5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 12/18/2023] Open
Abstract
Background The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.
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Affiliation(s)
| | | | - Monique Buttignol
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho;São Paulo, SP, Brazil
| | - Fernanda Machado Kutchak
- Universidade Vale dos Sinos, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Porto Alegre, RS, Brazil:
| | | | | | | | | | - Luiz Alberto Forgiarini
- Universidade Católica de Pelotas - UCPel, Medicine Course, Postgraduate Program in Health and Behavior, Pelotas, RS, Brazil
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Silva-Gutiérrez A, Artigas-Arias M, Alegría-Molina A, Guerra-Vega P, Navarrete P, Venegas Á, Montecinos C, Vásquez L, Moraga K, Rubilar C, Villagrán G, Parada R, Vitzel KF, Marzuca-Nassr GN. Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness. Front Physiol 2023; 14:1095228. [PMID: 36846316 PMCID: PMC9950093 DOI: 10.3389/fphys.2023.1095228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Objective: Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Design: Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Setting: Intensive care unit in a public hospital. Participants: 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Interventions: Not applicable. Results: Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; p = 0.025), rectus femoris (-20%; p < 0.001) and total quadriceps (-16%; p < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, p < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Conclusion: Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.
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Affiliation(s)
| | - Macarena Artigas-Arias
- Doctorado en Ciencias mención Biología Celular y Molecular Aplicada, Universidad de La Frontera, Temuco, Chile,Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Andrea Alegría-Molina
- Magíster en Terapia Física con mención, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | | | - Pablo Navarrete
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Ángela Venegas
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Carlos Montecinos
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Lorena Vásquez
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Karen Moraga
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - César Rubilar
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Germán Villagrán
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Rodrigo Parada
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Kaio Fernando Vitzel
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
| | - Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile,*Correspondence: Gabriel Nasri Marzuca-Nassr,
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18
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Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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19
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Rocha LPB, da Rocha Medeiros F, de Oliveira HN, Valduga R, Cipriano G, Cipriano GFB. Analysis of physical function, muscle strength, and pulmonary function in surgical cancer patients: a prospective cohort study. Support Care Cancer 2023; 31:105. [PMID: 36625997 DOI: 10.1007/s00520-022-07507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength and pulmonary function in surgical cancer patients admitted to an intensive care unit (ICU). We conducted a prospective cohort study with 85 patients. Mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength, and pulmonary function were assessed using the following tests: ICU Mobility Scale (IMS); Chelsea Critical Care Physical Assessment (CPAx); handgrip strength and Medical Research Council Sum-Score (MRC-SS); maximal inspiratory pressure (MIP) and S-Index; and peak inspiratory flow, respectively. The assessments were undertaken at ICU admission and discharge. The data were analyzed using the Shapiro-Wilk and Wilcoxon tests and Spearman's correlation coefficient. Significant differences in inspiratory muscle strength, CPAx, grip strength, MRC-SS, MIP, S-Index, and peak inspiratory flow scores were observed between ICU admission and discharge. Grip strength showed a moderate correlation with MIP at admission and discharge. The findings also show a moderate correlation between S-Index scores and both MIP and peak inspiratory flow scores at admission and a strong correlation at discharge. Patients showed a gradual improvement in mobility, physical functioning, peripheral and inspiratory muscle strength, and inspiratory flow during their stay in the ICU.
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Affiliation(s)
- Lara Patrícia Bastos Rocha
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil.,Institute of Strategic Health Management of the Federal District Brasília, Brasília, Brazil
| | | | | | - Renato Valduga
- Institute of Strategic Health Management of the Federal District Brasília, Brasília, Brazil
| | - Gerson Cipriano
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil.,Science and Technology in Health Program, University of Brasília, DF, Brasília, Brazil
| | - Graziella França Bernardelli Cipriano
- Science of Rehabilitation Program, Physical Therapy Department, University of Brasília, Brasília, DF, Brazil. .,University of Brasília, QNN 14 Área Especial, Ceilândia Sul., DF, CEP: 72220-140, Brasília, Brazil.
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Astrup K, Corner E, Van Tulder M, Sørensen L. Reliability and responsiveness of the Danish version of The Chelsea Critical Care Physical Assessment tool (CPAx). Physiother Theory Pract 2023; 39:193-199. [PMID: 34784835 DOI: 10.1080/09593985.2021.2005197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Measurement instruments are important in clinical practice and research for assessing physical function in critically ill patients in the intensive care unit (ICU). OBJECTIVE To investigate inter-rater reliability and responsiveness of the Danish version of the CPAx (CPAx-D). METHOD Critically ill patients from three Danish ICUs were included. Patients were assessed with CPAx-D by two blinded testers during a regular physiotherapy session. Follow-up tests were performed in patients who stayed in the ICU for more than 24 hours, were not transferred to another hospital or received palliative care. Floor and ceiling effects were examined in all assessments.Results For the reliability analysis 66 patients were included. Results Showed no significant difference between raters. For the total score, intra class correlation coefficient (ICC) was 0.996 (95% CI: 0.993; 0.997), standard error of measurement was 0.72 point and minimal detectable change 2.0 points. Bland-Altman plot revealed no heteroscedacity. The responsiveness results of 24 patients showed that the effect size was 1.2 and the standardized response mean 1.1, which was in accordance with the hypothesis. No ceiling or floor effect was revealed. CONCLUSION The CPAx-D showed excellent inter-rater reliability and responsiveness.
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Affiliation(s)
- Katrine Astrup
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Evelyn Corner
- Department of Health Sciences, Brunel University London, London, UK
| | - Maurits Van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Imperial College NHS Healthcare Trust, London, UK
| | - Lotte Sørensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Faculty Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Netherlands
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21
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Gutierrez-Arias R, Nydahl P, Pieper D, González-Seguel F, Jalil Y, Oliveros MJ, Torres-Castro R, Seron P. Effectiveness of physical rehabilitation interventions in critically ill patients-A protocol for an overview of systematic reviews. PLoS One 2023; 18:e0284417. [PMID: 37053257 PMCID: PMC10101388 DOI: 10.1371/journal.pone.0284417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients' outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. METHODS An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome. DISCUSSION The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. REGISTRATION NUMBER CRD42023389672.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Servicio de Medicina Física y Rehabilitación, Unidad de Kinesiología, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Laboratory, Faculty of Rehabilitation Sciences, School of Physical Therapy, Universidad Andres Bello, Santiago, Chile
| | - Peter Nydahl
- Department of Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Yorschua Jalil
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria-Jose Oliveros
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | | | - Pamela Seron
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
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22
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Nawa RK, Uhlig SE, Batista CL, Eid RAC, Mól CG. Rehabilitation approach after 2 years of the COVID-19 pandemic: lessons to be learned. EINSTEIN-SAO PAULO 2023; 21:eCE0367. [PMID: 37132665 PMCID: PMC10124585 DOI: 10.31744/einstein_journal/2023ce0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/18/2022] [Indexed: 05/04/2023] Open
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23
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de Carvalho DA, Malaguti C, Cabral LF, Oliveira CC, Annoni R, José A. Upper limb function of individuals hospitalized in intensive care: A 6-month cohort study. Heart Lung 2023; 57:283-289. [PMID: 36332353 DOI: 10.1016/j.hrtlng.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impaired physical function is a common complication in intensive care unit (ICU) patients. However, specific upper limb (UL) function is still poorly studied in this population. OBJECTIVE To evaluate UL function at discharge and after a 6-month follow-up of individuals hospitalized in the ICU. METHODS This was a longitudinal prospective 6-month multicentre cohort study with forty-six individuals hospitalized in the ICU undergoing mechanical ventilation for ≥ 48 h (ICU Group) and forty-six healthy individuals matched by sex, age, and socioeconomic status (control Group). The primary outcomes were measurements of UL disability using the Jebsen-Taylor Hand Function Test (JTT) and the Nine Hole Peg Test (NHPT). Secondary outcomes were physical function (Barthel index), muscle strength (Medical Research Council scale and hand grip strength), and quality of life (EuroQol-5 Dimension). All measurements were assessed after ICU discharge and at a 6-month follow-up. RESULTS The JTT performance time in the ICU group after discharge was worse than that in the control group [121 s (86-165) vs. 54 s (49-61), median (IQR), p<0,001] and was reduced after 6 months [62 s (54-81), p<0,01]. The NHPT performance time at discharge in the ICU group was worse than that in the controls [39 s (33-59) vs. 21 s (20-23), p<0,001] and was reduced after 6 months of follow-up [24 s (21-27), p<0,01]. Physical function, muscle strength and quality of life were reduced after ICU discharge. CONCLUSION Individuals hospitalized in the ICU presented with reduced UL function at discharge and at the 6-month follow-up.
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Affiliation(s)
- Daniela Andrade de Carvalho
- Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance - Federal University of Juiz de Fora/MG, Brazil
| | - Carla Malaguti
- Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance - Federal University of Juiz de Fora/MG, Brazil
| | - Leandro Ferracini Cabral
- Department of Cardiac and Respiratory Physiotherapy, Federal University of Juiz de Fora/MG, Brazil
| | - Cristino Carneiro Oliveira
- Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance - Federal University of Juiz de Fora/MG, Brazil
| | - Raquel Annoni
- Department of Physiotherapy, Federal University of Minas Gerais/MG, Brazil
| | - Anderson José
- Postgraduate Program in Rehabilitation Sciences and Physical Functional Performance - Federal University of Juiz de Fora/MG, Brazil.
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24
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Giray E, Turan Z, Öke D, Topalo M, Baygul A, Curci C, de Sire A, Taskiran OO. Validity, inter-rater reliability, and feasibility of the Chelsea Physical Assessment Tool for assessing physical function in post-acute COVID-19 patients: A cross-sectional study. J Back Musculoskelet Rehabil 2022; 36:527-539. [PMID: 36617777 DOI: 10.3233/bmr-220191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. OBJECTIVE This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. METHODS Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48 hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen's Kappa (κ) coefficient and weighed Kappa (κw) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. RESULTS The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) (p< 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p< 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71-0.98). κ and κw analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests (n= 4) and MRC sum score (n= 14). CONCLUSION CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Turan
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
| | - Deniz Öke
- Department of Physical Medicine and Rehabilitation, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mahir Topalo
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
| | - Arzu Baygul
- Statistics Unit, Koç University School of Medicine, Istanbul, Turkey
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Ozden Ozyemisci Taskiran
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
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25
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Do JG, Suh GY, Won YH, Chang WH, Hiser S, Needham DM, Chung CR. Reliability and validity of the Korean version of the Functional Status Score for the ICU after translation and cross-cultural adaptation. Disabil Rehabil 2022; 44:7528-7534. [PMID: 34713766 DOI: 10.1080/09638288.2021.1994660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The Functional Status Score for the Intensive Care Unit (FSS-ICU) evaluates the physical function of ICU patients. The objective of the study was to translate and cross-culturally adapt the FSS-ICU into Korean and assess its reliability and validity. METHODS An expert committee supervised the forward and backward translation process and the final translated version. Experienced physiotherapists assessed patients (n= 31) from a medical ICU using the Korean version of FSS-ICU. Intra-class correlation coefficients (ICCs) and Bland-Altman's plots were used to evaluate reliability, and Cronbach's alpha for internal consistency. Construct validity was evaluated using Spearman's correlation coefficients. RESULTS Two physiotherapists in each of the two university hospitals independently assessed 31 medical ICU patients, with a mean FSS-ICU total score of 23 (range: 4-35). The FSS-ICU Korean version demonstrated excellent internal consistency, with Cronbach's alpha of 0.897 for the total FSS-ICU score, and a range of 0.844-0.892 with deletion of each individual activity within the FSS-ICU. Intra-rater and inter-rater reliability were excellent for all of five FSS-ICU activities and the total score, with an ICC range of 0.930-0.993. Bland-Altman's plots revealed a mean difference in FSS-ICU total score of 0.2 (95% limits of agreement: -1.9 to 2.3) between two physiotherapists. The Korean version of FSS-ICU had good convergent and divergent validity with moderate to strong correlation with mobility and muscle strength measures, and poor correlation with unrelated measures. CONCLUSIONS The Korean version of the FSS-ICU showed excellent intra-rater and inter-rater reliability, internal consistency, and construct validity for medical ICU patients. The results of this study, along with prior publications, support that the FSS-ICU Korean version is a valid and reliable assessment tool for the ICU environment.Implications for rehabilitationIntensive care unit patients usually experience decreased muscle strength and physical function.The Korean version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) is suitable for use with Korean speakers and has a valid, reliable measurement tool for physical function of intensive care unit patients.A well-standardized training with videos and written materials is important to ensure correct implementation of the Korean version of the FSS-ICU.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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26
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Zaga CJ, Cigognini B, Vogel AP, Berney S. Outcome measurement tools for communication, voice and speech intelligibility in the ICU and their clinimetric properties: A systematic review. J Intensive Care Soc 2022; 23:459-472. [PMID: 36751341 PMCID: PMC9679912 DOI: 10.1177/1751143720963757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To identify outcome measurement tools used to evaluate communication, voice and speech intelligibility in the mechanically ventilated ICU population. Secondly, to evaluate, synthesise and compare the clinimetric properties of the tools identified. Materials and methods A systematic review of articles was undertaken via electronic databases in two parts. Eligibility criteria for selection: part one - quantitative or mixed methods studies which assessed communication, voice or speech intelligibility; part two - studies which evaluated a clinimetric property for one of the tools identified in part one. Two independent reviewers assessed articles for inclusion and used the consensus-based standards for health status measurement instruments (COSMIN) risk of bias checklist. Results The part one search yielded five included studies comprised of eight outcome measurement tools. The part two search yielded 22 included studies comprised of nine tools. Few studies had adequate reliability and measurement error properties. No studies established responsiveness. A notable proportion of studies utilised tools that have no clinimetric properties. Conclusions There is a relatively small number of studies which have established clinimetric properties for outcome measurement tools that evaluate communication, voice and/or speech intelligibility, and a fewer number which have done so in the mechanically ventilated ICU population.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Austin Health,
Melbourne, Australia,Centre for Neuroscience of Speech, University
of Melbourne, Melbourne, Australia,Charissa J Zaga, Austin Health, 145 Studley Road,
Heidelberg, Melbourne, Australia.
| | - Bridie Cigognini
- Department of Speech Pathology, Austin Health,
Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University
of Melbourne, Melbourne, Australia,Department of Neurodegeneration, Hertie
Institute for Clinical Brain Research, Tübingen, Germany,Redenlab, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Health,
Melbourne, Australia,Department of Physiotherapy, School of Health
Sciences, University of Melbourne, Melbourne, Australia
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27
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The Development of a Comprehensive Physical Function Measure for the Intensive Care Unit Using Rasch Analysis and Item Response Theory. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Lima FDS, Carvalho VDS, Bittencourt IS, Fontana AP. Analyzes of the ICF Domain of Activity After a Neurological Early Mobility Protocol in a Public Hospital in Brazil. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:864907. [PMID: 36188978 PMCID: PMC9397758 DOI: 10.3389/fresc.2022.864907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
BackgroundEarly Mobility (EM) has been recognized as a feasible and safe intervention that improves functional outcomes in hospitalized patients. The International Classification of Functioning, Disability and Health (ICF) supports understanding of functioning and disability in multidimensional concepts and efforts have been taken to apply ICF in a hospital environment. EM protocols might be linked with the ICF component of activity and participation. The correlations between ICF, EM, and functional scales might help the multidisciplinary team to conduct the best rehabilitation program, according to patients' functional demands.ObjectivesThe primary outcome is to analyze the activity level of neurological inpatients on admission and delivery after a Neurological Early Mobility Protocol (NEMP) at intermediate care settings in a public hospital in Brazil using Activity Level categories, HPMQ, and MBI scores. The secondary outcome is to analyze the ICF performance qualifier, specifically in the activity domain, transposing HPMQ and MBI scores to the corresponding ICF performance qualifiers.DesignAn international prospective study.MethodsNEMP was used to promote patients' mobility during a hospital stay in neurological ward settings. First, patients were categorized according to their Activity Levels (ALs) to determine the NEMP phase to initiate the EM protocol. ALs also were evaluated in the first and last sessions of NEMP. Thereafter, the Hospitalized Patient Mobility Questionnaire (HPMQ) was applied to identify whether patients needed assistance during the performance of hospital activities as well as the Modified Barthel Index (MBI). Both measures were applied in NEMP admission and discharge, and the Wilcoxon Signed Rank Test was used to compare data in these two time points. HPMQ and MBI scores were re-coded in the correspondent ICF performance qualifier.ResultsFifty-two patients were included with age of 55 ± 20 (mean ± SD) years and a length of hospital stay of 33 ± 21 days. Patients were classified along ALs categories at the admission/discharge as follows: AL 0 n = 6 (12%)/n = 5 (9%); AL 1 n = 12 (23%)/n = 6 (12%); AL 2 n = 13 (25%)/n = 8 (15%); AL 3 n = 10 (19%)/n = 13 (25%); AL 4 n = 11 (21%)/n = 20 (39%). HPMQ data revealed progressions for the activities of bathing (p < 0.001), feeding (p < 0.001), sitting at the edge of the bed (p < 0.001), sit to stand transition (p < 0.001), orthostatism (p < 0.001) and walking (p < 0.001). Transposing HPMQ activities into ICF performance qualifiers, improvements were shown in bathing (d510.3 to d510.1—severe problem to mild problem) and sitting at the edge of the bed (d4153.2 to d4153.1—moderate problem to mild problem). At MBI score were observed an average of 36 [IQR−35. (95% CI 31.5; 41.1)] on NEMP admission to 52 at discharge [IQR−50 (95% CI 43.2; 60.3)] (p < 0.001). Recoding MBI scores into ICF there were improvements from severe problem (3) to moderate problem (2).LimitationsThe delay in initiating NEMP compared to the period observed in the literature (24–72 h). The study was carried out at only one center.ConclusionsThis study suggests that neurological inpatients, in a public hospital in Brazil had low activity levels as could be seen by MBI and HPMQ scores and in the ICF performance qualifier. However, improvements in the evaluated measures and ICF activity domain were found after NEMP. The NEMP protocol has been initiated much longer than 72 h from hospital admission, a distinct window than seen in the literature. This enlargement period could be a new perspective for hospitals that are not able to apply mobility in the earliest 24–72 h.
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29
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Davies TW, van Gassel RJJ, van de Poll M, Gunst J, Casaer MP, Christopher KB, Preiser JC, Hill A, Gundogan K, Reintam-Blaser A, Rousseau AF, Hodgson C, Needham DM, Castro M, Schaller S, McClelland T, Pilkington JJ, Sevin CM, Wischmeyer PE, Lee ZY, Govil D, Li A, Chapple L, Denehy L, Montejo-González JC, Taylor B, Bear DE, Pearse R, McNelly A, Prowle J, Puthucheary ZA. Core outcome measures for clinical effectiveness trials of nutritional and metabolic interventions in critical illness: an international modified Delphi consensus study evaluation (CONCISE). Crit Care 2022; 26:240. [PMID: 35933433 PMCID: PMC9357332 DOI: 10.1186/s13054-022-04113-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/25/2022] [Indexed: 01/06/2023] Open
Abstract
Background Clinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worsening clinical outcomes. We aimed to identify and develop a set of core outcome domains and associated measurement instruments to include in all research in critically ill patients.
Methods An updated systematic review informed a two-stage modified Delphi consensus process (domains followed by instruments). Measurement instruments for domains considered ‘essential’ were taken through the second stage of the Delphi and a subsequent consensus meeting. Results In total, 213 participants (41 patients/caregivers, 50 clinical researchers and 122 healthcare professionals) from 24 countries contributed. Consensus was reached on time points (30 and 90 days post-randomisation). Three domains were considered ‘essential’ at 30 days (survival, physical function and Infection) and five at 90 days (survival, physical function, activities of daily living, nutritional status and muscle/nerve function). Core ‘essential’ measurement instruments reached consensus for survival and activities of daily living, and ‘recommended’ measurement instruments for physical function, nutritional status and muscle/nerve function. No consensus was reached for a measurement instrument for Infection. Four further domains met criteria for ‘recommended,’ but not ‘essential,’ to measure at 30 days post-randomisation (organ dysfunction, muscle/nerve function, nutritional status and wound healing) and three at 90 days (frailty, body composition and organ dysfunction). Conclusion The CONCISE core outcome set is an internationally agreed minimum set of outcomes for use at 30 and 90 days post-randomisation, in nutritional and metabolic clinical research in critically ill adults.
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04113-x.
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Affiliation(s)
- T W Davies
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - R J J van Gassel
- Department of Intensive Care Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M van de Poll
- Department of Intensive Care Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - M P Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - K B Christopher
- Division of Renal Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, USA
| | - J C Preiser
- Medical Direction, Erasme University Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - A Hill
- Departments of Intensive Care and Anesthesiology, University Hospital RWTH Aachen University, 52074, Aachen, Germany
| | - K Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - A Reintam-Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.,Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - A F Rousseau
- Department of Intensive Care, University Hospital of Liège, Liege, Belgium
| | - C Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 3/553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - D M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Castro
- Clinical Nutrition, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - S Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany.,School of Medicine, Klinikum Rechts Der Isar, Department of Anesthesiology and Intensive Care, Technical University of Munich, Munich, Germany
| | - T McClelland
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - J J Pilkington
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - C M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P E Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, DUMC, Box 3094 Mail # 41, 2301 Erwin Road, Durham, NC, 5692 HAFS27710, USA
| | - Z Y Lee
- Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - D Govil
- Institute of Critical Care and Anesthesia, Medanta: The Medicty, Gurugram, Haryana, India
| | - A Li
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Intensive Care Medicine, Woodlands Health, Singapore, Singapore
| | - L Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - L Denehy
- The University of Melbourne, School of Health Sciences, Melbourne, Australia.,Department of Allied Health, Peter McCallum Cancer Centre, Melbourne, Australia
| | - J C Montejo-González
- Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Taylor
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - D E Bear
- Department of Critical Care and Department of Nutrition and Dietetics, Guy´S and St Thomas' NHS Foundation Trust, London, UK
| | - R Pearse
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - A McNelly
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Prowle
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - Z A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK.
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30
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Zhou W, Yu L, Fan Y, Shi B, Wang X, Chen T, Yu H, Liu J, Wang X, Liu C, Zheng H. Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): A dual-center, randomized controlled trial. PLoS One 2022; 17:e0268599. [PMID: 35617287 PMCID: PMC9135241 DOI: 10.1371/journal.pone.0268599] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023] Open
Abstract
AIM The study aimed to investigate the effect of early mobilization combined with early nutrition (EMN) on intensive care unit-acquired weakness (ICU-AW) in intensive care unit (ICU) settings compared with early mobilization (EM) or routine care. METHODS A prospective, dual-center, randomized controlled trial was conducted. The control group underwent standard care without a pre-established routine for mobilization and nutrition. The EM group underwent early, individualized, progressive mobilization within 24 h of ICU admission. The EMN group underwent early mobilization, similar to the EM group plus guideline-based early nutrition (within 48 h of ICU admission). The primary outcome was the occurrence of ICU-AW at discharge from the ICU. Secondary outcomes included muscle strength, functional independence, organ failure, nutritional status, duration of mechanical ventilation (MV), length of ICU stay, and ICU mortality at ICU discharge. RESULTS A total of 150 patients were enrolled and equally distributed into the three groups. Patients undergoing routine care only were more susceptible to ICU-AW upon ICU discharge than those in the EM or EMN groups (16% vs. 2%; p = 0.014 for both), and had a lower Barthel Index than others (control vs. EM/EMN: 57.5 vs 70.0; p = 0.022). The EMN group had improved muscle strength (p = 0.028) and better nutritional status than the control group (p = 0.031). Both interventions were associated with a lower ICU-AW (EM vs. control: p = 0.027, OR [95% CI] = 0.066 [0.006-0.739]; EMN vs. control: p = 0.016, OR [95% CI] = 0.065 [0.007-0.607]). CONCLUSION EM and EMN had positive effects. There was little difference between the effects of EM and EMN, except for muscle strength improvement. Both EM and EMN may lead to a lower occurrence of ICU-AW and better functional independence than standard care. EMN might benefit nutritional status more than usual care and promote improvement in muscle strength.
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Affiliation(s)
- Wendie Zhou
- Clinical Nursing Teaching Department, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- School of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lili Yu
- Clinical Nursing Teaching Department, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- School of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
- Nursing Department, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, Heilongjiang, China
| | - Yuying Fan
- School of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
- * E-mail:
| | - Baisheng Shi
- Department of Rehabilitation, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Wang
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianling Chen
- Department of Intensive Care Unit, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China
| | - Haixia Yu
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jie Liu
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xizhen Wang
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Caihong Liu
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Huijia Zheng
- Department of Intensive Care Unit, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Kangalgil M, Ulusoy H, Turan S, Oncu K. Association between skeletal muscle changes, anthropometric measurements, and clinical outcomes in critically ill trauma and surgical patients: A prospective observational study. Nutr Clin Pract 2022; 37:1326-1335. [PMID: 35594361 DOI: 10.1002/ncp.10865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acute skeletal muscle wasting may predict clinical outcomes in critically ill patients. This study aimed to assess acute muscle loss, changes in anthropometric measurements, and the relationship between muscle loss and clinical outcomes in critically ill trauma and surgical patients. METHODS This single-center, prospective observational study was conducted in critically ill trauma and surgical patients who were expected to stay in the intensive care unit (ICU) for at least 7 days. Rectus femoris cross-sectional area muscle measurements were performed by bedside ultrasound, and anthropometric measurements were obtained at baseline and 7 days after the first assessment. Length of mechanical ventilation, ICU and hospital stay, and mortality were recorded. RESULTS Thirty-five patients with a mean age of 49.6 ± 18.6 years and 74.1% male were enrolled. The rectus femoris cross-sectional area, mid-arm circumference, and calf circumference were reduced at second assessment from baseline (P < 0.05). In univariate analysis, muscle loss and changes in anthropometric measurements were not associated with 90-day mortality (P > 0.05). CONCLUSION Muscle loss in critical trauma and surgical patients occurred rapidly during the first week of critical illness. Rectus femoris muscle cross-sectional area assessment can be used to detect skeletal muscle changes in critically ill patients. Further investigations on the skeletal muscle changes and clinical outcomes need to be conducted.
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Affiliation(s)
- Melda Kangalgil
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Hülya Ulusoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sekine Turan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kıvanç Oncu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults: A Feasibility Prospective Observational Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davoudi A, Shickel B, Tighe PJ, Bihorac A, Rashidi P. Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit. Front Digit Health 2022; 4:773387. [PMID: 35656333 PMCID: PMC9152012 DOI: 10.3389/fdgth.2022.773387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States,*Correspondence: Anis Davoudi
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Patrick James Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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34
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Floegel TA, Flórez-Pregonero A, Bolin LP, Taylor CL. Progressing to Objective Measures of Daily Mobility in Hospitalized Older Adults. J Gerontol Nurs 2022; 48:35-41. [PMID: 35511066 DOI: 10.3928/00989134-20220405-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Accurate mobility assessment of hospitalized older adults is necessary to aid nurses in planning and providing appropriate mobility support; however, nurses cite lack of resources and time limitations as barriers. Accelerometry enables a detailed objective measurement of predominant hospital mobility activities in the older adult population, such as percent time sitting, and the sit-to-stand (STS) transition. The current exploratory study examined the use of a novel, unobtrusive accelerometry technique to obtain postural and STS metrics on 27 older adults during their hospital stay. Total device wear time in the hospital was 96.2%. Participants spent 60.3% time lying, 20.3% time sitting, 5.3% time standing, and 2% time stepping during hospitalization, and, on average, completed the STS transition 20 times (SD = 13) per 24-hour period. There were no participant complaints about wearing the device. Our exploratory study shows accelerometry provides automated, continuous data and may support accurate nursing assessment of patient mobility. [Journal of Gerontological Nursing, 48(5), 35-41.].
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35
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González-Seguel F, Camus-Molina A, Cárcamo M, Hiser S, Needham DM, Leppe J. Inter-observer reliability of trained physiotherapists on the Functional Status Score for the Intensive Care Unit Chilean-Spanish version. Physiother Theory Pract 2022; 38:365-371. [PMID: 32316800 PMCID: PMC9152696 DOI: 10.1080/09593985.2020.1753272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Evaluate inter-observer reliability of trained physiotherapists administering the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU).Methods: Six adult patients in a medical-surgical ICU were assessed and video-recorded by 1 of 2 expert physiotherapists. Twelve physiotherapists were then trained using recommended Spanish-language FSS-ICU materials. The 12 physiotherapists independently scored the FSS-ICU for the 6 video-recorded patients. Intraclass Correlation Coefficient (ICC) was used to evaluate the inter-observer reliability, and modified Bland-Altman plots evaluated agreement between the physiotherapists and experts.Results: This study was performed between May and August 2018. The FSS-ICU total score had a median score of 18 (range: 6 to 34) for the 6 patients. The ICC of the total score was 0.96 (95% CI, 0.92 to 1.00), and for each of the 5 individual FSS-ICU tasks, the ICC ranged between 0.87 and 0.92. The modified Bland-Altman plot revealed a mean difference of 0.6 (95% limits of agreement: -3.3 to 4.5).Conclusions: Twelve trained physiotherapists had excellent inter-observer reliability when administering the Chilean-Spanish FSS-ICU using videos of six critically ill patients, and had excellent agreement with an expert, revealing differences within the established minimal important difference. These findings provide new data supporting clinimetric properties of the Chilean-Spanish FSS-ICU.
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Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Marcela Cárcamo
- Departamento de Salud Pública y Epidemiología, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA,Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jaime Leppe
- Carrera De Kinesiología, Facultad De Medicina, Clínica Alemana Universidad Del Desarrollo, Santiago, Chile
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Rousseau AF, Kellens I, Delanaye P, Bruyère O, Misset B, Croisier JL. Experimental Approach of Quadriceps Strength Measurement: Implications for Assessments in Critically Ill Survivors. Diagnostics (Basel) 2022; 12:diagnostics12010202. [PMID: 35054369 PMCID: PMC8774621 DOI: 10.3390/diagnostics12010202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The supine testing position is suitable for early quadriceps strength (QS) assessment in intensive care unit, while a seated position is more appropriate for survivors who have regained mobility. Acquiring consistent measurements is essential for longitudinal follow-up. We compared the QS generated in different settings in healthy volunteers. (2) Methods: Isometric QS was assessed using a MicroFet2 and standardised protocols comparing different modalities. Hip and knee flexion angles were, respectively, 45° and 40° (H45-K40) in the supine position, and both at 90° (H90-K90) in the seated position. Dynamometer was either handheld (non-fixed configuration, NFC), or fixed (FC) in a cubicle. (3) Results: QS in H90–K90 and H45-K40 positions were strongly correlated, but QS was higher in the later position regardless of the configuration. Compared to H45-K40, biases of 108.2N (or 28.05%) and 110.3N (27.13%) were observed in H90-K90 position, respectively, in the NFC and FC. These biases were independently and positively associated with QS (p < 0.001). For both position, there were no significant differences between QS measured in NFC or FC. (4) Conclusions: The quadriceps was less efficient in the seated position, compared to the supine position, in healthy volunteers. These findings have practical implications for further assessments and research in critically ill patients.
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Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, 4000 Liège, Belgium; (I.K.); (B.M.)
- Correspondence: ; Tel.: +32-43667495
| | - Isabelle Kellens
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, 4000 Liège, Belgium; (I.K.); (B.M.)
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University Hospital, University of Liège, 4000 Liège, Belgium;
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, 30900 Nîmes, France
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium;
| | - Benoit Misset
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, 4000 Liège, Belgium; (I.K.); (B.M.)
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, 4000 Liège, Belgium;
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Zacarias Maldaner da Silva1,2 V, Sanches Lima1 A, Nadiele Santos Alves1 H, Pires-Neto3 R, Denehy4 L, M. Parry4 S. ERRATUM. J Bras Pneumol 2022; 47:e20180366errata. [PMID: 35081250 PMCID: PMC8946556 DOI: 10.36416/1806-3713/e20180366errata] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vinicius Zacarias Maldaner da Silva1,2
- 1. Programa de Pós-Grauação em Ciencias da Saúde, Escola Superior de Ciências da Saúde, Brasília (DF) Brasil. 2. Instituto Hospital de Base do Distrito Federal, Brasília (DF) Brasil
| | - Amanda Sanches Lima1
- 1. Programa de Pós-Grauação em Ciencias da Saúde, Escola Superior de Ciências da Saúde, Brasília (DF) Brasil
| | | | - Ruy Pires-Neto3
- 3. Departamento de Fisioterapia, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Linda Denehy4
- 4. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne (Vic) Australia
| | - Selina M. Parry4
- 4. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne (Vic) Australia
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Martins GDS, Alencar RCD, Holanda K, Valduga R. Physiotherapeutic approach and profile of patients treated in the emergency room surgical unit of a tertiary care hospital in the Federal District. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction The emergency room (ER) is the main entry door for the care of critically ill patients. The inclusion of physiotherapists in these sectors is being consolidated in Brazil. Objective To characterize the physiotherapeutic approach and the clinical-functional profile of patients in the ER surgical unit of a tertiary hospital. Methods This was a retrospective cross-sectional study conducted from August to December of 2020. Clinical and functional data, and the main physiotherapeutic procedures performed, were collected. Analyses were conducted by means of the Friedman and Pearson Correlation tests, using SPSS software v.23. Results The sample included 98 patients, 68% male, mean age of 52 ± 19 years. The most common (64%) physiotherapeutic diagnosis was central nervous system (CNS) deficiency with mechanical ventilation (MV) dependence. The mean time of MV use was 4 ± 5 days. Association (p < 0.05) between MV time and admission in the emergency department (r = 0.972) and between MV time and age (r = 0.330) was identified. The most used physiotherapeutic actions were: suction (69%), lung re-expansion therapy (51%), and bed kinesiotherapy (37%). Conclusion Adult men with CNS-related disabilities were the principal patient profile. The physiotherapeutic action in the surgical emergency unit was diverse, with application of motor and respiratory techniques, and the predominant activity was the management and maintenance of MV.
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Affiliation(s)
| | | | - Katryne Holanda
- Instituto de Gestão Estratégica em Saúde do Distrito Federal, Brazil
| | - Renato Valduga
- Instituto de Gestão Estratégica em Saúde do Distrito Federal, Brazil
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39
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Martins GDS, Alencar RCD, Holanda K, Valduga R. Abordagem fisioterapêutica e perfil dos pacientes assistidos na unidade cirúrgica do pronto-socorro de um hospital terciário do Distrito Federal. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35136.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução O pronto-socorro (PS) tornou-se a principal porta para o início da assistência a pacientes graves. A inserção do fisioterapeuta nesses setores está em processo de consolidação no Brasil. Objetivo Carac-terizar a abordagem fisioterapêutica e o perfil clínico-funcional dos pacientes na unidade cirúrgica PS de um hospital terciário. Métodos Trata-se de um estudo transversal retrospectivo realizado no período de agosto a dezembro de 2020. Coletaram-se dados clínicos, funcionais e as principais condutas fisioterapêuticas utilizadas. As análises foram conduzidas por meio dos testes de Friedman e Correlação de Pearson, utilizando o software Statistical Package for the Social Sciences v.23. Resultados Ao todo, a amostra foi de 98 pacientes, dos quais 68% eram homens, com idade média de 52 ± 19 anos. O principal (64%) diagnóstico fisioterapêutico foi deficiência do sistema nervoso central (SNC) com dependência de ventilação mecânica (VM). O tempo médio de uso de VM foi de 4 ± 5 dias. Houve associação (p < 0,05) entre tempo de VM e internação no PS (r = 0,972) e entre tempo de VM e idade (r = 0,330). As condutas fisioterapêuticas mais utilizadas foram a aspiração (69%), terapia de reexpansão pulmonar (51%) e cinesioterapia no leito (37%). Conclusão Os homens em faixa etária adulta e com deficiências relacionadas ao SNC constituíram o principal perfil dos usuários. A atuação fisioterapêutica na unidade de emergência cirúrgica foi ampla, com emprego de técnicas motoras e respiratórias, das quais a atuação predominante ocorreu no manejo e condução da VM.
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Affiliation(s)
| | | | - Katryne Holanda
- Instituto de Gestão Estratégica em Saúde do Distrito Federal, Brazil
| | - Renato Valduga
- Instituto de Gestão Estratégica em Saúde do Distrito Federal, Brazil
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dos Reis NF, Figueiredo FCXS, Biscaro RRM, Lunardelli EB, Maurici R. Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge. Am J Crit Care 2022; 31:65-72. [PMID: 34972844 DOI: 10.4037/ajcc2022732] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. OBJECTIVES To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. METHODS In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. RESULTS The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were -10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). CONCLUSION The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.
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Affiliation(s)
- Nair Fritzen dos Reis
- Nair Fritzen dos Reis is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University, Florianopolis, Brazil
| | | | - Roberta Rodolfo Mazzali Biscaro
- Roberta Rodolfo Mazzali Biscaro is a physiotherapist and doctoral student in medical sciences at Santa Catarina Federal University
| | - Elizabeth Buss Lunardelli
- Elizabeth Buss Lunardelli is a physician and a doctoral student in medical sciences at Santa Catarina Federal University
| | - Rosemeri Maurici
- Rosemeri Maurici is a physician and professor in the postgraduate program in medical sciences at Santa Catarina Federal University
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Rousseau AF, Kellens I, Dardenne N, Misset B, Croisier JL. Physical capacities assessment in critically ill patients: An exploratory study. Aust Crit Care 2021; 35:709-713. [PMID: 34903433 DOI: 10.1016/j.aucc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests. OBJECTIVES The objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting. METHODS Adults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively. RESULTS Ninety-three patients with a median age of 64 [57-71.5] years, body mass index of 26.4 [23.4-29.6] kg/m2, and Simplified Acute Physiology Score II of 33 [27.7-41] were included. Absolute and relative QS were, respectively, 146.7 [108.5-196.6] N and 1.87 [1.43-2.51] N/kg. HG was 22 [16-31] kg. The ICU-MS score was 4 [1-5]. A significant positive correlation was observed between HG and absolute QS (rs = 0.695, p < 0.001) and between HG and relative QS (rs = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (rs = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum rs = 0.414, p < 0.001). CONCLUSIONS The present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.
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Affiliation(s)
| | - Isabelle Kellens
- Department of Intensive Care and Burn Center, University Hospital of Liège, Liège, Belgium
| | - Nadia Dardenne
- Public Health Department, Biostatistics, University of Liège, Sart-Tilman, Liège, Belgium
| | - Benoit Misset
- Department of Intensive Care and Burn Center, University Hospital of Liège, Liège, Belgium
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, Sart-Tilman, Liège, Belgium
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Reis NFD, Biscaro RRM, Figueiredo FCXS, Lunardelli ECB, Silva RMD. Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:353-361. [PMID: 35107546 PMCID: PMC8555403 DOI: 10.5935/0103-507x.20210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Traduzir, adaptar transculturalmente para o português do Brasil o
instrumento Early Rehabilitation Index e validar para uso
na unidade de terapia intensiva o instrumento Early Rehabilitation
Barthel Index, para avaliação do estado
funcional. Métodos Foram executadas as seguintes etapas: preparação,
tradução, reconciliação, tradução
reversa, revisão, harmonização, pré-teste e
avaliação psicométrica. Após esse processo
inicial, a versão em português foi aplicada por dois
avaliadores em pacientes que permaneciam pelo menos 48 horas internados na
unidade de terapia intensiva. Verificou-se a confiabilidade da escala por
meio da consistência interna, da confiabilidade entre avaliadores e
do efeito piso e teto. Para a validade de constructo, correlacionou-se o
Early Rehabilitation Barthel Index com instrumentos que
usualmente são utilizados para avaliação do estado
funcional na unidade de terapia intensiva. Resultados Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O
Early Rehabilitation Barthel Index teve confiabilidade
adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre
avaliadores foi excelente, com coeficiente de correlação
intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com
índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso
e teto foram mínimos. Observou-se a validade do Early
Rehabilitation Barthel Index por meio das
correlações com o escore total do Perme Escore (rô =
0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do
Physical Function in Intensive Care Test-score
(rô = 0,69), do Medical Research Council sum score
(rô = 0,58), além das dinamometrias de preensão palmar
(rô = 0,58) e manual de coxa (rô = 0,55), todos com p <
0,001. Conclusão A versão adaptada do Early Rehabilitation Index para
o português brasileiro e na sua totalidade, Early
Rehabilitation Barthel Index é confiável e
válida para avaliação do estado funcional dos pacientes
na alta da unidade de terapia intensiva.
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Affiliation(s)
- Nair Fritzen Dos Reis
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Fernanda Cabral Xavier Sarmento Figueiredo
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Elizabeth Cristiane Buss Lunardelli
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Rosemeri Maurici da Silva
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
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Tay MRJ, Thio JML, Low YH, Lau SWT, Chan WLW. Management of persistent sinus tachycardia during post-acute rehabilitation in a critical patient with COVID-19: a single-case study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Sinus tachycardia is a common arrhythmia in patients with COVID-19, and may pose challenges during rehabilitation. Case description This is a case report of a 39-year-old critically ill patient with COVID-19 with no premorbid conditions, who presented with intensive care unit-acquired weakness and persistent sinus tachycardia after their stay in an intensive care unit. The sinus tachycardia and exertional symptoms contributed to a severely limited exercise capacity (assessed through the 6-Minute Walk Test and 2-Minute Step Test), which impaired the progress of inpatient rehabilitation. This was addressed through the use of bisoprolol for heart rate control and a rehabilitation programme based on cardiac rehabilitation principles. Results The patient's intensive care unit-acquired weakness improved with exercise-based rehabilitation, and the Functional Independence Measure motor subscore improved from 54/91 to 91/91 on discharge after 6 weeks of inpatient rehabilitation. After bisoprolol was started for sinus tachycardia, the patient's resting heart rate improved from 106 beats per minute to less than 90 beats per minute during this period of inpatient rehabilitation. During the same period, the patient exhibited concurrent improvement in exercise capacity on weekly 6-Minute Walk Test measurements. Improvements in the 2-Minute Step Test were also documented. Conclusions Patient assessment using submaximal exercise testing with serial 6-Minute Walk Tests and 2-Minute Step Tests, along with using beta-blockers and cardiac rehabilitation principles, can be useful in the post-acute rehabilitation of patients recovering from COVID-19 with persistent sinus tachycardia.
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Affiliation(s)
| | | | - Yee Hong Low
- Tan Tock Seng Hospital Rehabilitation Centre, Singapore
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González-Seguel F, Pinto-Concha JJ, Ríos-Castro F, Silva-Gutiérrez A, Camus-Molina A, Mayer KP, Parry SM. Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists. Arch Rehabil Res Clin Transl 2021; 3:100142. [PMID: 34589692 PMCID: PMC8463476 DOI: 10.1016/j.arrct.2021.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate learning results of critical care physiotherapists participating in a muscle ultrasound (MUS) educational program. DESIGN Cross-sectional study. SETTING A custom-made 20-hour MUS course was performed over a 2-week time period, including knobs familiarization, patient positioning, anatomic landmarks, image acquisition, and limb muscle measurements. PARTICIPANTS Nineteen critical care physiotherapists with little to no prior experience in ultrasound (N=19). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Theoretical knowledge, hands-on skills acquisition, and satisfaction were assessed. Inter- and intrarater reliability on landmarks, thickness, and pennation angle of quadriceps between participants was evaluated using intraclass correlation coefficients (ICCs). Reliability among instructors measured prior to the course was also reported as a reference. RESULTS The percentage score (mean±SD) of knowledge questionnaires was 69±11 (pre-course), 89±10 (post-course), and 92±9 (hands-on skills). Course satisfaction scores ranged from 90%-100%. Pooled interrater reliability of participants (median ICC [interquartile range]) was good (0.70 [0.59-0.79]) for thickness, moderate (0.47 [0.46-0.92]) for landmarks, and absent (0.00 [0.00-0.05]) for pennation angle and the intrarater reliability was good (0.76 [0.51-0.91]) for thickness and weak (0.35 [0.29-0.52]) for pennation angle. Interrater ICC values for instructors were excellent (0.90) for thickness, good (0.67) for landmarks, and moderate (0.41) for pennation angle and intrarater ICC values were excellent (0.94) for thickness and good (0.75) for pennation angle. CONCLUSIONS Although our sample was quite small and homogeneous, increased theoretical knowledge, high hands-on performance acquisition, and good satisfaction of physiotherapists were observed. Reliability was moderate to excellent for thickness and landmarks and absent to weak for pennation angle. Landmarking and pennation angle remain challenges for physiotherapist training in the application of MUS. Further studies are needed to identify variables that could modify reliability during MUS training.
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Key Words
- CV, coefficient of variation
- Critical care
- Education
- ICC, intraclass correlation coefficient
- ICU, intensive care unit
- IQR, interquartile range
- Knowledge assessment
- MUS, muscle ultrasound
- Muscular atrophy
- PA, pennation angle
- Physiotherapy
- QC, quadriceps complex
- RF, rectus femoris
- Rehabilitation
- SEM, standard error of measurement
- Ultrasonography
- VI, vastus intermedius
- VL, vastus lateralis
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Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Francisco Ríos-Castro
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Agustín Camus-Molina
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Selina M. Parry
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. ENFERMERIA INTENSIVA 2021; 32:153-163. [PMID: 34366295 DOI: 10.1016/j.enfie.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, Spain
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, Spain; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, Spain; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, Spain
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Shpata V, Kreka M, Tani K. Current Physiotherapy Practice in Intensive Care Units Needs Cultural and Organizational Changes: An Observational Cross-Sectional Study in Two Albanian University Hospitals. J Multidiscip Healthc 2021; 14:1769-1781. [PMID: 34262288 PMCID: PMC8275147 DOI: 10.2147/jmdh.s319236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Although physiotherapy is beneficial to intensive care unit (ICU) patients and recommended by guidelines, the role of physiotherapy in ICU settings is not fully explored in Albania. Purpose To provide an overview of the current physiotherapy practice in Albanian ICUs and explore the involvement of physiotherapists and intensive care nurses regarding respiratory therapy and early mobility in the ICU. Patients and Methods This was an observational cross-sectional study, which included all ICU nurses working in six ICUs of University Hospital Center “Mother Theresa” and University Hospital of Trauma and all physiotherapists working in these hospitals. ICU nurses and hospital physiotherapists were approached to complete the survey regarding respiratory therapy and early mobility in critically ill patients. Results One hundred thirty-one completed questionnaires were returned from 189 questionnaires distributed to the survey participants (151 nurses and 38 physiotherapists); the response rate was 69.3%. Physiotherapy procedures were performed on a non-regular basis in ICUs in Tirana, Albania. Physiotherapists were not actively involved or exclusively employed in the ICU, and these ICUs did not use protocols for physiotherapist consultation. Physiotherapists occasionally performed respiratory therapy and early mobility in patients without an artificial airway. Nursing staff regularly performed airway suctioning in mechanically ventilated patients (100%) and participated in adjusting ventilator settings (82.2% regularly and 17.8% occasionally). In contrast, physiotherapists did not participate in these procedures and the early mobility of mechanically ventilated patients. Conclusion We report limited physiotherapy involvement in Albanian ICUs. Efforts should focus on improving physiotherapy practice in ICU, potentially making organizational and cultural changes in the ICU, and establishing protocols and guidelines.
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Affiliation(s)
- Vjollca Shpata
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
| | - Manika Kreka
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania.,University Hospital Center "Mother Theresa", Tirana, Albania
| | - Klejda Tani
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
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Özsoy İ, Özcan Kahraman B, Kahraman T, Tanrıverdi A, Acar S, Özpelit E, Şentürk B, Akdeniz B, Savcı S. Assessment of psychometric properties, cross-cultural adaptation, and translation of the Turkish version of the ICU mobility scale. Turk J Med Sci 2021; 51:1153-1157. [PMID: 33421968 PMCID: PMC8283473 DOI: 10.3906/sag-2005-319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/07/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim The aim of the study was to carry out the cultural adaptation and translation of the ICU mobility scale (IMS) into Turkish and research the psychometric properties. Materials and methods This study was based on methodological design. The IMS was translated from English to the Turkish through a regularised translation process. Two physiotherapists assessed patients independently in the coronary intensive care unit. The measures such as construct validity, intra and interrater reliability, and internal consistency of the IMS Turkish version were assessed. Results A total of 70 intensive care patients were included in the study. The intrarater and interrater reliability of the IMS was excellent. The weighted Kappa value was 0.92 (0.87–0.96) for the intrarater reliability, and 0.87 (0.80–0.93) for the interrater reliability. There were significant correlations between the IMS and functional status score for the intensive care unit (r = 0.83), Perme intensive care unit mobility score (r = 0.84), Katz activities of daily living (r = 0.73), handgrip strength (r = 0.62), knee extension strength (r = 0.46), and age (r = –0.44). Conclusion This study suggests that the IMS Turkish version is a reliable and valid scale for assessing functional status and mobility level in ICU patients.
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Affiliation(s)
- İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkey
| | - Buse Özcan Kahraman
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Katip Çelebi University, İzmir, Turkey
| | - Aylin Tanrıverdi
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Serap Acar
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Ebru Özpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bihter Şentürk
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Sema Savcı
- Department of Cardiopulmonary Physiotherapy-Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
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Zhou W, Ruksakulpiwat S, Fan Y, Ji L. Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review. J Multidiscip Healthc 2021; 14:1489-1507. [PMID: 34177267 PMCID: PMC8219235 DOI: 10.2147/jmdh.s314132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor physical functioning (PF) is a common issue among critically ill patients. It was suggested that reasonable nutrition accelerates PF recovery. However, the details and types of nutritional interventions on the PF of different intensive care unit (ICU) patients at present have not been well analyzed yet. This study aimed to systematically synthesize nutritional interventions on PF in different ICU populations. Methods Whittemore and Knafl’s framework was employed. PubMed, EMBASE, Web of Science, CINAHL Plus with Full Text, and Cochrane Library were searched to obtain studies from January 2010 to September 2020, with a manual search of the included studies’ references. Record screening, data extraction, and quality appraisal were conducted independently by each reviewer before reaching an agreement after discussion. Results Twelve studies were included reporting the effects of early parenteral nutrition, early enteral nutrition, early goal-directed nutrition, early adequate nutrition, higher protein delivery, higher energy delivery, low energy delivery, energy and protein delivery, intermittent enteral feeding on PF like muscle mass, muscle strength, and function. Function was the most common outcome but showed little improvements. Muscle strength outcomes improved the most. The mechanically ventilated were the most popular target ICU population. The commenced time of the interventions is usually within 24 to 48 hours after ICU admission. Conclusion Research on nutritional interventions on critically ill patients’ PF is limited, but most are of a high level of evidence. Few intervention studies specified their evidence basis. Qualitative studies investigating timeframe of initiating feeding, perspectives of the patients’ perspectives and caregivers are warranted to advance research and further discuss this topic.
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Affiliation(s)
- Wendie Zhou
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.,Office of General Affairs, School of Nursing, Harbin Medical University, Harbin, People's Republic of China
| | - Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Yuying Fan
- Clinical Nursing Teaching Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.,Office of General Affairs, School of Nursing, Harbin Medical University, Harbin, People's Republic of China
| | - Lingling Ji
- Department of Pediatrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
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Evaluating Physical Functioning in Survivors of Critical Illness: Development of a New Continuum Measure for Acute Care. Crit Care Med 2021; 48:1427-1435. [PMID: 32931188 DOI: 10.1097/ccm.0000000000004499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Evaluation of physical functioning is central to patient recovery from critical illness-it may enable the ability to determine recovery trajectories, evaluate rehabilitation efficacy, and predict individuals at highest risk of ongoing disability. The Physical Function in ICU Test-scored is one of four recommended physical functioning tools for use within the ICU; however, its utility outside the ICU is poorly understood. The De Morton Mobility Index is a common geriatric mobility tool, which has had limited evaluation in the ICU population. For the field to be able to track physical functioning recovery, we need a measurement tool that can be used in the ICU and post-ICU setting to accurately measure physical recovery. Therefore, this study sought to: 1) examine the clinimetric properties of two measures (Physical Function in ICU Test-scored and De Morton Mobility Index) and 2) transform these measures into a single measure for use across the acute care continuum. DESIGN Clinimetric analysis. SETTING Multicenter study across four hospitals in three countries (Australia, Singapore, and Brazil). PATIENTS One hundred fifty-one ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Physical function tests (Physical Function in ICU Test-scored and De Morton Mobility Index) were assessed at ICU awakening, ICU, and hospital discharge. A significant floor effect was observed for the De Morton Mobility Index at awakening (23%) and minimal ceiling effects across all time points (5-12%). Minimal floor effects were observed for the Physical Function in ICU Test-scored across all time points (1-7%) and a significant ceiling effect for Physical Function in ICU Test-scored at hospital discharge (27%). Both measures had strong concurrent validity, responsiveness, and were predictive of home discharge. A new measure was developed using Rasch analytical principles, which involves 10 items (scored out of 19) with minimal floor/ceiling effects. CONCLUSIONS Limitations exist for Physical Function in ICU Test-scored and De Morton Mobility Index when used in isolation. A new single measure was developed for use across the acute care continuum.
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Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E. Variables associated with mobility levels in critically ill patients: A cohort study. Nurs Crit Care 2021; 27:546-557. [PMID: 34008238 DOI: 10.1111/nicc.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice. AIM AND OBJECTIVES To identify mobility levels acquired by critically ill patients and their variables. DESIGN A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours. METHODS The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility. RESULTS Six hundred and forty-two patients were included from 80 ICUs. Active moving in and out of bed was found on 9.9% of patient-days from day 8 of the ICU stay. Bed exercises, or passive transfers, and immobility were observed on 45.6% and 42.2% of patient-days, respectively. Patients achieving active mobility (189/642, 29.4%) were in ICUs with more physiotherapist hours. Active mobility was more likely with a 1:4 nurse-patient ratio (odds ratio [OR] 3.7 95% confidence interval [CI] [1.2-11.2]), high MRC sum-score (OR 1.05 95% CI [1.04-1.06]) and presence of delirium (OR 1.01 95% CI [1.00-1.02]). By contrast, active mobility was hindered by higher BMI (OR 0.92 95% CI [0.88-0.97]), a 1:3 nurse-patient ratio (OR 0.54 95% CI [0.32-0.93]), or a shift-dependent nurse-patient ratio (OR 0.27 95% CI [0.12-0.62]). CONCLUSIONS Immobility and passive mobilization were prevalent. A high MRC sum-score and presence of delirium are protective factors of mobilization. A 1:4 nurse-patient ratio shows a stronger association with active mobility than a 1:3 ratio. RELEVANCE TO CLINICAL PRACTICE Severity-criteria-based nurse-patient ratios hinder mobilization. Active mobilization may be enhanced by using nursing-intervention-based ratios, increasing physiotherapist hours, and achieving wider application of the ABCDEF bundle, resulting in more awake, cooperative patients.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Arias-Rivera
- Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.,Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain
| | - María Jesús Frade-Mera
- Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.,Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain
| | - Elisabet Gallart
- Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Critical Care Department, San Carlos University Hospital, Madrid, Spain
| | - Alicia San José-Arribas
- Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain
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