Quantitative Evaluation of Muscle Function, Gait, and Postural Control in People Experiencing Critical Illness After Discharge From the Intensive Care Unit

Force Production Measurements During a Supine Medicine Ball Throw: a Reliability and Correlation Study

OBJECTIVES

This study aimed to examine the reliability of supine medicine ball throw peak force and rate of force development (RFD) measurements. A secondary aim was to investigate the correlations between these measurements and vertical jump height.

METHODS

Twenty young women (21±3 years) reported for experimental testing on two different occasions. Supine medicine ball throw assessments were performed during each testing session to assess peak force, RFDmax, and RFD at specific percentages of peak force (RFD30% and RFD40-80%). Vertical jumps were performed on a jump mat. The jump mat measured vertical jump height based on flight time.

RESULTS

Good intraclass correlation coefficients (≥0.82) and coefficients of variation (≤14.0%) were observed between sessions for peak force, RFDmax, and RFD40-80%, but not for RFD30% (0.55, 27.2%). There were significant correlations between jump height and peak force (r=0.483, P=0.031), RFDmax (r=0.484, P=0.031), and RFD40-80% (r=0.491, P=0.028). There was no significant correlation between jump height and RFD30% (r=0.359, P=0.120).

CONCLUSIONS

Our results showed that supine medicine ball throw peak force, RFDmax, and RFD40-80% were reliable measures for assessing upper-body explosive strength in young adults. These measurements were significantly associated with vertical jump height and therefore, may be effective predictors of one's athletic ability.

How to avoid harm with feeding critically ill patients: a synthesis of viewpoints of a basic scientist, dietitian and intensivist

The optimal feeding strategy in critically ill patients is a matter of debate, with current guidelines recommending different strategies regarding energy and protein targets. Several recent trials have added to the debate and question our previous understanding of the provision of nutrition during critical illness. This narrative review aims to provide a summary of interpretation of recent evidence from the view of basic scientist, critical care dietitian and intensivist, resulting in joined suggestions for both clinical practice and future research. In the most recent randomised controlled trial (RCT), patients receiving 6 versus 25 kcal/kg/day by any route achieved readiness for ICU discharge earlier and had fewer GI complications. A second showed that high protein dosage may be harmful in patients with baseline acute kidney injury and more severe illness. Lastly, a prospective observational study using propensity score matched analysis suggested that early full feeding, especially enteral, compared to delayed feeding is associated with a higher 28-day mortality. Viewpoints from all three professionals point to the agreement that early full feeding is likely harmful, whereas important questions regarding the mechanisms of harm as well as on timing and optimal dose of nutrition for individual patients remain unanswered and warrant future studies. For now, we suggest giving low dose of energy and protein during the first few days in the ICU and apply individualised approach based on assumed metabolic state according to the trajectory of illness thereafter. At the same time, we encourage research to develop better tools to monitor metabolism and the nutritional needs for the individual patient accurately and continuously.

Musculoskeletal health state and physical function of intensive care unit survivors: protocol for a UK multicentre prospective cohort study (the MSK-ICU study)

INTRODUCTION

Survivors of critical illness frequently experience long-term physical impairment, decreased health-related quality of life and low rates of return to employment. There has been limited investigation of the underlying problems affecting physical function post-intensive care unit (ICU) admission. Musculoskeletal (MSK) conditions may be complex in presentation, with ICU survivors potentially at greater risk of their development due to the rapid muscle mass loss seen in ICU. The MSK health state of ICU survivors and its impact on physical function remain largely unknown. The aim of the MSK-ICU study is to determine and characterise the MSK health state of ICU survivors 6 months following admission to ICU, in order to inform development of targeted rehabilitation interventions.

METHODS AND ANALYSIS

The MSK-ICU study is a multicentre prospective longitudinal cohort study, evaluating the MSK health state of ICU survivors 6 months after admission to ICU. The study consists of a primary study and two substudies. The primary study will be a telephone follow-up of adults admitted to ICU for more than 48 hours, collecting data on MSK health state, quality of life, employment, anxiety and depression and symptoms of post-traumatic stress disorder. The planned sample size is 334 participants. Multivariable regression will be used to identify prognostic factors for a worse MSK health state, as measured by the MSK-Health Questionnaire. In substudy 1, participants who self-report any MSK problem will undergo a detailed, in-person MSK physical assessment of pain, peripheral joint range of movement and strength. In substudy 2, participants reporting a severe MSK problem will undergo a detailed physical assessment of mobility, function and muscle architecture.

ETHICS AND DISSEMINATION

Ethical approval has been obtained through the North of Scotland Research Ethics Committee 2 (21/NS/0143). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media.

TRIAL REGISTRATION NUMBER

ISRCTN24998809.

Muscle weakness in critically ill patients: Effects of a systematized rehabilitation nursing program

OBJECTIVE

Intensive care unit-acquired muscle weakness (ICUAW) in critically ill patients is frequent and associated with negative outcomes. Early rehabilitation is a strategy to improve outcomes. The aim was to assess the effects of a rehabilitation nursing programme at discharge from intensive care unit.

METHODS

Quasi-experimental study with the comparison between two groups: one enrolled in a systematized nursing rehabilitation program and the other with usual nursing rehabilitation care. A non-probabilistic sample, sequential, of 42 critically ill ventilated patients, 21 patients in the control group and 21 patients the intervention group (June 2017 to June 2019), in three intensive care units of one large Portuguese teaching hospital. Mann-Whitney test was performed to compare Medical Research Council Sum Score (MRC-SS) values between groups.

RESULTS

Patients undergoing the rehabilitation program had a decrease in ICUAW (at ICU discharge mean MRC-SS = 38 vs. mean MRC-SS = 42.7, p = 0.043, U = 152,5). There was a decrease in severe muscle weakness (9.5% vs. 28.6%) and significant muscle weakness (42.9% vs. 52.4%) and an increase without muscle weakness (47,6% vs. 19%).

CONCLUSIONS

The systematic rehabilitation nursing program can improve muscle strength and reduce functional disability at the time of discharge from intensive care.

Musculoskeletal complications following critical illness: A scoping review

PURPOSE

To explore the extent to which musculoskeletal (MSK) complications have been reported following critical illness, identifying evidence gaps and providing recommendations for future research.

MATERIALS AND METHODS

We searched five databases from January 1st 2000 to March 31st 2021. We included published original research reporting MSK complications in patients discharged from hospital following an admission to an intensive care unit (ICU). Two reviewers independently screened English language articles for eligibility. Data extracted included the MSK area of investigation and MSK outcome measures. The overall quality of study was evaluated against standardised reporting guidelines.

RESULTS

4512 titles were screened, and 32 met the inclusion criteria. Only one study included was interventional, with the majority being prospective cohort studies (n = 22). MSK complications identified included: muscle weakness or atrophy, chronic pain, neuromuscular dysfunction, peripheral joint impairment and fracture risk. The quality of the overall reporting in the studies was deemed adequate.

CONCLUSIONS

We identified a heterogenous body of literature reporting a high prevalence of a variety of MSK complications extending beyond muscle weakness, therefore future investigation should include evaluations of more than one MSK area. Further investigation of MSK complications could inform the development of future post critical illness rehabilitation programs.

Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

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.

Reliability of quadriceps muscle power and explosive force, and relationship to physical function in people with chronic obstructive pulmonary disease: an observational prospective multicenter study

Background: Muscle power declines with age and is a stronger determinant of physical function than strength. Muscle power using computerized dynamometry has not been investigated in COPD.Objectives: To determine: 1) test-retest reliability of quadriceps power using a standardized protocol with computerized dynamometry; and 2) associations between quadriceps strength and power, and functional capacity.Design/Setting: Prospective observational study in four Canadian research labs.Participants: People with mild to very severe COPD.Methods: Tests were conducted on two days. Quadriceps muscle maximal strength was evaluated during a static maneuver using maximal voluntary isometric contractions (MVIC). Rate of torque development (RTD) during MVIC was used to assess explosive force. Muscle power was measured using a dynamic, isotonic protocol from which peak and average power and peak velocity were derived. Functional capacity was assessed with the Short Physical Performance Battery (SPPB). Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurements (SEM), and Bland Altman plots. Spearman and Pearson correlation coefficients were used for associations.Results: 65 patients (age 69 ± 8 years; FEV₁ 48 ± 21% of predicted) were included. ICC was 0.77 for RTD and 0.87-0.98 for isotonic power measures (95%CI 0.63-0.99, p < .001); SEM < 10% for average/peak power and peak velocity, and > 30% for RTD. SPPB had moderate correlation with average power, but not with MVIC or RTD.Conclusion: The standardized isotonic protocol with computerized dynamometry was reliable in assessing quadriceps power in COPD. Our data highlights that average power correlates best with functional capacity, indicating higher relevance than static measures when investigating determinants of function.

The fear and risk of community falls in patients following an intensive care admission: An exploratory cohort study

BACKGROUND

Muscle weakness and impairments in physical functioning are well-recognised sequelae after critical illness. Whether individuals have a higher risk of community falls and a fear of falling has not been examined amongst individuals after critical illness.

OBJECTIVES

The objective of this study was to explore the prevalence of falls, fear of falling, and fall risk in intensive care unit (ICU) survivors over a 6-month period after hospital discharge.

METHODS

This was a nested exploratory study within a medical ICU. Fall prevalence was measured in line with established guidelines over 6 months after ICU discharge. Fear of falling and prediction of fall risk were assessed at 2, 4, and 6 months after discharge.

RESULTS

Twelve individuals were included. Half of the cohort (n = 6) had at least one fall, with one-third sustaining more than one fall. There were 17 falls reported across the six individuals. Injuries requiring medical intervention were reported with five falls. Almost one-third were classified as 'moderate' to 'severe' injurious falls. Loss of balance and fatigue were reported as the main contributors to the falls. All individuals who had a fall reported a severe fear of falling at 2 months. Individuals classified as having 'moderate' to 'high' risk of falls at 2 months were more likely to have at least one fall.

CONCLUSIONS

This study suggests that ICU survivors may have a high fall risk, fear of falling, and fall prevalence, which can result in significant injury.