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Araújo F, Posadas-Calleja JG, Raman M, Tosh M, Wischmeyer P, Barreto P, Gillis C. Association between protein intake and functional capacity in critically ill patients: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024. [PMID: 39018085 DOI: 10.1002/jpen.2673] [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: 04/18/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Intensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured by the Chelsea Physical Assessment score (CPAx). METHODS Single-center retrospective cohort study on ICU survivors with length of stay ≥7 days admitted between October 2014 and September 2020. Eligible patients were divided according to protein intake (g/kg/day): low (<0.8), medium (0.8-1.19), high (1.2-1.5), and very high (>1.5). Protein dose effect on CPAx was assessed at ICU discharge with analysis of covariance adjusting for age, illness severity, hospital length of stay before ICU admission, time to start nutrition support, and mechanical ventilation duration. We also investigated effect modification by energy intake and nutrition status. RESULTS Enrolled patients (n = 531) were similar for age, nutrition status, and illness severity across groups. CPAxs were nonlinearly associated with protein doses and similar among low, medium, and very high groups. The CPAx for the high group was statistically different (P = 0.014), indicating that the data of three groups could be pooled. Mean CPAx difference remained statistically significant after adjusting for confounding variables (3.9 ± 1.8, P = 0.029 in the four-group model, and 2.7 ± 0.9, P = 0.003 in the pooled two-group model). Energy intake was equivalent between groups and did not modify CPAx. The high group had superior CPAx in both well-nourished and malnourished patients, indicating nutrition status was not an effect modifier. CONCLUSION Protein dose 1.2-1.5 g/kg/day was associated with superior functional capacity at ICU discharge compared with other doses. Neither energy intake nor nutrition status modified functional capacity across groups; therefore, the results appear to be influenced by 1.2-1.5 g/kg/day.
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Affiliation(s)
- Fábio Araújo
- Department of Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Maitreyi Raman
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Tosh
- Department of Rehabilitation, Alberta Health Services, Calgary, Alberta, Canada
| | - Paul Wischmeyer
- Department of Anesthesiology & Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Priscilla Barreto
- Department of Nutrition Services, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
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Patsaki I, Dimopoulos S. Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors. World J Crit Care Med 2024; 13:90428. [PMID: 38855270 PMCID: PMC11155501 DOI: 10.5492/wjccm.v13.i2.90428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/11/2024] [Accepted: 03/26/2024] [Indexed: 06/03/2024] Open
Abstract
In this editorial we comment on the detrimental consequences that post-intensive care syndrome (PICS) has in the quality of life of intensive care unit (ICU) survivors, highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU. Although, the syndrome was identified and well described early in 2012, more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 ICU survivors. It is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical, cognitive, or mental health as consequence of critical illness. PICS was described in order: (1) To raise awareness among clinicians, researchers, even the society; (2) to highlight the need for a multilevel screening of these patients that starts from within the ICU and continues after discharge; (3) to present preventive strategies; and (4) to offer guidelines in terms of rehabilitation. An early multidisciplinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.
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Affiliation(s)
- Irini Patsaki
- Department of Physiotherapy, University of West Attika, Athens 12243, Greece
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Centre, Athens 17674, Greece
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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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Siesage K, Joelsson-Alm E, Schandl A, Karlsson E. Extended physiotherapy after Intensive Care Unit (ICU) stay: A prospective pilot study with a before and after design. Physiother Theory Pract 2024; 40:1232-1240. [PMID: 36369693 DOI: 10.1080/09593985.2022.2143251] [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: 05/03/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors. METHODS This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann-Whitney U-test and Chi2 test. RESULTS Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items "transferring from bed to chair" (median 5 vs 4, p = .039) and "stepping" (median 5 vs 4, p = .005) at hospital discharge. CONCLUSION This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial.
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Affiliation(s)
- Katinka Siesage
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics and Rehabilitation, Unit of Occupational and Physical Therapy, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Anna Schandl
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Unit of Surgical Care Science, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Karlsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics and Rehabilitation, Unit of Occupational and Physical Therapy, Stockholm, Sweden
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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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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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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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Eggmann S, Verra ML, Stefanicki V, Kindler A, Schefold JC, Zante B, Bastiaenen CHG. Predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) in critically ill, mechanically ventilated adults: a prospective clinimetric study. Disabil Rehabil 2023; 45:111-116. [PMID: 34994664 DOI: 10.1080/09638288.2021.2022785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) at intensive care unit (ICU) discharge in critically ill adults for their 90-day outcomes. MATERIALS AND METHODS This prospective clinimetric study investigated four theory-driven, a-priori hypotheses in critically ill adults recruited within 72-144 h of mechanical ventilation. The primary hypothesis was a moderate accuracy (AUROC = 0.750) in predicting residence at home within 90 days. Secondary hypotheses included discrimination between hospital discharge destinations, correlation with subsequent health-related quality of life and length of ICU stay. RESULTS We observed a good accuracy (AUROC = 0.778) of the CPAx at ICU discharge in predicting a return to home within 90 days. The CPAx score significantly increased between the discharge groups "undesirable" ≤ "rehabilitation" ≤ "home" (p < 0.001), but was not associated with 90-day health-related quality of life (physical: r = 0.261, mental: r = 0.193). Measured at baseline, CPAx scores correlated as expected with length of ICU stay (r = -0.443). CONCLUSIONS The CPAx at ICU discharge had a good predictive validity in projecting residence at home within 90 days and general discharge destinations. The CPAx might therefore have clinical value in prediction, though it does not seem useful to predict subsequent health-related quality of life. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) identification number: DRKS00012983, registered on September 20, 2017IMPLICATIONS FOR REHABILITATIONThe CPAx is a valid and reliable measurement instrument to evaluate critically ill adults' physical function and activity, in addition the CPAx might be useful to predict rehabilitation needs.The CPAx had a moderate to good predictive validity with three out of four a-priori hypotheses accepted.A CPAx score of ≥18 at critical care discharge has a sensitivity of 80% and a specificity of 70% in predicting a return to home within 90 days.The CPAx might consequently be valuable to identify critically ill adults' rehabilitation needs, to advise on their potential trajectory of recovery or to screen patients for follow-up after hospital discharge.
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Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.,Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Angela Kindler
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
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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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Grove K, Edgar DW, Chih H, Harrold M, Natarajan V, Mohd S, Hurn E, Cavalheri V. Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19. J Clin Med 2022; 11:jcm11133602. [PMID: 35806891 PMCID: PMC9267535 DOI: 10.3390/jcm11133602] [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: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022] Open
Abstract
↔This study aims to compare the characteristics, in-hospital data and rehabilitation needs between those who tested positive versus negative for COVID-19 during hospitalisation with suspected COVID-19. In this cross-sectional study, a convenience sample of adults admitted to Western Australian tertiary hospitals with suspected COVID-19 was recruited. Participants were grouped according to their polymerase chain reaction (PCR) test result into COVID-19 positive (COVID+) and COVID-19 negative (COVID−) groups. Between-group comparisons of characteristics of the participants and hospital admission data were performed. Sixty-five participants were included (38 COVID+ and 27 COVID−; 36 females [55%]). Participants in the COVID+ group had greater acute hospital length of stay (LOS) (median [25−75th percentile] 10 [5−21] vs. 3 [2−5] days; p < 0.05] and only those with COVID+ required mechanical ventilation (8 [21%] participants). Twenty-one percent of the COVID+ participants were discharged to inpatient rehabilitation (7% of the COVID− participants). Of note, pre-existing pulmonary disease was more prevalent in the COVID− group (59% vs. 13%; p < 0.05). Within the COVID+ group, when compared to participants discharged home, those who required inpatient rehabilitation had worse peripheral oxygen saturation (SpO2) on admission (86 ± 5.7% vs. 93 ± 3.8%; p < 0.05) and longer median LOS (30 [23−37] vs. 7 [4−13] days; p < 0.05). Despite having less people with pre-existing pulmonary disease, the COVID+ group required more care and rehabilitation than the COVID− group. In the COVID+ group, SpO2 on hospital presentation was associated with LOS, critical care needs, mechanical ventilation duration and the need for inpatient rehabilitation.
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Affiliation(s)
- Kristen Grove
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
| | - Dale W. Edgar
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
- Burn Injury Research Node, University of Notre Dame Australia, Fremantle, WA 6160, Australia
- Division of Surgery, Medical School, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
| | - HuiJun Chih
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia;
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Meg Harrold
- Department of Physiotherapy, Royal Perth Hospital, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA 6000, Australia; (K.G.); (M.H.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
| | - Varsha Natarajan
- Department of Physiotherapy, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia; (D.W.E.); (V.N.)
| | - Sheeraz Mohd
- Department of Cardiology, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia;
| | - Elizabeth Hurn
- Department of Physiotherapy, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, WA 6009, Australia;
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- Allied Health, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Correspondence:
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Eggmann S, Verra ML, Stefanicki V, Kindler A, Seyler D, Hilfiker R, Schefold JC, Bastiaenen CHG, Zante B. German version of the Chelsea Critical Care Physical Assessment Tool (CPAx-GE): translation, cross-cultural adaptation, validity, and reliability. Disabil Rehabil 2021; 44:4509-4518. [PMID: 33874842 DOI: 10.1080/09638288.2021.1909152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To translate and cross-culturally adapt the Chelsea Critical Care Physical Assessment tool from English to German (CPAx-GE) and to examine its validity and reliability. MATERIALS AND METHODS Following a forward-backward translation including an expert round table discussion, the measurement properties of the CPAx-GE were explored in critically ill, mechanically ventilated adults. We investigated construct, cross-sectional, and cross-cultural validity of the CPAx-GE with other measurement instruments at pre-specified timepoints, analysed relative reliability with intraclass correlation coefficients (ICCs) and determined absolute agreement with the Bland-Altman plots. RESULTS Consensus for the translated CPAx-GE was reached. Validity was excellent with >80% of the pre-specified hypotheses accepted at baseline, critical care, and hospital discharge. Interrater reliability was high (ICCs > 0.8) across all visits. Limit of agreement ranged from -2 to 2 points. Error of measurement was small, floor, and ceiling effects limited. CONCLUSIONS The CPAx-GE demonstrated excellent construct, cross-sectional, and cross-cultural validity as well as high interrater reliability in critically ill adults with prolonged mechanical ventilation at baseline, critical care, and hospital discharge. Consequently, the CPAx-GE can be assumed equal to the original and recommended in the German-speaking area to assess physical function and activity of critically ill adults across the critical care and hospital stay. Trial registration: German Clinical Trials Register (DRKS) identification number: DRKS00012983 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012983), registered on 20 September 2017, first patient enrolled on 21 November 2017.Implications for rehabilitationEarly rehabilitation of critically ill patients is recommended to prevent and treat the subsequent functional disability, but a suitable measurement instrument for the German-speaking area is lacking.The translated, cross-culturally adapted German CPAx demonstrated excellent validity and reliability in assessing physical function and activity in critically ill adults.Cross-sectional validity of the CPAx has been newly established and allows the use of this tool at clinically relevant time-points in the course of a critical illness.The CPAx-GE can therefore be used in clinical practice by German-speaking therapists to assess physical function and activity during early rehabilitation in the ICU and hospital.
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Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.,Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Angela Kindler
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Daphne Seyler
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Zhang Z, Wang G, Wu Y, Guo J, Ding N, Jiang B, Wei H, Li B, Yue W, Tian J. Chinesisation, adaptation and validation of the Chelsea Critical Care Physical Assessment Tool in critically ill patients: a cross-sectional observational study. BMJ Open 2021; 11:e045550. [PMID: 33837104 PMCID: PMC8042994 DOI: 10.1136/bmjopen-2020-045550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To translate and adapt the Chelsea Critical Care Physical Assessment Tool (CPAx) into Chinese version ('CPAx-Chi'), test the reliability and validity of CPAx-Chi, and verify the cut-off point for the diagnosis of intensive care unit-acquired weakness (ICU-AW). STUDY DESIGN Cross-sectional observational study. METHODS Forward and back translation, cross-cultural adaptation and pretesting of CPAx into CPAx-Chi were based on the Brislin model. Participants were recruited from the general ICU of five third-grade class-A hospitals in western China. Two hundred critically ill adult patients (median age: 53 years; 64% men) with duration of ICU stay ≥48 hours and Glasgow Coma Scale ≥11 were included in this study. Two researchers simultaneously and independently assessed eligible patients using the Medical Research Council Muscle Score (MRC-Score) and CPAx-Chi. RESULTS The content validity index of items was 0.889. The content validity index of scale was 0.955. Taking the MRC-Score scale as standard, the criterion validity of CPAx-Chi was r=0.758 (p<0.001) for researcher A, and r=0.65 (p<0.001) for researcher B. Cronbach's α was 0.939. The inter-rater reliability was 0.902 (p<0.001). The area under the receiver operating characteristic curves of CPAx-Chi for diagnosing ICU-AW based on MRC-Score ≤48 were 0.899 (95% CI 0.862 to 1.025) and 0.874 (95% CI 0.824 to 0.925) for researcher B. The best cut-off point for CPAx-Chi for the diagnosis of ICU-AW was 31.5. The sensitivity was 87% and specificity was 77% for researcher A, whereas it was 0.621, 31.5, 75% and 87% for researcher B, respectively. The consistency was high when taking CPAx-Chi ≤31 and MRC-Score ≤48 as the cut-off points for the diagnosis of ICU-AW. Cohen's kappa=0.845 (p=0.02) in researcher A and 0.839 (p=0.04) for researcher B. CONCLUSIONS CPAx-Chi demonstrated content validity, criterion-related validity and reliability. CPAx-Chi showed the best accuracy in assessment of patients at risk of ICU-AW with good sensitivity and specificity at a recommended cut-off of 31.
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Affiliation(s)
- Zhigang Zhang
- Intensive Care Units, Lanzhou University First Affiliated Hospital, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Guoqiang Wang
- Intensive care uinits, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Yuchen Wu
- Intensive care uinits, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Jin Guo
- Nursing Department, First People's Hospital of Lanzhou City, Lanzhou, China
| | - Nannan Ding
- Nursing Department, Henan Provincial People's Hospital, Zhengzhou, China
| | - Biantong Jiang
- Nursing Department, Sichuan University West China Hospital, Chengdu, China
| | - Huaping Wei
- Intensive care uinits, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Bin Li
- Intensive care uinits, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Weigang Yue
- Intensive care uinits, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
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Smailes ST, Eagan JH, Matanle M, Barnes D. The predictive validity of the Functional Assessment for Burns - Critical Care (FAB-CC) score for discharge outcomes in major burns. Burns 2021; 47:1639-1646. [PMID: 33685813 DOI: 10.1016/j.burns.2021.02.011] [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: 05/27/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Physical function scoring of burn ICU patients is recommended but currently validated scores are lacking. OBJECTIVE To evaluate the predictive validity of the FAB -CC for burn ICU patients' discharge outcome. METHODS All patients underwent daily exercise and FAB -CC screen if they were stable. Two FAB-CC scores were performed; FAB-CC1 on the first day the patient passed the FAB-CC screen, FAB-CC2 within 48 h before ICU discharge. Hospital discharge outcome was defined as transfer for further inpatient rehabilitation or home with social care versus home with no social care. 76 patients' data were entered into the analyses. We used multiple logistic regression analysis to identify variables that predict discharge outcome. RESULTS Increasing patient age (p = 0.001), duration of ventilation (p = 0.0003), ICU Length of stay (LOS) (p = 0.0001), total hospital LOS (p < 0.0001), presence of cardiopulmonary disease (p = 0.008), neurological disorder (p = 0.0003) and psychiatric illness (p = 0.003) are positively associated with transfer for inpatient rehabilitation or home with social care. Increasing FAB-CC1 (p < 0.0001) and FAB -CC2 (p = 0.0001) are negatively associated with transfer for inpatient rehabilitation or home with social care. The most predictive model for discharge outcome combined the variables patient age, FAB-CC1, FAB-CC2 and psychiatric illness. Patient age (p = 0.01), FAB-CC1 (p = 0.02) and psychiatric illness (p = 0.009) independently predict discharge outcome. CONCLUSIONS FAB-CC2 is associated with, and FAB-CC1 has predictive validity for, patient hospital discharge outcome. These findings, in conjunction with our earlier work, confirm clinical utility of the FAB-CC for burns ICU patients.
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Affiliation(s)
- Sarah T Smailes
- Burn Intensive Care Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom.
| | - Jess H Eagan
- Burn Intensive Care Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom
| | - Marie Matanle
- Burn Intensive Care Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom
| | - David Barnes
- Burn Intensive Care Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom
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Hiesmayr M, Csomos A, Dams K, Elke G, Hartl W, Huet O, Krzych LJ, Kuechenhoff H, Matejovic M, Puthucheary ZA, Rooyackers O, Tetamo R, Tjäder I, Vaquerizo C. Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients. Clin Nutr ESPEN 2021; 43:104-110. [PMID: 34024501 DOI: 10.1016/j.clnesp.2021.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Limited data are available on the impact of clinical nutrition over the course of critical illness and post-discharge outcomes. The present study aims to characterize the use of nutrition support in patients admitted to European intensive care units (ICUs), and its impact on clinical outcomes. Here we present the procedures of data collection and evaluation. METHODS Around 100 medical, surgical, or trauma ICUs in 11 countries (Austria, Belgium, Czech Republic, Germany, France, Hungary, Italy, Poland, Spain, Sweden, United Kingdom) participate in the study. In defined months between November 2019 and April 2020, approximately 1250 patients are enrolled if staying in ICU for at least five consecutive days. Data from ICU day 1-4 are collected retrospectively, followed by a prospective observation period from day 5-90 after ICU admission. Data collection includes patient characteristics, nutrition parameters, complications, ICU and hospital length of stay, discharge status, and functional outcomes. For data analysis, the target is 1000 patients with complete data. Statistical analyses will be descriptive, with multivariate analyses adjusted for potential confounders to explore associations between nutritional balance and change in functional status, time-to-weaning from invasive mechanical ventilation, time to first clinical complication, and overall 15, 30 and 90-day survival. ETHICS AND DISSEMINATION This non-interventional study was reviewed and approved by the ethics committee of the Medical University Vienna, Vienna, Austria (approval number 1678/2019), and the respective ethical committees from participating sites at country and/or local level, as required. Results will be shared with investigators on a country level, and a publication and results presentation at the 2021 ESPEN Congress is planned. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04143503.
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Affiliation(s)
- M Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, and Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Spitalgasse 23, Vienna, Austria.
| | - A Csomos
- MH EK Honvedkorhaz, Budapest, Hungary.
| | - K Dams
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
| | - G Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - W Hartl
- Klinik Fuer Allgemeine, Viszeral-, und Transplantationschirurgie, Klinikum der Universitaet, Campus Grosshadern, Ludwig-Maximilians-Universität Muenchen, Munich, Germany.
| | - O Huet
- CHRU la Cavale Blanche, Brest, France.
| | - L J Krzych
- Medical University of Silesia, Katowice, Poland.
| | - H Kuechenhoff
- Statistisches Beratungslabor, Institut Fuer Statistik Ludwig-Maximilians-Universitaet Muenchen, Germany.
| | - M Matejovic
- First Medical Department, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Czech Republic.
| | - Z A Puthucheary
- Barts Health (Royal London) & Queen Mary University of London, London, England, UK.
| | - O Rooyackers
- Klinisk Vetenskap, Intervention Och Teknik, Anestesi, Karolinska Institut, Stockholm, Sweden.
| | - R Tetamo
- Ospedale Civile di Guastalla (Reggio Emilia), Italy.
| | - I Tjäder
- Karolinska University Hospital, PMI Huddinge, Stockholm, Sweden.
| | - C Vaquerizo
- Department of Intensive Care Medicine, Fuenlabrada University Hospital (Hospital Universitario de Fuenlabrada), Madrid, Spain.
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Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:7840743. [PMID: 33294221 PMCID: PMC7714600 DOI: 10.1155/2020/7840743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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Relationship of the Perme ICU Mobility Score and Medical Research Council Sum Score With Discharge Destination for Patients in 5 Different Intensive Care Units. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Nutrition-related outcomes and dietary intake in non-mechanically ventilated critically ill adult patients: A pilot observational descriptive study. Aust Crit Care 2020; 33:300-308. [PMID: 32456984 DOI: 10.1016/j.aucc.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Critically ill patients who do not receive invasive mechanical ventilation (IMV) are a growing population, experiencing complex interventions that may impair dietary intake and nutrition-related outcomes. OBJECTIVES The objectives of this study were to quantify intake and nutrition-related outcomes of non-IMV critically ill patients and to establish feasibility of methods to measure nutrition-related outcomes in this population. METHODS Non-IMV adult patients expected to remain in the intensive care unit (ICU) for ≥24 h were eligible. Nutrition-related outcomes were assessed at baseline by subjective global assessment (SGA); on alternate study days by mid-upper arm circumference (MUAC), calf circumference (CC), and ultrasound of quadriceps muscle layer thickness (QMLT); and daily by body weight and bioelectrical impedance analysis (BIA). Data were censored at day 5 or ICU discharge. Dietary intake from all sources, including oral intake via investigator-led weighed food records, was quantified on days 1-3. Feasibility was defined as data completion rate ≥70%. Data are expressed as mean (standard deviation) or median [interquartile range (IQR)]. RESULTS Twenty-three patients consented (50% male; 53 [42-64] y; ICU stay: 2.8 [1.9-4.0] d). Nutrition-related outcomes at baseline and ICU discharge were as follows: MUAC: 33.2 (8.6) cm (n = 18) and 29.3 (5.4) cm (n = 6); CC: 39.5 (7.4) cm (n = 16) and 37.5 (6.2) cm (n = 6); body weight: 95.3 (34.8) kg (n = 19) and 95.6 (41.0) kg (n = 10); and QMLT: 2.6 (0.8) cm (n = 15) and 2.5 (0.3) cm (n = 5), respectively. Oral intake provided 3155 [1942-5580] kJ and 32 [20-53] g protein, with poor appetite identified as a major barrier. MUAC, CC, QMLT, and SGA were feasible, while BIA and body weight were not. CONCLUSIONS Oral intake in critically ill patients not requiring IMV is below estimated requirements, largely because of poor appetite. The small sample and short study duration were not sufficient to quantify changes in nutrition-related outcomes. MUAC, CC, QMLT, and SGA are feasible methods to assess nutrition-related outcomes at a single time point in this population.
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Calthorpe S, Kimmel LA, Webb MJ, Gabbe BJ, Holland AE. Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619879326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionIt is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear.MethodsA systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness.ResultsFourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures.ConclusionEvidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.
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Affiliation(s)
- Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa J Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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Stollings JL, Devlin JW, Pun BT, Puntillo KA, Kelly T, Hargett KD, Morse A, Esbrook CL, Engel HJ, Perme C, Barnes-Daly MA, Posa PJ, Aldrich JM, Barr J, Carson SS, Schweickert WD, Byrum DG, Harmon L, Ely EW, Balas MC. Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative. Crit Care Nurse 2019; 39:36-45. [PMID: 30710035 DOI: 10.4037/ccn2019981] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.
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Affiliation(s)
- Joanna L Stollings
- Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - John W Devlin
- John Devlin is Professor of Pharmacy, Northeastern University, and a clinical scientist, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Brenda T Pun
- Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen A Puntillo
- Kathleen Puntillo is a professor of nursing emeritus, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Tamra Kelly
- Tamra Kelly is a respiratory therapist, Sutter Health, Sacramento, California
| | - Ken D Hargett
- Ken Hargett is a respiratory therapist, Houston Methodist Hospital, Houston, Texas
| | | | - Cheryl L Esbrook
- Cheryl Esbrook is an occupational therapist, University of Chicago Medicine, Chicago, Illinois
| | - Heidi J Engel
- Heidi Engel is a physical therapist, Department of Rehabilitative Services, University of California, San Francisco
| | - Christiane Perme
- Christiane Perme is a physical therapist, Houston Methodist Hospital
| | - Mary Ann Barnes-Daly
- Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health
| | - Patricia J Posa
- Patricia Posa is a population health clinical integration leader, Saint Joseph Mercy Health System, Ann Arbor, Michigan
| | - J Matthew Aldrich
- J. Matthew Aldrich is the Medical Director of Critical Care Medicine and an associate clinical professor, University of San Francisco, San Francisco
| | - Juliana Barr
- Juliana Barr is a staff intensivist and anesthesiologist, VA Palo Alto Health Care System, Palo Alto, California, and an associate professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Shannon S Carson
- Shannon Carson is a critical care pulmonologist, University of North Carolina School of Medicine, Chapel Hill
| | - William D Schweickert
- William Schweickert is an associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diane G Byrum
- Diane Byrum is a quality implementation consultant, Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina
| | - Lori Harmon
- Lori Harmon is director of quality, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - E Wesley Ely
- E. Wesley Ely is a professor of medicine, Vanderbilt University School of Medicine, and associate director, VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - Michele C Balas
- Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus
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20
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Holdar U, Eriksson F, Siesage K, Corner EJ, Ledström V, Svensson-Raskh A, Kierkegaard M. Cross-cultural adaptation and inter-rater reliability of the Swedish version of the Chelsea critical care assessment tool (CPAX-Swe) in critically ill patients. Disabil Rehabil 2019; 43:1600-1604. [PMID: 31558043 DOI: 10.1080/09638288.2019.1668971] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To translate and culturally adapt the Chelsea Critical Care Physical Assessment Tool into Swedish and to test the inter-rater reliability of the Swedish version in critically ill patients. DESIGN This is an observational study. METHODS Translation and cross-cultural adaptation was performed in line with international recommendations, including forward and backward translation and expert round table discussions. The inter-rater reliability of the Chelsea Critical Care Physical Assessment Tool - Swedish was then explored in 50 critically ill adult patients, pragmatically recruited, in a University Hospital clinical setting. Reliability was calculated using intraclass correlation coefficient for aggregated scores and quadratic weighted Cohen's kappa analysis for individual items. RESULTS The expert round table discussion group agreed that the translation was a satisfactory equivalent to the original version and applicable for use within the clinical setting. Reliability of aggregated scores and individual items were very good (intraclass correlation coefficient of 0.97 and quadric weighted kappa values ranging from 0.88 to 0.98). The measurement error for aggregated scores was low, with a standard error of measurement of 1.79, smallest detectable change of 4.95, and limits of agreement of 5.20 and -4.76. The percentage agreement for individual items ranged from 64% to 88%. CONCLUSION The Chelsea Critical Care Physical Assessment Tool - Swedish was found applicable and appropriate for assessment of functioning in critically ill patients in an acute setting in Sweden, and it displayed high inter-rater reliability. This implies that the Swedish version can be used as assessment tool within intensive care and acute wards in Sweden.Implications for rehabilitationThere is a lack of validated instruments to test the functional status of critically ill patients in Sweden.The Chelsea Critical Care Physical Assessment Tool is validated and reliable in English.The Chelsea Critical Care Physical Assessment Tool - Swedish is considered reliable for use by physiotherapist in intensive care settings in Sweden.The Swedish version is feasible for use within clinical practice due to its simplicity and strong clinical relevance.
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Affiliation(s)
- Ulrika Holdar
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Frances Eriksson
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Katinka Siesage
- Department of Physical Therapy, Södersjukhuset, Stockholm, Sweden
| | - Evelyn J Corner
- Department of Clinical Sciences, Brunel University London, London, UK.,Rehabilitation and Therapies, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Viktor Ledström
- Department of Physical Therapy, Örebro University Hospital, Örebro, Sweden
| | - Anna Svensson-Raskh
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Marie Kierkegaard
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Abdulai RM, Jensen TJ, Patel NR, Polkey MI, Jansson P, Celli BR, Rennard SI. Deterioration of Limb Muscle Function during Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:433-449. [PMID: 29064260 DOI: 10.1164/rccm.201703-0615ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Important features of both stable and acute exacerbation of chronic obstructive pulmonary disease (COPD) are skeletal muscle weakness and wasting. Limb muscle dysfunction during an exacerbation has been linked to various adverse outcomes, including prolonged hospitalization, readmission, and mortality. The contributing factors leading to muscle dysfunction are similar to those seen in stable COPD: disuse, nutrition/energy balance, hypercapnia, hypoxemia, electrolyte derangements, inflammation, and drugs (i.e., glucocorticoids). These factors may be the trigger for a downstream cascade of local inflammatory changes, pathway process alterations, and structural degradation. Ultimately, the clinical effects can be wide ranging and include reduced limb muscle strength. Current therapies, such as pulmonary/physical rehabilitation, have limited impact because of low participation rates. Recently, novel drugs have been developed in similar disorders, and learnings from these studies can be used as a foundation to facilitate discovery in patients hospitalized with a COPD exacerbation. Nevertheless, investigators should approach this patient population with knowledge of the limitations of each intervention. In this Concise Clinical Review, we provide an overview of acute muscle dysfunction in patients hospitalized with acute exacerbation of COPD and a strategic approach to drug development in this setting.
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Affiliation(s)
- Raolat M Abdulai
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts
| | - Tina Jellesmark Jensen
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Naimish R Patel
- 2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts.,4 Beth Israel Deaconess Hospital, Boston, Massachusetts
| | - Michael I Polkey
- 5 National Institute for Health Research, Respiratory Biomedical Research Unit at the Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Paul Jansson
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Bartolomé R Celli
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,6 Harvard Medical School, Boston, Massachusetts
| | - Stephen I Rennard
- 7 Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska; and.,8 Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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Elliott R, Yarad E, Webb S, Cheung K, Bass F, Hammond N, Elliott D. Cognitive impairment in intensive care unit patients: A pilot mixed-methods feasibility study exploring incidence and experiences for recovering patients. Aust Crit Care 2019; 32:131-138. [DOI: 10.1016/j.aucc.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/14/2018] [Indexed: 12/20/2022] Open
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Eagan JH, Ramdharry G, Smailes ST. Investigating the interrater reliability of a novel functional outcome measure for use in the burns intensive care unit: The Functional Assessment for Burns - Critical Care (FAB-CC). Burns 2018; 46:279-285. [PMID: 30595543 DOI: 10.1016/j.burns.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/16/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Intensive Care Unit Acquired Weakness challenges the clinical care of critically ill patients. Despite a surge in validated ICU functional outcome measures following the publication of Clinical Guideline 83 'Rehabilitation After Critical Illness' by the National Institute for Health and Care Excellence (2009), there are none composed specifically for use in the Burns ICU. We therefore developed and tested the inter-rater reliability of a burn specific novel functional outcome measure; The Functional Assessment for Burns-Critical Care (FAB-CC). OBJECTIVES This research aimed to investigate the interrater reliability of the FAB-CC. METHODS A quantitative reliability study assessed the ability of the FAB-CC to obtain accurate data when utilised by three separate raters (m=3) scoring the same clinical episodes (n=24). RESULTS The Intraclass Correlation Coefficient (ICC) for the FAB-CC as a complete tool revealed excellent agreement (ICC 0.998; P<0.001, 95% confidence interval 0.996-0.999), with Cronbach's Alpha (α 0.999). Individual components of the FAB-CC displayed excellent agreement (ICC>0.983; P<0.001) with narrow 95% confidence intervals. CONCLUSIONS The FAB-CC is a novel functional outcome measure that is reliable for use with critically ill burn patients. It has demonstrated real clinical utility in the identification and management of ICU-AW in this unique patient group.
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Affiliation(s)
- J H Eagan
- St Andrew's Centre for Plastic Surgery and Burns, United Kingdom.
| | | | - S T Smailes
- St Andrew's Centre for Plastic Surgery and Burns, United Kingdom
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Cuello-Garcia CA, Mai SHC, Simpson R, Al-Harbi S, Choong K. Early Mobilization in Critically Ill Children: A Systematic Review. J Pediatr 2018; 203:25-33.e6. [PMID: 30172429 DOI: 10.1016/j.jpeds.2018.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/18/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize how early mobilization is defined in the published literature and describe the evidence on safety and efficacy on early mobilization in critically ill children. STUDY DESIGN Systematic search of randomized and nonrandomized studies assessing early mobilization-based physical therapy in critically ill children under 18 years of age in MEDLINE, Embase, CINAHL, CENTRAL, the National Institutes of Health, Evidence in Pediatric Intensive Care Collaborative, Physiotherapy Evidence Database, and the Mobilization-Network. We extracted data to identify the types of mobility-based interventions and definitions for early, as well as barriers, feasibility, adverse events, and efficacy outcomes (mortality, morbidities, and length of stay). RESULTS Of 1199 titles found, we included 11 studies (2 pilot trials and 9 observational studies) and 1 clinical practice guideline in the analyses. Neurodevelopmentally appropriate increasing mobility levels have been described for critically ill children, and "early" mobilization was defined as either a range (within 48-72 hours) from admission to the pediatric intensive care unit or when clinical safety criteria are met. Current evidence suggests that early mobilization is safe and feasible and institutional practice guidelines significantly increase the frequency of rehabilitation consults, improve the proportion of patients who receive early mobilization, and reduce the time to mobilization. However, there were inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies that precluded us from pooling data to evaluate the efficacy outcomes of early mobilization. CONCLUSIONS The definition of early mobilization varies, but seems to be feasible and safe in critically ill children. The efficacy for early mobilization in this population is yet undetermined because of the low certainty of the evidence available.
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Affiliation(s)
- Carlos A Cuello-Garcia
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada.
| | - Safiah Hwai Chuen Mai
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
| | - Racquel Simpson
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
| | - Samah Al-Harbi
- Pediatric Department of Medical College at King Abdulaziz University, Jeddah, Saudi Arabia
| | - Karen Choong
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
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Astrup K, Corner EJ, Hansen MG, Petersen AK. Translation and cross-cultural adaptation of the Chelsea Critical Care Physical Assessment tool into Danish. Physiother Theory Pract 2018; 36:1027-1034. [PMID: 30499357 DOI: 10.1080/09593985.2018.1548048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the study was to validate the Chelsea Critical Care Physical Assessment Tool (CPAx) in Danish, including translation, cross-cultural adaptation and evaluation of clinemetric properties. METHOD International recommendations for translation and cross-cultural adaptation of outcome measures were followed. Physiotherapists with ICU experience investigated the clinemetric properties of the Danish CPAx version among 30 critically ill patients at three different ICUs. Furthermore, a focus group interview was carried out to examine cross-cultural adaptation of the CPAx tool. RESULTS Translation and pre-test of the Danish version of CPAx resulted in a measurement tool with good clinemetric properties. Few adaptations were made with consideration of comparability between the Danish and the English version. The author of the original version of CPAx, Eve Corner, approved the Danish translation. CONCLUSION The Danish version of the CPAx seems to be an appropriate measurement instrument for evaluation of physical function in ICU patients. This study is the first step toward a validation of a Danish version of the CPAx tool. However, further research is needed to investigate reliability and responsiveness among patients in the ICU.
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Affiliation(s)
- Katrine Astrup
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital , Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University , Aarhus, Denmark
| | - Evelyn J Corner
- Department of Clinical Sciences, Centre for Human Performance Exercise and Rehabilitation, Brunel University London , London, England.,Department of Surgery and Cancer, Imperial College London , London, England.,Chelsea and Westminster NHS Foundation Trust , London, England
| | | | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital , Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University , Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
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Whelan M, van Aswegen H, Corner E. Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: An experimental study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:450. [PMID: 30214949 PMCID: PMC6131696 DOI: 10.4102/sajp.v74i1.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/21/2018] [Indexed: 12/31/2022] Open
Abstract
Background Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans. Method A single-centred pre–post quasi-experimental study was conducted. The population was a consecutive sample of surgical and trauma ICU patients. Participants’ functional ability was assessed with the CPAx tool on alternative days during their ICU stay, and rehabilitation goals were modified according to their CPAx score. Intensive care unit and hospital LOS data were collected and compared to data of a matched historical control group. Descriptive and inferential statistics were used. Results A total of 26 ICU patients were included in the intervention group (n = 26). They received CPAx-guided therapy, and outcomes were matched with ICU patients in the historical control group (n = 26). The median sequential organ failure assessment (SOFA) score was significantly higher in the control group (p = 0.005) (3.5 [IQR 2–6.3]) versus (2 [IQR 1.8–2.5]) for the intervention group. The median admission CPAx score for the intervention group was 33.5 (IQR 16.1–44), and the median ICU discharge score was 38 (IQR 28.5–43.8). No significant differences were found in ICU days (control 2.7 [IQR 1.1–5.2]; intervention 3.7 [IQR 2.3–5.4]; p = 0.27) or hospital LOS (control 13.5 [IQR 9.3–18.3]; intervention 11.4 [IQR 8.4–20.3], p = 0.42). Chelsea critical care physical assessment scores on ICU admission had a moderate negative correlation with hospital LOS (r = −0.58, p = 0.00, n = 23). Chelsea critical care physical assessment scores at ICU discharge had strong positive correlation with discharge SOFA scores (r = 0.7; p = 0.025; n = 10). Conclusion Problem-oriented patient rehabilitation informed by the CPAx tool resulted in improvement of physical function but did not reduce ICU or hospital LOS. Clinical implications A higher level of physical function at ICU admission, measured with CPAx, was associated with shorter hospital LOS.
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Affiliation(s)
- Megan Whelan
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Evelyn Corner
- Department of Clinical Sciences, Brunel University London, United Kingdom.,Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, United Kingdom.,Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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Psychometric Properties of Physical Function Measures Used in the Intensive Care Unit: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The ICU Mobility Scale Has Construct and Predictive Validity and Is Responsive. A Multicenter Observational Study. Ann Am Thorac Soc 2018; 13:887-93. [PMID: 27015233 DOI: 10.1513/annalsats.201510-717oc] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The ICU Mobility Scale (IMS) is a measure of mobility milestones in critically ill patients. OBJECTIVES This study aimed to determine the validity and responsiveness of the IMS from a prospective cohort study of adults admitted to the intensive care unit (ICU). METHODS Construct and predictive validity were assessed by comparing IMS values at ICU discharge in 192 patients to other variables using Spearman rank correlation coefficient, Mann-Whitney U tests, and logistic regression. Responsiveness was assessed using change over time, effect size, floor and ceiling effects, and percentage of patients showing change. MEASUREMENTS AND MAIN RESULTS The IMS at ICU discharge demonstrated a moderate correlation with muscle strength (r = 0.64, P < 0.001). There was a significant difference between the IMS at ICU discharge in patients with ICU-acquired weakness (median, 4.0; interquartile range, 3.0-5.0) compared with patients without (median, 8.0; interquartile range, 5.0-8.0; P < 0.001). Increasing IMS values at ICU discharge were associated with survival to 90 days (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.14-1.66) and discharge home (OR, 1.16; 95% CI, 1.02-1.32) but not with return to work at 6 months (OR, 1.09; 95% CI, 0.92-1.28). The IMS was responsive with a significant change from study enrollment to ICU discharge (d = 0.8, P < 0.001), with IMS values increasing in 86% of survivors during ICU admission. No substantial floor (14% scored 0) or ceiling (4% scored 10) effects were present at ICU discharge. CONCLUSIONS Our findings support the validity and responsiveness of the IMS as a measure of mobility in the ICU.
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Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc 2017; 10:391-398. [PMID: 29066907 PMCID: PMC5644554 DOI: 10.2147/jmdh.s118419] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.
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Affiliation(s)
- Barbara Bonvento
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Sarah Wallace
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester.,Royal College of Speech and Language Therapists, London, UK
| | - James Lynch
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Barry Coe
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
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Parry SM, Huang M, Needham DM. Evaluating physical functioning in critical care: considerations for clinical practice and research. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:249. [PMID: 28978333 PMCID: PMC5628423 DOI: 10.1186/s13054-017-1827-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The evaluation of physical functioning is valuable in the intensive care unit (ICU) to help inform patient recovery after critical illness, to identify patients who may require rehabilitation interventions, and to monitor responsiveness to such interventions. This viewpoint article discusses: (1) the concept of physical functioning with reference to the World Health Organization International Classification of Functioning, Disability and Health; (2) the importance of measuring physical functioning in the ICU; and (3) methods for evaluating physical functioning in the ICU. Recommendations for clinical practice and research are made, along with discussion of future directions.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Minxuan Huang
- Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA. .,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. .,Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. .,Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD, 21205, USA.
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Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference. Crit Care Med 2017; 44:e1155-e1164. [PMID: 27488220 DOI: 10.1097/ccm.0000000000001949] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN Clinimetric analysis. SETTINGS Five international datasets from the United States, Australia, and Brazil. PATIENTS Eight hundred nineteen ICU patients. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The Functional Status Score for the ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30-0.95) between Functional Status Score for the ICU and other physical function measures, and generally weaker correlations with nonphysical measures (|r| = 0.01-0.70). Known group validity was demonstrated by significantly higher Functional Status Score for the ICU scores among patients without ICU-acquired weakness (Medical Research Council sum score, ≥ 48 vs < 48) and with hospital discharge to home (vs healthcare facility). Functional Status Score for the ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased Functional Status Score for the ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0-5.0. CONCLUSIONS The Functional Status Score for the ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients.
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Physical Therapist-Led Ambulatory Rehabilitation for Patients Receiving CentriMag Short-Term Ventricular Assist Device Support: Retrospective Case Series. Phys Ther 2016; 96:1865-1873. [PMID: 27256069 DOI: 10.2522/ptj.20150644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Short-term ventricular assist device (VAD) support is used in the intensive care unit (ICU) to support individuals in end-stage heart failure prior to heart transplantation or implantation of a long-term left VAD. The literature investigating the feasibility, safety, and content of rehabilitation for this patient group is lacking. This report retrospectively describes the rehabilitation strategy, safety measures used, and nature of any adverse events and, therefore, the feasibility of this practice. CASE SERIES DESCRIPTION Ten individuals (80% male) admitted to the ICU in critical cardiogenic shock required support via a short-term VAD. A prerehabilitation risk assessment was used to reduce the risk of cannula dislodgement. The therapeutic strategy was a stepwise progression of exercises, mobilization, and ambulation. OUTCOMES Retrospective inspection of the case notes showed 330 rehabilitation sessions (X̅=33, SD=18.1, range=16-72) were performed and progressed to ambulation on 71 occasions (X̅=7.1, SD=7.7, range=1-27). Distance ambulated ranged from 7 to 1,200 m (X̅=157.7, SD=367.3). The Chelsea Critical Care Physical Assessment Tool (CPAx) score for 7 patients improved from a median of 0 (interquartile range=0-1) on day 1 to a median peak score of 39 (interquartile range=37-42). There were 8 episodes of minor adverse events (2.4% incidence rate), including 7 of transient low VAD flows. There were no major adverse events. DISCUSSION Early rehabilitation and ambulation of recipients of short-term VAD support was safe and feasible. Recipients demonstrated improvements in physical function (CPAx score) while the VAD was in situ.
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Describing and measuring recovery and rehabilitation after critical illness. Curr Opin Crit Care 2016; 21:445-52. [PMID: 26348422 DOI: 10.1097/mcc.0000000000000233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data. RECENT FINDINGS The International Classification of Functioning, Disability and Health (ICF) model is a useful framework to guide selection of outcome measures representing physical function at the level of impairment, activity limitation and participation restriction. Clinimetric data are emerging to support a number of physical function outcome measures in the ICU, albeit further research is required to corroborate tools used beyond ICU discharge. Factors associated with outcome measure selection have contributed to interpreting findings from recent interventional trials of physical rehabilitation. SUMMARY Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
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Corner EJ, Handy JM, Brett SJ. eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical illness. BMJ Open 2016; 6:e010614. [PMID: 27067895 PMCID: PMC4838744 DOI: 10.1136/bmjopen-2015-010614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of eLearning in the widespread standardised teaching, distribution and implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool-a validated tool to assess physical function in critically ill patients. DESIGN Prospective educational study. An eLearning module was developed through a conceptual framework, using the four-stage technique for skills teaching to teach clinicians how to use the CPAx. Example and test video case studies of CPAx assessments were embedded within the module. The CPAx scores for the test case studies and demographic data were recorded in a secure area of the website. Data were analysed for inter-rater reliability using intraclass correlation coefficients (ICCs) to see if an eLearning educational package facilitated consistent use of the tool. A utility and content validity questionnaire was distributed after 1 year to eLearning module registrants (n=971). This was to evaluate uptake of the CPAx in clinical practice and content validity of the CPAx from the perspective of clinical users. SETTING The module was distributed for use via professional forums (n=2) and direct contacts (n=95). PARTICIPANTS Critical care clinicians. PRIMARY OUTCOME MEASURE ICC of the test case studies. RESULTS Between July and October 2014, 421 candidates from 15 countries registered for the eLearning module. The ICC for case one was 0.996 (95% CI 0.990 to 0.999; n=207). The ICC for case two was 0.988 (0.996 to 1.000; n=184). The CPAx has a strong total scale content validity index (s-CVI) of 0.94 and is well used. CONCLUSIONS eLearning is a useful and reliable way of teaching psychomotor skills, such as the CPAx. The CPAx is a well-used measure with high content validity rated by clinicians.
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Affiliation(s)
- Evelyn J Corner
- Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, London, UK
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jonathan M Handy
- Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, London, UK
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Stephen J Brett
- Imperial College London, Chelsea and Westminster Hospital, London, UK
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Reliability and utility of the Acute Care Index of Function in intensive care patients: An observational study. Heart Lung 2015; 45:10-4. [PMID: 26542832 DOI: 10.1016/j.hrtlng.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To establish the inter-rater reliability of the Acute Care Index of Function (ACIF) in intensive care unit (ICU) patients and determine whether ACIF scores have predictive utility beyond ICU discharge. BACKGROUND Accurate and reliable measures of physical function are required to describe the recovery trajectory of ICU survivors. The clinimetric properties of the ACIF are yet to be established in ICU patients. METHODS Prospective observational study in a single tertiary ICU. ACIF scores were recorded independently by 2 physiotherapists across a convenience sample of 100 physiotherapy assessments, and at ICU discharge. RESULTS Inter-rater reliability of total ACIF scores was very strong (ICC = 0.94). ACIF <0.40 at ICU discharge predicted hospital discharge to a destination other than home (area under ROC = 0.79, 95% CI 0.64-0.89) (sensitivity 0.78). CONCLUSION The ACIF has excellent inter-rater reliability in ICU patients and scores at ICU discharge predict the likelihood of discharge home. TRIAL REGISTRATION ACTRN12614001008617 (September 18 2014).
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Key Measurement and Feasibility Characteristics When Selecting Outcome Measures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU – what should we be using? – an observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:127. [PMID: 25888469 PMCID: PMC4404223 DOI: 10.1186/s13054-015-0829-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/20/2015] [Indexed: 02/08/2023]
Abstract
Introduction With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study. Methods Sixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman’s rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated. Results Mean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen’s d = 0.71). Conclusions There is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the ICU. Trial registration Clinicaltrials.gov NCT02214823. Registered 7 August 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0829-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia. .,Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia.
| | - Lisa J Beach
- Department of Physiotherapy, Melbourne Health, 3050, Melbourne, VIC, Australia.
| | - Sue Berney
- Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia. .,Department of Physiotherapy, Austin Health, 3084, Melbourne, VIC, Australia.
| | - Hannah C Williamson
- Department of Physiotherapy, Austin Health, 3084, Melbourne, VIC, Australia.
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville, 3010, Melbourne, VIC, Australia. .,Department of Physiotherapy, Melbourne Health, 3050, Melbourne, VIC, Australia. .,Institute for Breathing and Sleep, 3084, Melbourne, VIC, Australia.
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Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, Koopman R, Denehy L. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med 2015; 41:744-62. [PMID: 25652888 DOI: 10.1007/s00134-015-3672-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/16/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified. METHODS A systematic review of articles was carried out using the databases Medline (1950-2014), CINAHL (1982-2014), EMBASE (1980-2014), Cochrane Library (2014) and Scopus (1960-2014). Additional studies were identified by searching personal files. Eligibility criteria for selection: Search 1: studies which assessed muscle mass, strength or function using objective non-laboratory measures; Search 2: studies which evaluated a clinimetric property (reliability, measurement error, validity or responsiveness) for one of the measures identified in search one. Two independent reviewers assessed articles for inclusion and assessed risk of bias using the consensus-based standards for selection of health status measurement instruments checklist. RESULTS Thirty-three measures were identified; however, only 20 had established clinimetric properties. Ultrasonography, dynamometry, physical function in intensive care test scored and the Chelsea critical care physical assessment tool performed the strongest for the measurement of impairment of body systems (muscle mass and strength) and activity limitations (physical function), respectively. CONCLUSIONS There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness. Future work should identify a core set of standardized measures, which can be utilized across the continuum of critical illness recovery embedded within the International Classification of Functioning framework. This will enable improved comparisons between future studies, which in turn will assist in identifying the most effective treatment strategies to ameliorate the devastating longer-term outcomes of a critical illness.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia,
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Soulsby CR, McPeake J, Ashcroft C, Kinsella J, Shaw M, Quasim T. Utilisation of existing community rehabilitation services by critical care survivors. Crit Care 2015. [PMCID: PMC4471146 DOI: 10.1186/cc14637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: an observational study. Burns 2014; 41:241-7. [PMID: 25554262 DOI: 10.1016/j.burns.2014.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Severe burn leads to a state of hypercatabolism, resulting in rapid muscle loss and long-term disability. As survival rates from severe burn are improving, early rehabilitation is essential to facilitate functional recovery. However, there is no way of measuring the degree of disability in the acute stages, and hence, no marker of functional recovery. This hampers both communication and research into interventions to improve functional outcomes. The Chelsea Critical Care Physical Assessment tool (CPAx) is a simple objective measure of function, designed and validated in the general Intensive Care Unit (ICU) cohort. The aim of this study was to test the responsiveness of the CPAx in the burns ICU (BICU) cohort and validate its use. METHODS Observational study of 52 BICU patients admitted for over 48h. All patients were assessed on the CPAx retrospectively for pre-admission, and prospectively at ICU admission, ICU discharge (or final ICU assessment for non-survivors) and hospital discharge. Analysis of variance, post hoc between group differences in median CPAx score, and floor and ceiling effect (i.e. the percentage of patients scoring full marks (50), or zero) for the four time points were completed. Minimal clinically important difference (MCID) was estimated as half of the standard deviation of the CPAx score at ICU discharge. RESULTS A total of 30 patients were included in the final analysis; mean age was 47.1 years (SD 21.2), 63.3% were male, with a median burn total body surface area (TBSA) of 30% (IQR 11.3-48.8). There was a significant difference in the analysis of variance in median CPAx scores at all four time points (p<.001). In survivors, the differences in CPAx scores post hoc were significant for all time points (p<.05), aside from ICU discharge and hospital discharge. The CPAx MCID for BICU patients was six. Twenty-three (86.7%) patients scored full marks or zero on the CPAx pre-admission. For survivors, no patients scored full marks or zero on the CPAx at ICU and hospital discharge. On ICU admission 66.7% (n=20) scored zero on the CPAx and no patients scored 50. CONCLUSIONS The CPAx score appears to be able to detect improvements in physical function as patients recover from acute severe burn. It has a limited floor and ceiling effect in the acute setting and a change in CPAx score of 6 represents clinically important progress. Further work is required in a larger cohort.
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Corner EJ, Brett SJ. Early identification of patients at risk of long-term critical illness-associated physical disability: is it possible? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:629. [PMID: 25672518 PMCID: PMC4331459 DOI: 10.1186/s13054-014-0629-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
ICU-acquired weakness can hinder and determine the course of recovery from critical illness, leading to life-changing disability. Risk factors include multiorgan failure and prolonged bed rest; however, no prognostic model or screening tool for new-onset disability has been established to date. With no way of targeting the at-risk population, it is difficult to demonstrate the benefit of rehabilitation interventions in research and prioritize resources clinically. In a recent issue of Critical Care, Schandl and colleagues aimed to establish a predictive screening tool for new-onset disability using 23 possible predictors. They found that using the following risk factors – low educational level, fractures, reduced core stability and length of ICU stay over 2 days – they were able to develop a risk score predictive of disability at 2 months after hospital discharge. These investigators propose that this will help to identify patients requiring follow-up and may increase the power to detect change in interventional studies. Whilst this is promising work, further validation is essential: firstly, to make it a clinically workable tool in terms of appropriate ‘cut offs’; secondly, to ensure that it is transferable in different socio-economic environments; and finally, to make sure that those identified as ‘at risk’ are those that would benefit the most from targeted intervention.
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