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Haylett R, Grant J, Williams MA, Gustafson O. Does the level of mobility on ICU discharge impact post-ICU outcomes? A retrospective analysis. Disabil Rehabil 2024; 46:5576-5581. [PMID: 38293804 DOI: 10.1080/09638288.2024.2310186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. MATERIALS AND METHODS A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. RESULTS MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI -17.6 to -6.1, p < 0.001). CONCLUSIONS The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions.
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Affiliation(s)
- Rebekah Haylett
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Grant
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark A Williams
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Watson MA, Sandi M, Bixby J, Perry G, Offner PJ, Burnham EL, Jolley SE. An Exploratory Analysis of Sociodemographic Factors Associated With Physical Functional Impairment in ICU Survivors. Crit Care Explor 2024; 6:e1100. [PMID: 38836576 PMCID: PMC11155592 DOI: 10.1097/cce.0000000000001100] [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] [Indexed: 06/06/2024] Open
Abstract
IMPORTANCE Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors. OBJECTIVES To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment. DESIGN, SETTING, AND PARTICIPANTS This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data. MAIN OUTCOMES AND MEASURES Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities. RESULTS More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up. CONCLUSIONS AND RELEVANCE In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.
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Affiliation(s)
- Megan A Watson
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Marie Sandi
- Section of Pulmonary/Critical Care, Louisiana State University, New Orleans, LA
| | - Johanna Bixby
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Grace Perry
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Patrick J Offner
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Ellen L Burnham
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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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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Cijs B, Valkenet K, Heijnen G, Visser-Meily JMA, van der Schaaf M. Patients With and Without COVID-19 in the Intensive Care Unit: Physical Status Outcome Comparisons 3 Months After Discharge. Phys Ther 2023; 103:pzad039. [PMID: 37079487 PMCID: PMC10492575 DOI: 10.1093/ptj/pzad039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/16/2022] [Accepted: 02/15/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Many patients with coronavirus disease 2019 (COVID-19) infections were admitted to an intensive care unit (ICU). Physical impairments are common after ICU stays and are associated with clinical and patient characteristics. To date, it is unknown if physical functioning and health status are comparable between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The primary objective of this study was to compare handgrip strength, physical functioning, and health status between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The second objective was to identify factors associated with physical functioning and health status in patients in the ICU with COVID-19. METHODS In this observational, retrospective chart review study, handgrip strength (handheld dynamometer), physical functioning (Patient-Reported Outcomes Measurement Information System Physical Function), and health status (EuroQol 5 Dimension 5 Level) were compared between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 using linear regression. Multilinear regression analyses were used to investigate whether age, sex, body mass index, comorbidities in medical history (Charlson Comorbidity Index), and premorbid function illness (Identification of Seniors At Risk-Hospitalized Patients) were associated with these parameters in patients in the ICU with COVID-19. RESULTS In total, 183 patients (N = 92 with COVID-19) were included. No significant between-group differences were found in handgrip strength, physical functioning, and health status 3 months after ICU discharge. The multilinear regression analyses showed a significant association between sex and physical functioning in the COVID-19 group, with better physical functioning in men compared with women. CONCLUSION Current findings suggest that handgrip strength, physical functioning, and health status are comparable for patients who were in the ICU with COVID-19 and patients who were in the ICU without COVID-19 3 months after ICU discharge. IMPACT Aftercare in primary or secondary care in the physical domain of postintensive care syndrome after ICU discharge in patients with COVID-19 and in patients without COVID-19 who had an ICU length of stay >48 hours is recommended. LAY SUMMARY Patients who were in the ICU with and without COVID-19 had a lower physical status and health status than healthy people, thus requiring personalized physical rehabilitation. Outpatient aftercare is recommended for patients with an ICU length of stay >48 hours, and functional assessment is recommended 3 months after hospital discharge.
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Affiliation(s)
- Bastiaan Cijs
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Germijn Heijnen
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - J M Anne Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Patsaki I, Bachou G, Sidiras G, Nanas S, Routsi C, Karatzanos E. Post Hospital Discharge Functional Recovery of Critical Illness Survivors. Systematic Review. J Crit Care Med (Targu Mures) 2023; 9:87-96. [PMID: 37593254 PMCID: PMC10429620 DOI: 10.2478/jccm-2023-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 08/19/2023] Open
Abstract
Background Millions of people face critical illnesses and need to be hospitalized in an Intensive Care Unit (ICU) annually worldwide. Despite the fact that survival rates of these patients have increased, they develop various cognitive, psychological and functional impairments. This study aims to investigate the significance of the recovery interventions following intensive care unit discharge, the effectiveness of the rehabilitative protocols and their possible deficits. Methods MEDLINE (PubMed) and Physiotherapy Evidence Database (PEDro) were searched for studies analyzing the recovery potentials post-ICU among adults, who spent at least 48 hours at the ICU. Methodological quality of the studies was assessed via PEDro Scale. Results Nine randomized controlled trials were included. These took place mainly at specialized rehabilitation gyms as well as patients home environments. Studies analyses showed that treatment group showed improvement in functional ability in relation to control group. Nevertheless, differences between two groups were not statistically significant (P<0.05). The majority of studies assessed cardiorespiratory endurance and muscular strength. Conclusions The included rehabilitation programs were determined to be effective. Although they didn't prove any statistically significant difference between groups, quality of life enhancements and stress reduction were reported. Hence, new randomized controlled trials are required in order to provide more accurate data on the potential benefits of rehabilitation strategies among post-ICU patients.
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Affiliation(s)
| | - Georgia Bachou
- National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Sidiras
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Christina Routsi
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
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Heimburg K, Cronberg T, Tornberg ÅB, Ullén S, Friberg H, Nielsen N, Hassager C, Horn J, Kjærgaard J, Kuiper M, Rylander C, Wise MP, Lilja G. Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Resusc Plus 2022; 11:100275. [PMID: 36164471 PMCID: PMC9508620 DOI: 10.1016/j.resplu.2022.100275] [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: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Limitations in physical function are common in cardiac arrest survivors. Age and gender are associated with limitations in physical function. Cognitive impairment is a predictive variable for physical limitations. Anxiety and depression symptoms are associated with physical limitations. Physical function should be addressed at follow-up after cardiac arrest.
Title Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. Background Out-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. Aims To describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. Methods A cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results 287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. Conclusion Self-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registration ClinicalTrials.gov Identifier: NCT01946932.
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Objective assessment of metabolism and guidance of ICU rehabilitation with cardiopulmonary exercise testing. Curr Opin Crit Care 2021; 27:390-398. [PMID: 33973897 DOI: 10.1097/mcc.0000000000000843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET). RECENT FINDINGS Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function. This manifests in reduced aerobic exercise capacity and metabolic inflexibility. CPET-guided targeted metabolic conditioning has proved beneficial in several clinical populations, including those undergoing high-risk surgery, and could be successfully applied to the rehabilitation of ICU survivors. SUMMARY CPET shows great promise in the guidance of rehabilitation in functionally limited ICU survivors. Parallels in the physiological response to exercise in athletes and clinical populations with the stress and consequences of critical illness must be investigated and ultimately applied to the burgeoning population of ICU survivors in order to treat the consequences of survival from critical illness.
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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: 1.3] [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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Physical Function in Critical Care Tool Bridges the Waters of ICU and Post Acute Care Physical Functioning Assessments. Crit Care Med 2021; 48:1532-1533. [PMID: 32925260 DOI: 10.1097/ccm.0000000000004537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blanjean A, Kellens I, Misset B, Joris J, Croisier JL, Rousseau AF. Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity. Aust Crit Care 2020; 34:311-318. [PMID: 33243568 DOI: 10.1016/j.aucc.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/23/2020] [Accepted: 10/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Muscle weakness is common in patients who survive a stay in the intensive care unit (ICU). Quadriceps strength (QS) measurement allows evaluation of lower limb performances that are associated with mobility outcomes. OBJECTIVES The objective of the study was to characterise the range of QS in ICU survivors (ICUS) during their short-term evolution, by comparing them with surgical patients without critical illness and with healthy participants. The secondary aim was to explore whether physical activity before ICU admission influenced QS during that trajectory. METHODS Patients with length of ICU stay ≥2 days, adults scheduled for elective colorectal surgery, and young healthy volunteers were included. Maximal isometric QS was assessed using a handheld dynamometer and a previously validated standardised protocol. The dominant leg was tested in the supine position. ICUSs were tested in the ICU and 1 month after ICU discharge, while surgical patients were tested before and on the day after surgery, as well as 1 month after discharge. Healthy patients were tested once only. Patients were classified as physically inactive or active before admission from the self-report. RESULTS Thirty-eight, 32, and 34 participants were included in the ICU, surgical, and healthy groups, respectively. Demographic data were similar in the ICUS and surgical groups. In the ICU, QS was lower in the ICU group than in the surgical and healthy groups (3.01 [1.88-3.48], 3.38 [2.84-4.37], and 5.5 [4.75-6.05] N/kg, respectively). QS did not significantly improve 1 month after ICU discharge, excepted in survivors who were previously physically active (22/38, 56%): the difference between the two time points was -6.6 [-27.1 to -1.7]% vs 20.4 [-3.4 to 43.3]%, respectively, in physically inactive and active patients (p = 0.002). CONCLUSIONS Patients who survived an ICU stay were weaker than surgical patients. However, a huge QS heterogeneity was observed among them. Their QS did not improve during the month after ICU discharge. Physically inactive patients should be early identified as at risk of poorer recovery.
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Affiliation(s)
- Arielle Blanjean
- Anaesthesiology Department, University Hospital, University of Liège, Liège, Belgium
| | - Isabelle Kellens
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Benoit Misset
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Jean Joris
- Anaesthesiology Department, University Hospital, University of Liège, Liège, Belgium
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, Liège, Belgium
| | - Anne-Françoise Rousseau
- Intensive Care Department and Burn Centre, University Hospital, University of Liège, Liège, Belgium.
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Jarvis L, Moninger S, Pavon J, Throckmorton C, Caves K. Accelerometer-Based Machine Learning Categorization of Body Position in Adult Populations. COMPUTERS HELPING PEOPLE WITH SPECIAL NEEDS : ... INTERNATIONAL CONFERENCE, ICCHP ... : PROCEEDINGS. INTERNATIONAL CONFERENCE ON COMPUTERS HELPING PEOPLE WITH SPECIAL NEEDS 2020; 12377:242-249. [PMID: 33047112 DOI: 10.1007/978-3-030-58805-2_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This manuscript describes tests and results of a study to evaluate classification algorithms derived from accelerometer data collected on healthy adults and older adults to better classify posture movements. Specifically, tests were conducted to 1) compare performance of 1 sensor vs. 2 sensors; 2) examine custom trained algorithms to classify for a given task 3) determine overall classifier accuracy for healthy adults under 55 and older adults (55 or older). Despite the current variety of commercially available platforms, sensors, and analysis software, many do not provide the data granularity needed to characterize all stages of movement. Additionally, some clinicians have expressed concerns regarding validity of analysis on specialized populations, such as hospitalized older adults. Accurate classification of movement data is important in a clinical setting as more hospital systems are using sensors to help with clinical decision making. We developed custom software and classification algorithms to identify laying, reclining, sitting, standing, and walking. Our algorithm accuracy is 93.2% for healthy adults under 55 and 95% for healthy older adults over 55 for the tasks in our setting. The high accuracy of this approach will aid future investigation into classifying movement in hospitalized older adults. Results from these tests also indicate that researchers and clinicians need to be aware of sensor body position in relation to where the algorithm used was trained. Additionally, results suggest more research is needed to determine if algorithms trained on one population can accurately be used to classify data from another population.
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Amundadottir OR, Jónasdóttir RJ, Sigvaldason K, Gunnsteinsdottir E, Haraldsdottir B, Sveinsson T, Sigurdsson GH, Dean E. Effects of intensive upright mobilisation on outcomes of mechanically ventilated patients in the intensive care unit: a randomised controlled trial with 12-months follow-up. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1645880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Olof R. Amundadottir
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Rannveig J. Jónasdóttir
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristinn Sigvaldason
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ester Gunnsteinsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Brynja Haraldsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Gisli H. Sigurdsson
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elizabeth Dean
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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A feasibility study to assess pre-admission status and six month outcomes of major trauma patients admitted to an intensive care unit, using the WHO DAS 2.0. J Crit Care 2018; 48:140-144. [PMID: 30193172 DOI: 10.1016/j.jcrc.2018.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/25/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the feasibility of assessing pre-admission functional status of ICU trauma patients, with repeat assessment at six months post ICU discharge using a standardised measure. MATERIALS AND METHODS A prospective longitudinal observational cohort design recruited consecutive adult major trauma admissions to a UK general ICU, between 1st November 2016 and 1st November 2017. The 12-item World Health Organisation Disability Schedule 2.0 was completed to assess pre-admission functional status as soon as possible after ICU admission. This was repeated at six months post ICU discharge, through ICU follow-up clinic, by post, or by telephone. RESULTS The ICU physiotherapy team were trained in the use of the measure in 2.5 h. Initial assessments were completed for 57 participants. Mean time from admission to assessment was 38 h, with assessments completed in an average of three minutes. The median six month score was 28.5, increasing from baseline by a median of 15.5 points. Of the responses received 20 (65%) were via post, 4 (13%) by telephone, and 7 (23%) via follow-up clinic. CONCLUSIONS Standardised assessment of pre-admission function was feasible. Future research should investigate the clinical relevance of scores and the validity of the measure in trauma patients.
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15
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Denehy L, Granger CL, El-Ansary D, Parry SM. Advances in cardiorespiratory physiotherapy and their clinical impact. Expert Rev Respir Med 2018; 12:203-215. [PMID: 29376440 DOI: 10.1080/17476348.2018.1433034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cardiorespiratory physiotherapy is an evidence-based practice that has evolved alongside changes in medical and surgical management, analgesia, the ageing society and increasing comorbidities of our patient populations. Continued research provides the profession with the ability to adapt to meet the changing patient and community needs. Areas covered: This review focuses on surgical, respiratory and critical care settings discussing the most significant changes over the past decade with an increased focus on rehabilitation across the care continuum and a shift away from providing predominately airway clearance in established disease populations but also providing this in emerging groups. Further important changes are identification and emphases on patient self-management including changing their behaviour to more positively embrace wellness, particularly increasing physical activity levels. This paper outlines these changes and offers speculation on factors that may impact the profession in the future. Expert commentary: The increasing focus on new technologies, physical activity levels, changes to the health systems in different countries and an increasingly comorbid and ageing society will shape the next steps in the evolution of cardiorespiratory physiotherapy. Continued research is vital to keep pace with these changes so that physiotherapists can provide the most effective treatments to improve patient outcomes.
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Affiliation(s)
- Linda Denehy
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
| | - Catherine L Granger
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
| | - Doa El-Ansary
- b Department of Cardiothoracic Surgery , Royal Melbourne Hospital, Royal Parade , Parkville , Australia
| | - Selina M Parry
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
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