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Zheng L, Yuan X, Wang P, Zheng H, Lin J, Li C, Chen T, Tong Z, Liu Y, Ke L, Ma P, Li W. The impact of protein delivery on short-term and long-term clinical outcomes in critically ill patients: Protocol for a multicenter, prospective, observational study (The ACTION study). Clin Nutr ESPEN 2024; 64:1-6. [PMID: 39244157 DOI: 10.1016/j.clnesp.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/05/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND AIMS Nutrition therapy is a vital part of the management of critically ill patients. Efforts have been made to optimize nutrition therapy in the ICU setting, and it is argued that protein might be the most important substrate to deliver during critical illness. However, the impact of protein delivery on patient-centered outcomes, including short-term and long-term outcomes, is controversial. Moreover, previous studies showed that compliance with the guidelines is poor in practice, and the amounts of protein intake vary significantly among different hospitals. The objective of this study is to describe the current practice of protein delivery for critically ill patients and to investigate the association between different protein delivery amounts and approaches during ICU admission and multiple patient-centered outcomes (short-term and long-term). METHODS This is a multicenter, prospective, observational study conducted in 70 hospitals, aiming to recruit more than 1800 newly admitted critically ill patients who are expected to stay in ICU for at least 48 h. Data, including the baseline characteristics, illness severity scores, requirements of organ support therapy, and daily nutritional therapy, will be recorded until day 28 after enrollment unless discharge from the ICU or death occurs first. The key long-term clinical outcomes, like readmission post the index discharge and health-related quality of life, will be collected via telephone contact on Day 90 and Day 180 after recruitment. Quality of life will be assessed by the EuroQol five dimensions five-level questionnaire (EQ5D5L) visual analogue scale score. Apart from descriptive data, multivariate analyses adjusted for potential confounders will be applied to assess the association between protein intake during ICU stay and short-term and long-term clinical outcomes. ETHICS AND TRIAL REGISTRATION This study was reviewed and approved by the ethics committee of Jinling Hospital (2021NZKY-027-01) and the participating sites. The study was registered at the Chinese Clinical Trials Registry (ChiCTR2200067016) before enrollment.
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Affiliation(s)
- Lijiang Zheng
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Xin Yuan
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Pingrong Wang
- Department of Critical Care Medicine, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210002, China
| | - Hengyu Zheng
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Research Institute of Critical Care Medicine and Emergency Rescue at Nanjing University, Nanjing, China.
| | - Penglin Ma
- Department of Critical Care Medicine, Guiqian International General Hospital, Guiyang, Guizhou 550004, China.
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Feng S, Wang J, Yin C, Li H, Wang T, Liu J, Liang Y, Liu J, Han D. The association between lower extremity function and cardiovascular diseases risk in older Chinese adults: Longitudinal evidence from a nationwide cohort. Arch Gerontol Geriatr 2024; 124:105463. [PMID: 38723574 DOI: 10.1016/j.archger.2024.105463] [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: 03/07/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 06/17/2024]
Abstract
BACKGROUND Older adults in China are at a high risk of cardiovascular diseases (CVD), and impaired lower extremity function (LEF) is commonly observed in this demographic. This study aimed at assessing the association between LEF and CVD, thus providing valuable insights for clinical practice and public health policies. METHODS A sample of 4,636 individuals was included from the China Health and Retirement Longitudinal Study (CHARLS) dataset. Logistic regression and cox proportional hazard regression model was utilized to study the association between LEF and CVD incidence. Cross-lagged panel models were utilized to investigate the potential causal association between LEF and CVD over time. RESULTS Poor LEF was significantly associated with a higher risk of CVD in the total population [OR (95 % CI): 1.62 (1.27-2.05), P < 0.001]. Individuals with poor LEF demonstrated an increased risk of developing CVD [HR (95 % CI): 1.11 (1.02-1.23), P < 0.05], particularly stroke, compared to those with good LEF. And those with poor LEF had higher risks for heart disease [1.21 (1.00-1.45), P < 0.05] and stroke [1.98 (1.47-2.67), P < 0.001]. CONCLUSION The results suggest the potential usefulness of the Short Physical Performance Battery (SPPB) for classifying stroke risk in older Chinese adults, which also suggested that preventing and/or improving LEF may be beneficial for reducing stroke incidence and promoting healthy aging for older adults.
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Affiliation(s)
- Shixing Feng
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing 100000, China; School of Life and Science, Beijing University of Chinese Medicine, Beijing, China; Centre France Chine de la Médecine Chinoise, Selles sur Cher, France
| | - Junqi Wang
- Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chaohui Yin
- School of Resources and Environment, Henan Agricultural University, Zhengzhou 450046, China
| | - Hangyu Li
- School of Life and Science, Beijing University of Chinese Medicine, Beijing, China
| | - Tianyi Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Jialin Liu
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing 100000, China
| | - Yafeng Liang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jinmin Liu
- Dongfang Hospital Beijing University of Chinese Medicine, Beijing 100000, China.
| | - Dongran Han
- School of Life and Science, Beijing University of Chinese Medicine, Beijing, China.
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Lu Y, Li Q, Wang W, Du L, He Q, Chen S, Zhang X, Pan Y. Associations between accelerometer-measured physical activity and sedentary behaviour with physical function among older women: a cross-sectional study. BMC Public Health 2024; 24:1754. [PMID: 38956531 PMCID: PMC11218370 DOI: 10.1186/s12889-024-19270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationships between accelerometer-measured physical activity (PA) and sedentary behaviour (SB) with physical function (PF) among older Chinese women in the community. METHODS The present study comprised 1,113 community-dwelling older females, with an average age of 65 ± 2 years. We employed a linear regression analysis to investigate the relationship between patterns of PA and SB with PF. PA variables consisted of total PA time, bouted PA time (a continuous PA that lasts equal to or more than 10 min), and sporadic PA time (a continuous PA that lasts less than 10 min). SB variables included total SB time, 30-min bout of SB (a continuous SB that lasts equal to or more than 30 min), and 60-min bout of SB (a continuous SB that lasts equal to or more than 60 min). PF variables comprised handgrip strength (HGS), one-legged stance test with eyes closed (OLSTEC), usual walking speed (UWS), maximum walking speed (MWS) and chair-stand time (CT). To explore the joint effects of moderate-to-vigorous-intensity PA (MVPA) and SB on PF, we divided the duration of SB and MVPA participation in older women into different combinations: low MVPA & high SB, low MVPA & low SB, high MVPA & high SB, high MVPA & low SB. RESULTS The study revealed a significant association between 30-min bout of SB and CT, which remained after adjusting for total MVPA time (P = 0.021). Both total MVPA and bouted MVPA were found to be positively associated with better UWS, MWS, CT, and PF Z-score. When the combination of low MVPA & high SB was used as a reference, the regression coefficients for PF ascended by 1.32 (P < 0.001) in the high MVPA & high SB group and by 1.13 (P < 0.001) in the high MVPA & low SB group. CONCLUSIONS A significant association was observed between poorer lower limb function and prolonged, uninterrupted SB in older women, rather than with the total SB time. Concurrently, the insufficient engagement in MVPA may also be a crucial factor contributing to poorer PF in older women. Engaging in longer durations and higher intensity of PA, such as bouts of MVPA lasting a minimum of 10 min or longer, may contribute to better PF.
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Affiliation(s)
- Yanyu Lu
- School of Physical Education, Shandong University, Jinan, China
| | | | - Wenbo Wang
- Zaozhuang Vocational College of Science and Technology, Zaozhuang, China
| | - Litao Du
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Yang Pan
- School of Physical Education, Shandong University, Jinan, China.
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Wu TT, Su QP, Xiong J, Hiser S, Needham DM, Li H. Reliability and validity of the Chinese version of the functional status score for the ICU (FSS-ICU) after translation and cross-cultural adaptation. Disabil Rehabil 2024:1-8. [PMID: 38934539 DOI: 10.1080/09638288.2024.2369944] [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: 01/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The Functional Status Score for the Intensive Care Unit (FSS-ICU) is designed to assess the physical functional status of patients in ICU settings. This study aimed to translate and culturally adapt the FSS-ICU for the Chinese context and to evaluate its reliability and validity. METHODS Following Beaton's translation model, the original FSS-ICU was subjected to forward translation, back-translation, and synthesis. After cultural adaptation and preliminary testing, the Chinese version of the FSS-ICU was established, and then two rehabilitation therapists assessed the functional status of 51 ICU patients using this scale, evaluating its reliability and validity. RESULTS The Chinese version of the FSS-ICU exhibits excellent internal consistency with a Cronbach's alpha coefficient of 0.934. The inter-rater and intra-rater correlation coefficients are 0.995 and 0.997, respectively. Both item-level and scale-level content validity indices are 1.00. The FSS-ICU demonstrates good convergent validity with other physical function assessment tools (Medical Research Council Sum-Score, grip strength, the Intensive Care Unit Mobility Scale), with |rs| values all above 0.5, and satisfactory discriminant validity with non-physical function assessment indicators (body mass index, blood glucose), with |rs| values all below 0.2. Additionally, it demonstrated no ceiling or floor effects. CONCLUSION The Chinese FSS-ICU, demonstrating strong reliability and validity, can serve as an effective assessment tool for physical function in ICU patients.
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Affiliation(s)
- Ting-Ting Wu
- Department of Nursing, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qing-Ping Su
- Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Jing Xiong
- Department of Nursing, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Stephanie Hiser
- Department of Health, Human Function, and Rehabilitation Sciences, The George University, Washington, DC, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine Baltimore, MD, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Hong Li
- School of Nursing, Fujian Medical University, Fuzhou, China
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Costa ACGD, Martins TF, da Silva VZM, Leite CF, Castro SSD, Cipriano G, Cipriano GFB. Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome. Disabil Rehabil 2024:1-13. [PMID: 38835177 DOI: 10.1080/09638288.2024.2358897] [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: 11/21/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories. MATERIALS AND METHODS Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams. RESULTS The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes. CONCLUSION The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.
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Affiliation(s)
| | | | - Vinicius Zacarias Maldaner da Silva
- Physiotherapy department, University of Brasília, Brazil
- Postgraduate Program in Human Moviment and Rehabilitation, UniEVANGÉLICA, Anápolis, Brazil
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Brazil
| | | | - Gerson Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brazil
- Postgraduate Program in Rehabilitation Science, University of Brasília, Brazil
- Physiotherapy department, University of Brasília, Brazil
- Postgraduate Program in Human Moviment and Rehabilitation, UniEVANGÉLICA, Anápolis, Brazil
| | - Graziella França Bernardelli Cipriano
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brazil
- Postgraduate Program in Rehabilitation Science, University of Brasília, Brazil
- Physiotherapy department, University of Brasília, Brazil
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Rollinson TC, Connolly B, Denehy L, Hepworth G, Berlowitz DJ, Berney S. Ultrasound-derived rates of muscle wasting in the intensive care unit and in the post-intensive care ward for patients with critical illness: Post hoc analysis of an international, multicentre randomised controlled trial of early rehabilitation. Aust Crit Care 2024:S1036-7314(24)00076-6. [PMID: 38834392 DOI: 10.1016/j.aucc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND AIMS Muscle wasting results in weakness for patients with critical illness. We aim to explore ultrasound-derived rates of change in skeletal muscle in the intensive care unit (ICU) and following discharge to the post-ICU ward. DESIGN Post hoc analysis of a multicentre randomised controlled trial of functional-electrical stimulated cycling, recumbent cycling, and usual care delivered in intensive care. METHOD Participants underwent ultrasound assessment of rectus femoris at ICU admission, weekly in the ICU, upon awakening, ICU discharge, and hospital discharge. The primary outcome was rate of change in rectus femoris cross-sectional area (ΔRFCSA) in mm2/day in the ICU (enrolment to ICU discharge) and in the post-ICU ward (ICU discharge to hospital discharge). Secondary outcomes included rate of change in echo intensity (ΔEI), standard deviation of echo intensity (ΔEISD), and the intervention effect on ultrasound measures. Echo intensity is a quantitative assessment of muscle quality. Elevated echo intensity may indicate fluid infiltration, adipose tissue, and reduced muscle quality. RESULTS 154 participants were included (mean age: 58 ± 15 years, 34% female). Rectus femoris cross-sectional area declined in the ICU (-4 mm2/day [95% confidence interval {CI}: -9 to 1]) and declined further in the ward (-9 mm2/day [95% CI: -14 to -3]) with a mean difference between ICU and ward of -5 mm2/day ([95% CI: -2, to 11]; p = 0.1396). There was a nonsignificant difference in ΔEI between in-ICU and the post-ICU ward of 1.2 ([95% CI: -0.1 to 2.6]; p = 0.0755), a statistically significant difference in ΔEISD between in-ICU and in the post-ICU ward of 1.0 ([95% CI, 0.5 to 1.5]; p = 0.0003), and no difference in rate of change in rectus femoris cross-sectional area between groups in intensive care (p = 0.411) or at hospital discharge (p = 0.1309). CONCLUSIONS Muscle wasting occurs in critical illness throughout the hospital admission. The average rate of loss in muscle cross-sectional area does not slow after ICU discharge, even with active rehabilitation.
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Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - David J Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Yasumura D, Katsukawa H, Matsuo R, Kawano R, Taito S, Liu K, Hodgson C. Feasibility and Inter-rater Reliability of the Japanese Version of the Intensive Care Unit Mobility Scale. Cureus 2024; 16:e59135. [PMID: 38803745 PMCID: PMC11129613 DOI: 10.7759/cureus.59135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose The purpose of this study was to verify the feasibility and inter-rater reliability of the Japanese version of the Intensive Care Unit Mobility Scale (IMS). Methods A prospective observational study was conducted at two intensive care units (ICUs) in Japan. The feasibility of the Japanese version of the IMS was assessed by 25 ICU staff (12 physical therapists and 13 nurses) using a 10-item questionnaire. Inter-rater reliability was assessed by two experienced physical therapists and two experienced nurses working with 100 ICU patients using the Japanese version of the IMS. Results In the questionnaire survey assessing feasibility, a high agreement rate was shown in 8 out of the 10 questions. All respondents could complete the IMS evaluation, and most respondents were able to complete the scoring of the IMS in a short time. The inter-rater reliability of the Japanese version of the IMS on the first day of physical therapy for ICU patients was 0.966 (95% CI: 9.94-9.99) for the weighted kappa coefficient and 0.985 (95% CI: 9.97-9.99) on the ICU discharge date assessment. The weighted κ coefficient showed an "almost perfect agreement" of 0.8 or higher. Conclusion The Japanese version of the IMS is a feasible tool with strong inter-rater reliability for the measurement of physical activity in ICU patients.
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Affiliation(s)
| | - Hajime Katsukawa
- Department of Academic Research, Japanese Society for Early Mobilization, Tokyo, JPN
| | - Ryu Matsuo
- Healthcare Administration and Management, Kyushu University, Fukuoka, JPN
| | - Reo Kawano
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Aichi, JPN
| | - Shunsuke Taito
- Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
| | - Keibun Liu
- Department of Academic Research, Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, JPN
| | - Carol Hodgson
- Critical Care, Monash University, Monash, AUS
- Intensive Care Unit, Alfred Hospital, Melbourn, AUS
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Latronico N, Eikermann M, Ely EW, Needham DM. Improving management of ARDS: uniting acute management and long-term recovery. Crit Care 2024; 28:58. [PMID: 38395902 PMCID: PMC10893724 DOI: 10.1186/s13054-024-04810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/12/2024] [Indexed: 02/25/2024] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is an important global health issue with high in-hospital mortality. Importantly, the impact of ARDS extends beyond the acute phase, with increased mortality and disability for months to years after hospitalization. These findings underscore the importance of extended follow-up to assess and address the Post-Intensive Care Syndrome (PICS), characterized by persistent impairments in physical, cognitive, and/or mental health status that impair quality of life over the long-term. Persistent muscle weakness is a common physical problem for ARDS survivors, affecting mobility and activities of daily living. Critical illness and related interventions, including prolonged bed rest and overuse of sedatives and neuromuscular blocking agents during mechanical ventilation, are important risk factors for ICU-acquired weakness. Deep sedation also increases the risk of delirium in the ICU, and long-term cognitive impairment. Corticosteroids also may be used during management of ARDS, particularly in the setting of COVID-19. Corticosteroids can be associated with myopathy and muscle weakness, as well as prolonged delirium that increases the risk of long-term cognitive impairment. The optimal duration and dosage of corticosteroids remain uncertain, and there's limited long-term data on their effects on muscle weakness and cognition in ARDS survivors. In addition to physical and cognitive issues, mental health challenges, such as depression, anxiety, and post-traumatic stress disorder, are common in ARDS survivors. Strategies to address these complications emphasize the need for consistent implementation of the evidence-based ABCDEF bundle, which includes daily management of analgesia in concert with early cessation of sedatives, avoidance of benzodiazepines, daily delirium monitoring and management, early mobilization, and incorporation of family at the bedside. In conclusion, ARDS is a complex global health challenge with consequences extending beyond the acute phase. Understanding the links between critical care management and long-term consequences is vital for developing effective therapeutic strategies and improving the quality of life for ARDS survivors.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra BONO" Interdepartmental University Research Center on Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - M Eikermann
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
- Klinik fur Anästhesiologie und Intensivmedizin, Universitaet Duisburg-Essen, Essen, Germany
| | - E W Ely
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - D M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Morales-Hernández D, Lugo-García DS, Melo-Villalobos A, Navarrete-Rodríguez CA, Delgado-Camacho J. Physical and respiratory therapy in the critically ill patient with obesity: a narrative review. Front Med (Lausanne) 2024; 11:1321692. [PMID: 38455478 PMCID: PMC10918845 DOI: 10.3389/fmed.2024.1321692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.
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Affiliation(s)
- Miguel Ángel Martínez-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Doctorate Programme in Health Sciences, Universidad Anahuac Norte, State of Mexico, Mexico
| | - Robert Alexander Jones-Baro
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Master’s Programme in Health Sciences, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Alberto Gómez-González
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Diego Morales-Hernández
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Dalia Sahian Lugo-García
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Andrea Melo-Villalobos
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Carlos Alberto Navarrete-Rodríguez
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Josué Delgado-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
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Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Lugo-García DS, Astorga PCG, Melo-Villalobos A, Gonzalez-Rodriguez BK, Pérez-Calatayud ÁA. Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic. Acute Crit Care 2024; 39:47-60. [PMID: 38303585 PMCID: PMC11002617 DOI: 10.4266/acc.2023.01284] [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: 10/10/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.
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Affiliation(s)
| | - Robert Alexander Jones-Baro
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Alberto Gómez-González
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Dalia Sahian Lugo-García
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | | | - Andrea Melo-Villalobos
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
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11
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Latronico N, Rasulo FA, Eikermann M, Piva S. Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes. Crit Care 2023; 27:439. [PMID: 37957759 PMCID: PMC10644573 DOI: 10.1186/s13054-023-04676-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage. MAIN BODY CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient's condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician. CONCLUSIONS Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
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12
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Naz İ, Turgut B, Ediboglu O, Kirakli C. Clinimetric properties of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit survivors - a cross-sectional observational study. Disabil Rehabil 2023; 45:3730-3736. [PMID: 36263947 DOI: 10.1080/09638288.2022.2134935] [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: 05/07/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. METHODS Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. RESULTS One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = -0.515), and total mechanical ventilation duration (r = -0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. CONCLUSION The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. TRIAL REGISTRATION NUMBER NCT05196997Implications for RehabilitationThe Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors.The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge.
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Affiliation(s)
- İlknur Naz
- Department of Physiotherapy and Rehabilitation, Izmir Kâtip Celebi University, Izmir, Turkey
| | - Busra Turgut
- Institute of Health Sciences, Izmir Kâtip Celebi University, Izmir, Turkey
| | - Ozlem Ediboglu
- Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Intensive Care Unit, University of Health Sciences, Izmir, Turkey
| | - Cenk Kirakli
- Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Intensive Care Unit, University of Health Sciences, Izmir, Turkey
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13
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Cui M, Liu S. Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer. Medicine (Baltimore) 2023; 102:e34922. [PMID: 37682135 PMCID: PMC10489332 DOI: 10.1097/md.0000000000034922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To compare the effect of laparoscopic surgery and open surgery on the quality of life of patients with colorectal cancer (CRC) in the growth period after the operation, and to provide a reference for surgical treatment decisions of patients with CRC. METHODS PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched through May 7, 2022 for clinical studies comparing the postoperative quality of life in CRC patients who underwent laparoscopic surgery with those who underwent open surgery. Data were extracted from eligible studies following rigorous quality review. All studies included patient numbers, surgery type, follow-up length, and quality of life scores. RESULTS A total of 6 studies were included, resulting in significantly better physical functioning scores with laparoscopic versus open surgery. (Standardized mean difference = 0.45; 95% CI (0.15, 0.75), P = .003). However, in general health, social functioning, bodily pain, vitality, quality of life index, Global Quality Scale, physical component summary and mental component summary, there was no telling difference between the 2 surgical therapies. CONCLUSION Compared with open surgery, laparoscopic surgery has weak advantages. There was no noteworthy difference in the long-term quality of life between the 2 surgical treatments for CRC patients. Whether laparoscopic surgery can bring more improvement to the quality of life of patients with CRC needs more high-quality clinical randomized studies to verify.
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Affiliation(s)
- Mengfan Cui
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shimin Liu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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14
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Johnson JK, Young DL, Guo N, Tereshchenko LG, Martinez M, Hohman JA, Rothberg MB. Physical therapy provision for patients with pneumonia in US hospitals. J Hosp Med 2023; 18:787-794. [PMID: 37602532 DOI: 10.1002/jhm.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Physical therapy (PT) appears beneficial for hospitalized patients. Little is known about PT practice patterns and costs across hospitals. OBJECTIVE To examine whether receiving PT is associated with specific patient and hospital characteristics for patients with pneumonia. We also explored the variability in PT service provision and costs between hospitals. METHODS We included administrative claims from 2010 to 2015 in the Premier Healthcare Database, inclusive of 644 US hospitals. We examined associations between receiving at least one PT visit and patient (age, race, insurance, intensive care utilization, comorbidity status, and length of stay) and hospital (academic status, rurality, size, and location) characteristics. Exploratory measures included timing and proportion of days with PT visits, and per-visit and per-admission costs. RESULTS Of 768,010 patients, 49% had PT. After adjustment, older age most significantly increased the probability of receiving PT (+38.0% if >80 vs. ≤50 years). Higher comorbidity burden, longer length of stay, and hospitalization in an urban setting were also associated with higher probability. Hospitalization in the South most significantly decreased the probability (-9.1% vs. Midwest). Patients without Medicare and Non-White patients also had lower probability. Median (interquartile range) days to first visit was 2 (1-4). Mean proportion of days with a visit was 35% ± 20%. Median per-visit cost was $88.90 [$56.70-$130.90] and per-admission was $224.00 [$137.80-$369.20]. CONCLUSION Both clinical (intensive care utilization and comorbidity status) and non-clinical (age, race, rurality, location) factors were associated with receiving PT. Within and between hospitals, there was high variability in the number and frequency of visits, and costs.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jessica A Hohman
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Dos Santos JSF, Silva GAG, Lima NMFV, Gualdi LP, Dantas DDS, Lima ÍNDF. Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach. BMC Health Serv Res 2023; 23:871. [PMID: 37587469 PMCID: PMC10433595 DOI: 10.1186/s12913-023-09787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/05/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients. METHODS Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient. RESULTS The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832). CONCLUSIONS This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.
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Affiliation(s)
- Juliana S F Dos Santos
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Gabriely A G Silva
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal, 59078-970, Brasil.
| | - Nubia M F V Lima
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Lucien P Gualdi
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
| | - Diego de S Dantas
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Brasil
| | - Íllia N D F Lima
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Brasil
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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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Lange-Maia BS, El Khoudary SR, Crandall CJ, Zhang Y, Karvonen-Gutierrez CA, Gabriel KP, Appelhans BM, Strotmeyer ES, Ylitalo KR, Karavolos K, Kravitz HM, Dugan SA, Janssen I. Pre- and Early Peri-menopausal Physical Function and Risk of Cardiovascular Events: The Study of Women's Health Across the Nation. J Aging Health 2023; 35:383-391. [PMID: 36250945 PMCID: PMC10106523 DOI: 10.1177/08982643221133580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine whether physical function (PF) before menopause is related to cardiovascular disease (CVD) risk. METHODS Participants were N = 2950 pre-/early peri-menopausal women (median age 46, (25th-75th percentile: 43-48 years). Physical function was assessed at baseline using the Physical Function subscale of the SF-36 and scores were trichotomized (no, some, or substantial limitations). Clinical CVD events were ascertained at annual/biennial clinical assessments through the 15th follow-up visit. Risk of CVD was determined with Cox proportional hazards models. Results: Women were followed for a median of 19.1 years, during which 220 women had a CVD event. In fully adjusted models, women with substantial limitations at baseline had higher CVD risk compared to women with no limitations (hazards ratio [HR] = 1.55, 95% confidence interval [CI]: 1.12-2.33). Discussion: Substantial PF limitations in pre- and early peri-menopausal women are associated with higher risk of clinical CVD events, consistent with literature in older adults.
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Affiliation(s)
- Brittney S. Lange-Maia
- Rush Alzheimer’s Disease Center Rush University Medical Center
- Department of Family and Preventive Medicine, Rush University Medical Center
| | | | - Carolyn J. Crandall
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles
| | - Yanyu Zhang
- Rush Bioinformatics and Biostatics Core, Rush University Medical Center
| | | | | | | | | | | | - Kelly Karavolos
- Department of Family and Preventive Medicine, Rush University Medical Center
| | - Howard M. Kravitz
- Department of Family and Preventive Medicine, Rush University Medical Center
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | - Sheila A. Dugan
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center
| | - Imke Janssen
- Department of Family and Preventive Medicine, Rush University Medical Center
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Pinto-Ramos J, Moreira T, Costa L, Costa F, Barroso J, Sousa-Pinto B. Association Between Knee Extension Strength and Functional Capacity After Intensive Care Unit Discharge: A 6-Mo Prospective Cohort Study. Am J Phys Med Rehabil 2023; 102:513-521. [PMID: 36730791 DOI: 10.1097/phm.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Assessing functional improvement after intensive care unit discharge is particularly challenging. The aim of this study was to measure the association between (1) changes in knee extension muscle strength or quadriceps femoris and rectus femoris muscle thickness and (2) changes in functionality/function-related measurements in post-intensive care unit patients. METHODS This prospective cohort study included adult patients without previous disability, consecutively selected after intensive care unit discharge. Some parameters, such as Short-Form 36, 6-min walking test, 1-min sit-to-stand, and Short Physical Performance Battery, were measured at baseline and 3 and 6 mos after discharge. Correlations were assessed and regression models were built to assess the association between evolution in knee extension strength or muscle thickness and evolution in functional tests. RESULTS Thirty patients completed the follow-up. Moderate correlation was found between knee extension strength change and Short-Form 36 physical functioning (correlation coefficient [ ρ ] = 0.53), 6-min walking test ( ρ = 0.38), 1-min sit-to-stand ( ρ = 0.52), and Short Physical Performance Battery ( ρ = 0.38). Baseline values and changes in knee extension strength moderately predicted evolution in Short-Form 36 physical functioning ( r2 = 0.32, P = 0.006). Changes in muscle thickness were overall not associated with changes in functional variables. CONCLUSION Changes in knee extension muscle strength may inform on functional progression over time after intensive care unit discharge, although confirmatory studies are needed.
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Affiliation(s)
- João Pinto-Ramos
- From the Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário São João, Porto, Portugal (JP-R, TM, FC, JB); CINTESIS-Center for Health Technologies and Services Research, University of Porto, Porto, Portugal (JP-R, BS-P); Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal (LC); Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal (JB); i3s-Institute for Health Research and Innovation, University of Porto, Porto, Portugal (JB); Departments of Neuroscience and Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (JB); and MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal (BS-P)
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Silva-Gutiérrez A, Artigas-Arias M, Alegría-Molina A, Guerra-Vega P, Navarrete P, Venegas Á, Montecinos C, Vásquez L, Moraga K, Rubilar C, Villagrán G, Parada R, Vitzel KF, Marzuca-Nassr GN. Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness. Front Physiol 2023; 14:1095228. [PMID: 36846316 PMCID: PMC9950093 DOI: 10.3389/fphys.2023.1095228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Objective: Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Design: Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Setting: Intensive care unit in a public hospital. Participants: 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Interventions: Not applicable. Results: Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; p = 0.025), rectus femoris (-20%; p < 0.001) and total quadriceps (-16%; p < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, p < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Conclusion: Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.
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Affiliation(s)
| | - Macarena Artigas-Arias
- Doctorado en Ciencias mención Biología Celular y Molecular Aplicada, Universidad de La Frontera, Temuco, Chile,Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Andrea Alegría-Molina
- Magíster en Terapia Física con mención, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | | | - Pablo Navarrete
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Ángela Venegas
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Carlos Montecinos
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Lorena Vásquez
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Karen Moraga
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - César Rubilar
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Germán Villagrán
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Rodrigo Parada
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Kaio Fernando Vitzel
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
| | - Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile,*Correspondence: Gabriel Nasri Marzuca-Nassr,
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Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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21
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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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The sit-to-stand test as a patient-centered functional outcome for critical care research: a pooled analysis of five international rehabilitation studies. Crit Care 2022; 26:175. [PMID: 35698237 PMCID: PMC9195216 DOI: 10.1186/s13054-022-04048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background With ICU mortality rates decreasing, it is increasingly important to identify interventions to minimize functional impairments and improve outcomes for survivors. Simultaneously, we must identify robust patient-centered functional outcomes for our trials. Our objective was to investigate the clinimetric properties of a progression of three outcome measures, from strength to function. Methods Adults (≥ 18 years) enrolled in five international ICU rehabilitation studies. Participants required ICU admission were mechanically ventilated and previously independent. Outcomes included two components of the Physical Function in ICU Test-scored (PFIT-s): knee extensor strength and assistance required to move from sit to stand (STS); the 30-s STS (30 s STS) test was the third outcome. We analyzed survivors at ICU and hospital discharge. We report participant demographics, baseline characteristics, and outcome data using descriptive statistics. Floor effects represented ≥ 15% of participants with minimum score and ceiling effects ≥ 15% with maximum score. We calculated the overall group difference score (hospital discharge score minus ICU discharge) for participants with paired assessments. Results Of 451 participants, most were male (n = 278, 61.6%) with a median age between 60 and 66 years, a mean APACHE II score between 19 and 24, a median duration of mechanical ventilation between 4 and 8 days, ICU length of stay (LOS) between 7 and 11 days, and hospital LOS between 22 and 31 days. For knee extension, we observed a ceiling effect in 48.5% (160/330) of participants at ICU discharge and in 74.7% (115/154) at hospital discharge; the median [1st, 3rd quartile] PFIT-s difference score (n = 139) was 0 [0,1] (p < 0.05). For STS assistance, we observed a ceiling effect in 45.9% (150/327) at ICU discharge and in 77.5% (79/102) at hospital discharge; the median PFIT-s difference score (n = 87) was 1 [0, 2] (p < 0.05). For 30 s STS, we observed a floor effect in 15.0% (12/80) at ICU discharge but did not observe a floor or ceiling effect at hospital discharge. The median 30 s STS difference score (n = 54) was 3 [1, 6] (p < 0.05). Conclusion Among three progressive outcome measures evaluated in this study, the 30 s STS test appears to have the most favorable clinimetric properties to assess function at ICU and hospital discharge in moderate to severely ill participants. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04048-3.
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Do JG, Suh GY, Won YH, Chang WH, Hiser S, Needham DM, Chung CR. Reliability and validity of the Korean version of the Functional Status Score for the ICU after translation and cross-cultural adaptation. Disabil Rehabil 2022; 44:7528-7534. [PMID: 34713766 DOI: 10.1080/09638288.2021.1994660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The Functional Status Score for the Intensive Care Unit (FSS-ICU) evaluates the physical function of ICU patients. The objective of the study was to translate and cross-culturally adapt the FSS-ICU into Korean and assess its reliability and validity. METHODS An expert committee supervised the forward and backward translation process and the final translated version. Experienced physiotherapists assessed patients (n= 31) from a medical ICU using the Korean version of FSS-ICU. Intra-class correlation coefficients (ICCs) and Bland-Altman's plots were used to evaluate reliability, and Cronbach's alpha for internal consistency. Construct validity was evaluated using Spearman's correlation coefficients. RESULTS Two physiotherapists in each of the two university hospitals independently assessed 31 medical ICU patients, with a mean FSS-ICU total score of 23 (range: 4-35). The FSS-ICU Korean version demonstrated excellent internal consistency, with Cronbach's alpha of 0.897 for the total FSS-ICU score, and a range of 0.844-0.892 with deletion of each individual activity within the FSS-ICU. Intra-rater and inter-rater reliability were excellent for all of five FSS-ICU activities and the total score, with an ICC range of 0.930-0.993. Bland-Altman's plots revealed a mean difference in FSS-ICU total score of 0.2 (95% limits of agreement: -1.9 to 2.3) between two physiotherapists. The Korean version of FSS-ICU had good convergent and divergent validity with moderate to strong correlation with mobility and muscle strength measures, and poor correlation with unrelated measures. CONCLUSIONS The Korean version of the FSS-ICU showed excellent intra-rater and inter-rater reliability, internal consistency, and construct validity for medical ICU patients. The results of this study, along with prior publications, support that the FSS-ICU Korean version is a valid and reliable assessment tool for the ICU environment.Implications for rehabilitationIntensive care unit patients usually experience decreased muscle strength and physical function.The Korean version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) is suitable for use with Korean speakers and has a valid, reliable measurement tool for physical function of intensive care unit patients.A well-standardized training with videos and written materials is important to ensure correct implementation of the Korean version of the FSS-ICU.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Preoperative Nutritional Optimization and Physical Exercise for Patients Scheduled for Elective Implantation for a Left-Ventricular Assist Device—The PROPER-LVAD Study. SURGERIES 2022. [DOI: 10.3390/surgeries3040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Prehabilitation is gaining increasing interest and shows promising effects on short- and long-term outcomes among patients undergoing major surgery. The effect of multimodal, interdisciplinary prehabilitation has not yet been studied in patients with severe heart failure scheduled for the implantation of a left-ventricular assist device (LVAD). Methods: This randomized controlled multi-center study evaluates the effect of preoperative combined optimization of nutritional and functional status. Patients in the intervention group are prescribed daily in-bed cycling and oral nutrition supplements (ONS) from study inclusion until the day before LVAD-implantation. Patients in the control group receive standard of care treatment. The primary outcomes for the pilot study that involves 48 patients are safety (occurrence of adverse events), efficacy (group separation regarding the intake of macronutrients), feasibility of the trial protocol (compliance (percentage of received interventions) and confirmation of recruitment rates. Secondary outcomes include longitudinal measurements of muscle mass, muscle strength, physical function and quality of life, next to traditional clinical outcomes (30-day mortality, hospital and ICU length of stay, duration of mechanical ventilation and number of complications and infections). If the pilot study is successful, a larger confirmatory, international multicenter study is warranted.
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The Development of a Comprehensive Physical Function Measure for the Intensive Care Unit Using Rasch Analysis and Item Response Theory. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hiser S, Mantheiy E, Toonstra A, Aronson Friedman L, Ramsay P, Needham DM. Physiotherapists' and Physiotherapy Assistants' Perspectives on Using Three Physical Function Measures in the Intensive Care Unit: A Mixed-Methods Study. Physiother Can 2022; 74:240-246. [PMID: 37325213 PMCID: PMC10262833 DOI: 10.3138/ptc-2020-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Purpose: We sought to understand physiotherapists' and physiotherapist assistants' perspectives on using three physical function measures in the intensive care unit (ICU) setting: the Activity Measure for Post-Acute Care Inpatient Mobility Short Form, the Johns Hopkins Highest Level of Mobility scale, and the Functional Status Score for the Intensive Care Unit. Method: A six-item questionnaire was developed and administered to physiotherapists and physiotherapist assistants working in adult ICUs at one U.S. teaching hospital. A single semi-structured focus group was conducted with seven physiotherapists, recruited using purposive sampling to include participants with a range of clinical experience. Results: Of 22 potential participants, 18 physiotherapists and 2 physiotherapist assistants completed the questionnaire. Seven physiotherapists participated in the focus group. The questionnaire found favourable perspectives on the use of the three physical function measures in clinical practice, and the focus group identified five themes related to clinicians' experience with using them: (1) ease of scoring, (2) usefulness in inter-professional communication, (3) general ease of use, (4) responsiveness to change in physical function, and (5) generalizability across patients. Conclusions: The most frequently discussed themes in this study were ease of scoring and usefulness in inter-professional communication, highlighting their importance in designing and selecting physical function measures for clinical use in the ICU setting.
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Affiliation(s)
- Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Earl Mantheiy
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Amy Toonstra
- Department of Physical Therapy, Concordia University, St. Paul, Minnesota, United States
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Compernolle S, Cerin E, Barnett A, Zhang CJP, Van Cauwenberg J, Van Dyck D. The role of socio-demographic factors and physical functioning in the intra- and interpersonal variability of older adults' sedentary time: an observational two-country study. BMC Geriatr 2022; 22:495. [PMID: 35681115 PMCID: PMC9178546 DOI: 10.1186/s12877-022-03186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insight into the variability of older adults' sedentary time is needed to inform future interventions. The aim of this study was to examine the intra- and interpersonal variability in sedentary time, and the moderating role of socio-demographics, physical functioning and geographical location in this variability. METHODS Cross-sectional data from 818 community-dwelling older adults (mean age: 74.8 years; 61.1%women) of the Active Lifestyle and the Environment in Chinese Seniors and Belgian Environmental Physical Activity Study in Seniors were used. An interview questionnaire was administered to collect socio-demographic information. The Short Physical Performance Battery was performed to evaluate physical functioning, and Actigraph GT3X( +) accelerometers were used to estimate sedentary time. Linear mixed models with random intercepts at the neighborhood, person and day levels examined the variability in sedentary time, and the moderating role of socio-demographics, physical functioning and geographical location within this variability. RESULTS Most of the variance in accelerometry-assessed sedentary time was due to intrapersonal variability across periods of the day (72.4%) followed by interpersonal variability within neighborhoods (25.6%). Those who were older, men, lived in Hong Kong, and experienced a lower level of physical functioning were more sedentary than their counterparts. Sedentary time increased throughout the day, with highest levels of sedentary time observed between 6:00 and 9:00 pm. The patterns of sedentary time across times of the day differed by gender, educational attainment, age, physical functioning and/or geographical location. No significant differences were detected between week and weekend day sedentary time. CONCLUSIONS The oldest old, men, and those with functional limitations are important target groups for sedentary behavior interventions. As sedentary time was the highest in the evening future sedentary behavior intervention should pay particular attention to the evening hours. The variations in diurnal patterns of sedentary time between population subgroups suggest that personalized just-in-time adaptive interventions might be a promising strategy to reduce older adults' sedentary time.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Research Foundation Flanders (FWO), Brussels, Belgium.
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Jelle Van Cauwenberg
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Johnson JK, Rothberg MB, Adams K, Lapin B, Keeney T, Stilphen M, Bethoux F, Freburger J. Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home. Med Care 2022; 60:444-452. [PMID: 35293885 PMCID: PMC9106906 DOI: 10.1097/mlr.0000000000001708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical therapists (PTs) are consulted to address functional deficits during hospitalization, but the effect of PT visit frequency on patients' outcomes is not clear. OBJECTIVE The objective of this study was to examine whether PT visit frequency is independently associated with functional improvement, discharge home, and both outcomes combined. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS Patients discharged from hospitals in 1 health system between 2017 and 2020, stratified by diagnostic subgroup: cardiothoracic and vascular, general medical/surgical, neurological, oncology, and orthopedic. MEASURES PT visit frequency was categorized as ≤2, >2-4, >4-7, >7 visits/week. Functional improvement was defined as ≥5-point improvement in Activity Measure for Post-Acute Care mobility score. Other outcomes were discharge home and both outcomes combined. RESULTS There were 243,779 patients included. Proportions within frequency categories ranged from 11.0% (>7 visits/wk) to 40.5% (≤2 visits/wk) and varied by subgroup. In the full sample, 36% of patients improved function, 64% were discharged home, and 27% achieved both outcomes. In adjusted analyses, relative to ≤2 visits/week, the adjusted relative risk (aRR) for functional improvement increased incrementally with higher frequency (aRR=1.20, 95% confidence interval: 1.14-1.26 for >2-4 visits to aRR=1.78, 95% confidence interval: 1.55-2.03 for >7 visits). For all patients and within subgroups, the higher frequency was also associated with a greater likelihood of discharging home and achieving both outcomes. CONCLUSIONS More frequent PT visits during hospitalization may facilitate functional improvement and discharge home. Most patients, however, receive infrequent visits. Further research is needed to determine the optimal delivery of PT services to meet individual patient needs.
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Affiliation(s)
- Joshua K. Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
- Department of Geriatric and Internal Medicine, Community Care, Cleveland Clinic
| | - Kellie Adams
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Tamra Keeney
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
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Forgiarini Júnior LA, Fontoura BLD, Kobylinski DR, Forgiarini SGI, Maldaner V. Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties. Rev Bras Ter Intensiva 2022; 34:272-278. [PMID: 35946658 DOI: 10.5935/0103-507x.20220025-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil. METHODS The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure. RESULTS There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89. CONCLUSION The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.
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Affiliation(s)
| | | | | | | | - Vinicius Maldaner
- Programa de Ciências da Saúde, Escola Superior de Ciências da Saúde - Brasília (DF), Brasil
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Aglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022; 26:314-318. [PMID: 35519935 PMCID: PMC9015935 DOI: 10.5005/jp-journals-10071-24144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Impaired physical activity and functional ability is a significant problem in critical illness survivors. Measurement of physical functioning through intensive care unit (ICU) stay determines patients at risk of poor physical outcomes, monitors efficacy of intervention, and informs recovery trajectories. Objectives Study objective was to assess physical function trajectory and identify residual functional limitations in critically ill patients admitted to ICU at the point of discharge from the hospital using robust clinical measures. Materials and methods Following ethical approval, 100 patients (78 males and 22 females) admitted to medical and surgical ICUs were recruited. Scores on Functional Status Score in ICU (FSS-ICU), Physical Function ICU Test (PFIT), and Functional Independence Measure (FIM) were recorded. Day of physiotherapy reference in the ICU was considered as day of ICU admission. Data were collected at three points, namely ICU admission, ICU discharge, and hospital discharge. Results Scores on all outcome measures increased linearly, and an upward functional trajectory was observed in patients from the point of ICU admission till hospital discharge (p >0.001). Conclusion Deficits in functional recovery exist until hospital discharge, substantiating the need to implement home-based rehabilitation to recover optimum physical function and independence in activities of daily living. How to cite this article Aglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022;26(3):314–318.
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Affiliation(s)
- Damini R Aglawe
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
- Bela M Agarwal, Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India, Phone: +91 9819000674, e-mail:
| | - Bela M Agarwal
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Bhoomika D Sawant
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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González-Seguel F, Camus-Molina A, Cárcamo M, Hiser S, Needham DM, Leppe J. Inter-observer reliability of trained physiotherapists on the Functional Status Score for the Intensive Care Unit Chilean-Spanish version. Physiother Theory Pract 2022; 38:365-371. [PMID: 32316800 PMCID: PMC9152696 DOI: 10.1080/09593985.2020.1753272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Evaluate inter-observer reliability of trained physiotherapists administering the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU).Methods: Six adult patients in a medical-surgical ICU were assessed and video-recorded by 1 of 2 expert physiotherapists. Twelve physiotherapists were then trained using recommended Spanish-language FSS-ICU materials. The 12 physiotherapists independently scored the FSS-ICU for the 6 video-recorded patients. Intraclass Correlation Coefficient (ICC) was used to evaluate the inter-observer reliability, and modified Bland-Altman plots evaluated agreement between the physiotherapists and experts.Results: This study was performed between May and August 2018. The FSS-ICU total score had a median score of 18 (range: 6 to 34) for the 6 patients. The ICC of the total score was 0.96 (95% CI, 0.92 to 1.00), and for each of the 5 individual FSS-ICU tasks, the ICC ranged between 0.87 and 0.92. The modified Bland-Altman plot revealed a mean difference of 0.6 (95% limits of agreement: -3.3 to 4.5).Conclusions: Twelve trained physiotherapists had excellent inter-observer reliability when administering the Chilean-Spanish FSS-ICU using videos of six critically ill patients, and had excellent agreement with an expert, revealing differences within the established minimal important difference. These findings provide new data supporting clinimetric properties of the Chilean-Spanish FSS-ICU.
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Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Marcela Cárcamo
- Departamento de Salud Pública y Epidemiología, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA,Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jaime Leppe
- Carrera De Kinesiología, Facultad De Medicina, Clínica Alemana Universidad Del Desarrollo, Santiago, Chile
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Zacarias Maldaner da Silva1,2 V, Sanches Lima1 A, Nadiele Santos Alves1 H, Pires-Neto3 R, Denehy4 L, M. Parry4 S. ERRATUM. J Bras Pneumol 2022; 47:e20180366errata. [PMID: 35081250 PMCID: PMC8946556 DOI: 10.36416/1806-3713/e20180366errata] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vinicius Zacarias Maldaner da Silva1,2
- 1. Programa de Pós-Grauação em Ciencias da Saúde, Escola Superior de Ciências da Saúde, Brasília (DF) Brasil. 2. Instituto Hospital de Base do Distrito Federal, Brasília (DF) Brasil
| | - Amanda Sanches Lima1
- 1. Programa de Pós-Grauação em Ciencias da Saúde, Escola Superior de Ciências da Saúde, Brasília (DF) Brasil
| | | | - Ruy Pires-Neto3
- 3. Departamento de Fisioterapia, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Linda Denehy4
- 4. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne (Vic) Australia
| | - Selina M. Parry4
- 4. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne (Vic) Australia
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Parry SM, Baldwin CE. Clinimetrics: The Physical Function in ICU test-scored. J Physiother 2022; 68:73. [PMID: 34147396 DOI: 10.1016/j.jphys.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Claire E Baldwin
- Caring Futures Institute and College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Rousseau AF, Kellens I, Dardenne N, Misset B, Croisier JL. Physical capacities assessment in critically ill patients: An exploratory study. Aust Crit Care 2021; 35:709-713. [PMID: 34903433 DOI: 10.1016/j.aucc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests. OBJECTIVES The objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting. METHODS Adults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively. RESULTS Ninety-three patients with a median age of 64 [57-71.5] years, body mass index of 26.4 [23.4-29.6] kg/m2, and Simplified Acute Physiology Score II of 33 [27.7-41] were included. Absolute and relative QS were, respectively, 146.7 [108.5-196.6] N and 1.87 [1.43-2.51] N/kg. HG was 22 [16-31] kg. The ICU-MS score was 4 [1-5]. A significant positive correlation was observed between HG and absolute QS (rs = 0.695, p < 0.001) and between HG and relative QS (rs = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (rs = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum rs = 0.414, p < 0.001). CONCLUSIONS The present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.
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Affiliation(s)
| | - Isabelle Kellens
- Department of Intensive Care and Burn Center, University Hospital of Liège, Liège, Belgium
| | - Nadia Dardenne
- Public Health Department, Biostatistics, University of Liège, Sart-Tilman, Liège, Belgium
| | - Benoit Misset
- Department of Intensive Care and Burn Center, University Hospital of Liège, Liège, Belgium
| | - Jean-Louis Croisier
- Department of Sport Sciences and Rehabilitation, University of Liège, Sart-Tilman, Liège, Belgium
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Luna ECW, Perme C, Gastaldi AC. Relationship between potential barriers to early mobilization in adult patients during intensive care stay using the Perme ICU Mobility score. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:148-153. [PMID: 34820503 PMCID: PMC8607990 DOI: 10.29390/cjrt-2021-018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Identifying barriers to early mobilization is essential for the management of patients in the intensive care unit (ICU). Our objective was to identify the potential barriers to early mobilization in adult patients using the Perme ICU Mobility Score (Perme Score) and its relationship with days of mechanical ventilation (MV) and length of stay in ICU. Methods This was a pilot, observational, and prospective study. We included 142 adult patients admitted to a 14-bed ICU, in a fourth-level complexity hospital in Cali, Colombia. The Perme Score was used to evaluate potential barriers to mobility. We used the Spearman’s correlation coefficient to find potential correlations between the number of barriers to mobility per patient and the duration of MV and ICU stay. Results We identified significant inverse correlations between total days in MV and the total score of barriers to mobility at ICU admission (r = –0.773; p < 0.05) and at ICU discharge (r = –0.559; p < 0.05). Also, between ICU length of stay and total score of barriers to mobility at ICU admission (r = –0.420; p < 0.05) and at ICU discharge (r = –0.283; p < 0.05). Moreover, we found a significant correlation between total score of the barriers item and total Perme score (r = 0.91; p < 0.01). Conclusions Using the Perme Score we identified potential barriers to mobility upon admission to the ICU that were maintained until discharge. Our findings indicate a strong positive correlation at ICU admission between the total Perme Score and the total score of “Category #2 – Potential Mobility Barriers” in the Perme Score.
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Affiliation(s)
- Esther C Wilches Luna
- Exercise and Cardiopulmonary Health Research Group (GIESC by its Spanish acronym) Universidad del Valle, Cali, Colombia.,Faculty of Health, School of Human Rehabilitation, Universidad del Valle, Cali, Colombia.,Society of Respiratory Physiotherapists (SOFIRE SAS by its Spanish acronym), Cali, Colombia.,Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo / Brazil
| | - Christiane Perme
- Department Rehabilitation Services, Houston Methodist Hospital. Houston, TX, United States of America
| | - Ada Clarice Gastaldi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo / Brazil
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González-Seguel F, Pinto-Concha JJ, Ríos-Castro F, Silva-Gutiérrez A, Camus-Molina A, Mayer KP, Parry SM. Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists. Arch Rehabil Res Clin Transl 2021; 3:100142. [PMID: 34589692 PMCID: PMC8463476 DOI: 10.1016/j.arrct.2021.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate learning results of critical care physiotherapists participating in a muscle ultrasound (MUS) educational program. DESIGN Cross-sectional study. SETTING A custom-made 20-hour MUS course was performed over a 2-week time period, including knobs familiarization, patient positioning, anatomic landmarks, image acquisition, and limb muscle measurements. PARTICIPANTS Nineteen critical care physiotherapists with little to no prior experience in ultrasound (N=19). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Theoretical knowledge, hands-on skills acquisition, and satisfaction were assessed. Inter- and intrarater reliability on landmarks, thickness, and pennation angle of quadriceps between participants was evaluated using intraclass correlation coefficients (ICCs). Reliability among instructors measured prior to the course was also reported as a reference. RESULTS The percentage score (mean±SD) of knowledge questionnaires was 69±11 (pre-course), 89±10 (post-course), and 92±9 (hands-on skills). Course satisfaction scores ranged from 90%-100%. Pooled interrater reliability of participants (median ICC [interquartile range]) was good (0.70 [0.59-0.79]) for thickness, moderate (0.47 [0.46-0.92]) for landmarks, and absent (0.00 [0.00-0.05]) for pennation angle and the intrarater reliability was good (0.76 [0.51-0.91]) for thickness and weak (0.35 [0.29-0.52]) for pennation angle. Interrater ICC values for instructors were excellent (0.90) for thickness, good (0.67) for landmarks, and moderate (0.41) for pennation angle and intrarater ICC values were excellent (0.94) for thickness and good (0.75) for pennation angle. CONCLUSIONS Although our sample was quite small and homogeneous, increased theoretical knowledge, high hands-on performance acquisition, and good satisfaction of physiotherapists were observed. Reliability was moderate to excellent for thickness and landmarks and absent to weak for pennation angle. Landmarking and pennation angle remain challenges for physiotherapist training in the application of MUS. Further studies are needed to identify variables that could modify reliability during MUS training.
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Key Words
- CV, coefficient of variation
- Critical care
- Education
- ICC, intraclass correlation coefficient
- ICU, intensive care unit
- IQR, interquartile range
- Knowledge assessment
- MUS, muscle ultrasound
- Muscular atrophy
- PA, pennation angle
- Physiotherapy
- QC, quadriceps complex
- RF, rectus femoris
- Rehabilitation
- SEM, standard error of measurement
- Ultrasonography
- VI, vastus intermedius
- VL, vastus lateralis
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Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Francisco Ríos-Castro
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Agustín Camus-Molina
- Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Selina M. Parry
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
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Shpata V, Kreka M, Tani K. Current Physiotherapy Practice in Intensive Care Units Needs Cultural and Organizational Changes: An Observational Cross-Sectional Study in Two Albanian University Hospitals. J Multidiscip Healthc 2021; 14:1769-1781. [PMID: 34262288 PMCID: PMC8275147 DOI: 10.2147/jmdh.s319236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Although physiotherapy is beneficial to intensive care unit (ICU) patients and recommended by guidelines, the role of physiotherapy in ICU settings is not fully explored in Albania. Purpose To provide an overview of the current physiotherapy practice in Albanian ICUs and explore the involvement of physiotherapists and intensive care nurses regarding respiratory therapy and early mobility in the ICU. Patients and Methods This was an observational cross-sectional study, which included all ICU nurses working in six ICUs of University Hospital Center “Mother Theresa” and University Hospital of Trauma and all physiotherapists working in these hospitals. ICU nurses and hospital physiotherapists were approached to complete the survey regarding respiratory therapy and early mobility in critically ill patients. Results One hundred thirty-one completed questionnaires were returned from 189 questionnaires distributed to the survey participants (151 nurses and 38 physiotherapists); the response rate was 69.3%. Physiotherapy procedures were performed on a non-regular basis in ICUs in Tirana, Albania. Physiotherapists were not actively involved or exclusively employed in the ICU, and these ICUs did not use protocols for physiotherapist consultation. Physiotherapists occasionally performed respiratory therapy and early mobility in patients without an artificial airway. Nursing staff regularly performed airway suctioning in mechanically ventilated patients (100%) and participated in adjusting ventilator settings (82.2% regularly and 17.8% occasionally). In contrast, physiotherapists did not participate in these procedures and the early mobility of mechanically ventilated patients. Conclusion We report limited physiotherapy involvement in Albanian ICUs. Efforts should focus on improving physiotherapy practice in ICU, potentially making organizational and cultural changes in the ICU, and establishing protocols and guidelines.
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Affiliation(s)
- Vjollca Shpata
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
| | - Manika Kreka
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania.,University Hospital Center "Mother Theresa", Tirana, Albania
| | - Klejda Tani
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
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Schallom M, Tymkew H, Vyers K, Prentice D, Sona C, Norris T, Arroyo C. Implementation of an Interdisciplinary AACN Early Mobility Protocol. Crit Care Nurse 2021; 40:e7-e17. [PMID: 32737495 DOI: 10.4037/ccn2020632] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. METHODS A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. RESULTS The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. CONCLUSIONS Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.
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Affiliation(s)
- Marilyn Schallom
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Heidi Tymkew
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Kara Vyers
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Donna Prentice
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Carrie Sona
- Carrie Sona is a clinical nurse specialist, surgical/burn/trauma intensive care unit, Barnes-Jewish Hospital
| | - Traci Norris
- Traci Norris is a clinical specialist, Rehabilitation Department, Barnes-Jewish Hospital
| | - Cassandra Arroyo
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
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Abstract
Supplemental Digital Content is available in the text. Objectives: To conduct a scoping review to 1) describe findings and determinants of physical functioning in children during and/or after PICU stay, 2) identify which domains of physical functioning are measured, 3) and synthesize the clinical and research knowledge gaps. Data Sources: A systematic search was conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines. Study Selection: Two investigators independently screened and included studies against predetermined criteria. Data Extraction: One investigator extracted data with review by a second investigator. A narrative analyses approach was used. Data Synthesis: A total of 2,610 articles were identified, leaving 68 studies for inclusion. Post-PICU/hospital discharge scores show that PICU survivors report difficulties in physical functioning during and years after PICU stay. Although sustained improvements in the long-term have been reported, most of the reported levels were lower compared with the reference and baseline values. Decreased physical functioning was associated with longer hospital stay and presence of comorbidities. A diversity of instruments was used in which mobility and self-care were mostly addressed. CONCLUSIONS: The results show that children perceive moderate to severe difficulties in physical functioning during and years after PICU stay. Longitudinal assessments during and after PICU stay should be incorporated, especially for children with a higher risk for poor functional outcomes. There is need for consensus on the most suitable methods to assess physical functioning in children admitted to the PICU.
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Evaluating Physical Functioning in Survivors of Critical Illness: Development of a New Continuum Measure for Acute Care. Crit Care Med 2021; 48:1427-1435. [PMID: 32931188 DOI: 10.1097/ccm.0000000000004499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Evaluation of physical functioning is central to patient recovery from critical illness-it may enable the ability to determine recovery trajectories, evaluate rehabilitation efficacy, and predict individuals at highest risk of ongoing disability. The Physical Function in ICU Test-scored is one of four recommended physical functioning tools for use within the ICU; however, its utility outside the ICU is poorly understood. The De Morton Mobility Index is a common geriatric mobility tool, which has had limited evaluation in the ICU population. For the field to be able to track physical functioning recovery, we need a measurement tool that can be used in the ICU and post-ICU setting to accurately measure physical recovery. Therefore, this study sought to: 1) examine the clinimetric properties of two measures (Physical Function in ICU Test-scored and De Morton Mobility Index) and 2) transform these measures into a single measure for use across the acute care continuum. DESIGN Clinimetric analysis. SETTING Multicenter study across four hospitals in three countries (Australia, Singapore, and Brazil). PATIENTS One hundred fifty-one ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Physical function tests (Physical Function in ICU Test-scored and De Morton Mobility Index) were assessed at ICU awakening, ICU, and hospital discharge. A significant floor effect was observed for the De Morton Mobility Index at awakening (23%) and minimal ceiling effects across all time points (5-12%). Minimal floor effects were observed for the Physical Function in ICU Test-scored across all time points (1-7%) and a significant ceiling effect for Physical Function in ICU Test-scored at hospital discharge (27%). Both measures had strong concurrent validity, responsiveness, and were predictive of home discharge. A new measure was developed using Rasch analytical principles, which involves 10 items (scored out of 19) with minimal floor/ceiling effects. CONCLUSIONS Limitations exist for Physical Function in ICU Test-scored and De Morton Mobility Index when used in isolation. A new single measure was developed for use across the acute care continuum.
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Abstract
OBJECTIVES Although patient's health status before ICU admission is the most important predictor for long-term outcomes, it is often not taken into account, potentially overestimating the attributable effects of critical illness. Studies that did assess the pre-ICU health status often included specific patient groups or assessed one specific health domain. Our aim was to explore patient's physical, mental, and cognitive functioning, as well as their quality of life before ICU admission. DESIGN Baseline data were used from the longitudinal prospective MONITOR-IC cohort study. SETTING ICUs of four Dutch hospitals. PATIENTS Adult ICU survivors (n = 2,467) admitted between July 2016 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients, or their proxy, rated their level of frailty (Clinical Frailty Scale), fatigue (Checklist Individual Strength-8), anxiety and depression (Hospital Anxiety and Depression Scale), cognitive functioning (Cognitive Failure Questionnaire-14), and quality of life (Short Form-36) before ICU admission. Unplanned patients rated their pre-ICU health status retrospectively after ICU admission. Before ICU admission, 13% of all patients was frail, 65% suffered from fatigue, 28% and 26% from symptoms of anxiety and depression, respectively, and 6% from cognitive problems. Unplanned patients were significantly more frail and depressed. Patients with a poor pre-ICU health status were more often likely to be female, older, lower educated, divorced or widowed, living in a healthcare facility, and suffering from a chronic condition. CONCLUSIONS In an era with increasing attention for health problems after ICU admission, the results of this study indicate that a part of the ICU survivors already experience serious impairments in their physical, mental, and cognitive functioning before ICU admission. Substantial differences were seen between patient subgroups. These findings underline the importance of accounting for pre-ICU health status when studying long-term outcomes.
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Physical Function in Critical Care Tool Bridges the Waters of ICU and Post Acute Care Physical Functioning Assessments. Crit Care Med 2021; 48:1532-1533. [PMID: 32925260 DOI: 10.1097/ccm.0000000000004537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liew SM, Mordiffi SZ, Ong YJA, Lopez V. Nurses' perceptions of early mobilisation in the adult Intensive Care Unit: A qualitative study. Intensive Crit Care Nurs 2021; 66:103039. [PMID: 33931291 DOI: 10.1016/j.iccn.2021.103039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore nurses' perceptions of early mobilisation of patient in the adult intensive care unit. DESIGN AND METHODS An exploratory descriptive qualitative research design was used. Three focus group interviews were conducted in 2018-2019. Audiotaped interviews were transcribed verbatim and content analysis was used to extract emerging categories and sub-categories. SETTING Thirteen female intensive care nurses were interviewed from one university-affiliated public hospital in Singapore. FINDINGS The first category was barriers to early mobilisation with sub-categories: time constraints, safety concerns, resistance from patients. The second category was facilitators to early mobilisation with sub-categories: practical training, teamwork and positive outcomes. CONCLUSION Early mobilisation is a multifaceted process. A dynamic team approach is needed if early mobilisation is to be integrated as part of routine care in the intensive care unit. Findings suggest the need for a well-established protocol integrating standard mobility policy and set clear, achievable and patient-oriented goals for each patient as well as effective communication among nurses but also other healthcare professional involved in the care of patients.
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Affiliation(s)
- Sze Min Liew
- Alice Lee Centre for Nursing Studies, National University of Singapore, MD 11, 10 Medical Drive, Singapore
| | | | - Yi Jia Arielle Ong
- Intensive Care Unit, National University Hospital, 5 Lower Kent Ridge Road, Singapore
| | - Violeta Lopez
- School of Nursing, Hubei of University Medicine, China; Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
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Santos NCD, Soares NS, Anjos JLMD, Matos BSD, Carvalho DB. Testes funcionais validados em indivíduos hospitalizados e não hospitalizados: revisão sistemática. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Realizar uma revisão sistemática sobre os testes funcionais validados em diferentes perfis de indivíduos hospitalizados e não hospitalizados e avaliar as evidências psicométricas para confiabilidade e validade. Métodos: Trata-se de uma revisão sistemática. Foram utilizadas as bases de dados EMBASE, MEDLINE, Lilacs e SciELO com as palavras-chave Functional Tests (Walk Test, Gait Speed Test, Chair Stand Test, Timed Up And Go, Step Test),Validation Studies as Topic e sinônimos. Foram incluídos estudos de validação de testes funcionais em indivíduos hospitalizados ou não hospitalizados que utilizaram os critérios de validade e/ou confiabilidade e relacionaram os testes a diferentes variáveis. Esses artigos poderiam ser observacionais longitudinais ou de corte transversal ou estudos de validação que utilizaram dados de ensaios clínicos. Foram excluídos os artigos que não apresentaram características importantes da amostra e a descrição do teste. Resultados: A pesquisa resultou em 36.150 artigos, e 89 foram incluídos. Os estudos foram organizados em tabelas com informações como autor, ano; critérios de validação; amostra; teste; variáveis associadas; resultados. A qualidade dos artigos foi avaliada por meio da Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusão: Os testes funcionais são válidos e confiáveis para a avaliação de indivíduos hospitalizados e não hospitalizados, estando associados à força muscular, capacidade de caminhar, controle postural, atividades de vida diária, risco de quedas, hospitalização e mortalidade.
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Fazio SA, Doroy AL, Anderson NR, Adams JY, Young HM. Standardisation, multi-measure, data quality and trending: A qualitative study on multidisciplinary perspectives to improve intensive care early mobility monitoring. Intensive Crit Care Nurs 2020; 63:102949. [PMID: 33199104 DOI: 10.1016/j.iccn.2020.102949] [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: 04/14/2020] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore multi-clinician perspectives on intensive care early mobility, monitoring and to assess the perceived value of technology-generated mobility metrics to provide user feedback to inform research, practice improvement, and technology development. METHODS We performed a qualitative descriptive study. Three focus groups were conducted with critical care clinicians, including nurses (n = 10), physical therapists (n = 8) and physicians (n = 8) at an academic medical centre that implemented an intensive care early mobility programme in 2012. Qualitative thematic analysis was used to code transcripts and identify overarching themes. FINDINGS Along with reaffirming the value of performing early mobility interventions, four themes for improving mobility monitoring emerged, including the need for: 1) standardised indicators for documenting mobility; 2) inclusion of both quantitative and qualitative metrics to measure mobility 3) a balance between quantity and quality of data; and 4) trending mobility metrics over time. CONCLUSION Intensive care mobility monitoring should be standardised and data generated should be high quality, capable of supporting trend analysis, and meaningful. By improving measurement and monitoring of mobility, future researchers can examine the arc of activity that patients in the intensive care unit undergo and develop models to understand factors that influence successful implementation.
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Affiliation(s)
- Sarina A Fazio
- Division of Pulmonary, Critical Care, & Sleep Medicine, School of Medicine, University of California, Davis, USA; Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, USA; Medical ICU, UC Davis Medical Center, UC Davis Health, Sacramento, USA.
| | - Amy L Doroy
- Medical ICU, UC Davis Medical Center, UC Davis Health, Sacramento, USA
| | - Nicholas R Anderson
- Division of Health Informatics, School of Medicine, University of California, Davis, Sacramento, USA
| | - Jason Y Adams
- Division of Pulmonary, Critical Care, & Sleep Medicine, School of Medicine, University of California, Davis, USA; Medical ICU, UC Davis Medical Center, UC Davis Health, Sacramento, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, USA
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Schwab KE, To AQ, Chang J, Ronish B, Needham DM, Martin JL, Kamdar BB. Actigraphy to Measure Physical Activity in the Intensive Care Unit: A Systematic Review. J Intensive Care Med 2020; 35:1323-1331. [PMID: 31331220 PMCID: PMC7449762 DOI: 10.1177/0885066619863654] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy to measure patient activity in the ICU setting. DATA SOURCES We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016. STUDY SELECTION Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in ≥5 ICU patients. DATA EXTRACTION Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts. RESULTS Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay. CONCLUSION Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting.
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Affiliation(s)
- Kristin E. Schwab
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - An Q. To
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Jennifer Chang
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Bonnie Ronish
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dale M. Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L. Martin
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Biren B. Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego (UCSD) School of Medicine, University of California, San Diego, CA, USA
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Mayer KP, Welle MM, Evans CG, Greenhill BG, Montgomery-Yates AA, Dupont-Versteegden EE, Morris PE, Parry SM. Muscle Power is Related to Physical Function in Patients Surviving Acute Respiratory Failure: A Prospective Observational Study. Am J Med Sci 2020; 361:310-318. [PMID: 33189316 DOI: 10.1016/j.amjms.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 66% of patients admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) develop ICU-acquired weakness, which is diagnosed by muscle strength testing. Muscle power, different from strength, is an important determinant of function that is not a common focus in patients surviving critical illness. Therefore, the purpose of this study is to assess muscle power in survivors of ARF. METHODS A cross-sectional observational study performed with survivors of ARF. Muscle power, strength and physical function were assessed 4-8 weeks post-hospital discharge. Cross sectional area and echogenicity of rectus femoris and tibialis anterior muscles were assessed using ultrasonography. Healthy community-dwelling adults were included for comparison. RESULTS 12 survivors of ARF mean age of 55.6 ± 17.1 (66% male) and 12 healthy adults mean age of 51.6.1 ± 10.3 (66% male) participated in this study. Patients in the post-ARF group had a mean muscle power of 9.9 ± 3.5 W and 63.7 ± 31.6 W for 2-lb and 10% of body-weight loads, respectively. Compared to matched controls, power in ARF group was reduced by 43%. Muscle power in post-ARF group had moderate correlations with 5-times sit-to-stand testing (r = -0.644, P = 0.024), 4-m habitual gait speed (-0.780, P = 0.002), and 6-min walk distance (r = 0.589, P = 0.044). CONCLUSIONS Muscle power is significantly reduced in survivors of critical illness and associated with deficits in physical function. These preliminary findings may support therapeutic interventions aimed at improving muscle power to potentially increase functional benefit.
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Affiliation(s)
- Kirby P Mayer
- College of Health Sciences, Department of Physical Therapy, University of Kentucky, 900 Rose Street, Wethington 204D, Lexington, KY 40536, United States.
| | - Meghan M Welle
- Center of Excellence in Rural Health, Department of Physical Therapy, University of Kentucky, Lexington, KY, United States
| | - Corey G Evans
- Center of Excellence in Rural Health, Department of Physical Therapy, University of Kentucky, Lexington, KY, United States
| | - Bryana G Greenhill
- Center of Excellence in Rural Health, Department of Physical Therapy, University of Kentucky, Lexington, KY, United States
| | - Ashley A Montgomery-Yates
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, United States
| | - Esther E Dupont-Versteegden
- College of Health Sciences, Department of Physical Therapy, University of Kentucky, 900 Rose Street, Wethington 204D, Lexington, KY 40536, United States
| | - Peter E Morris
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, United States
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
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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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Hiser S, Toonstra A, Friedman LA, Colantuoni E, Needham DM. Inter-rater reliability of activity measure for post-acute care '6-Clicks' inpatient mobility short form in the intensive care unit. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1849. [PMID: 32449231 PMCID: PMC9115971 DOI: 10.1002/pri.1849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Examine the inter-rater reliability of the activity measure for post-acute care (AM-PAC) inpatient mobility short form (IMSF) when completed by physical therapists (PTs), during routine clinical practice, in a variety of patients with critical illness. METHODS A prospective observational evaluation at single, large academic hospital in the United States. Patients (n = 76) in surgical, medical and neurological intensive care units (ICUs) were evaluated as part of routine clinical practice using the AM-PAC IMSF administered by eight PTs with at least 6 months of experience using this tool. One of two reference rater PTs observed the physical therapy session, and simultaneously scored the AM-PAC IMSF. The reference rater and clinical PTs were blinded to each other's scores with a minimum of 10 assessments completed by each clinical PT. Bland-Altman plots were constructed and intra-class correlation coefficients (ICC) were computed using a random intercept (physical therapy session) model. RESULTS Eighty one assessments (five patients assessed twice) were scored by both a clinical PT and reference rater PT (total assessments = 162). Bland-Altman plots revealed a mean difference in AM-PAC IMSF scoring of 0.0 (95% limits of agreement: -3.0 to +3.0), with an ICC (95% confidence interval) of 0.957 (0.947-0.964). The ICC (95% confidence interval) for patients in surgical, medical and neurological ICUs was very similar: 0.949 (0.927-0.959), 0.963 (0.946-0.971) and 0.936 (0.886-0.955), respectively. CONCLUSIONS The AM-PAC IMSF demonstrates excellent reliability compared with reference rater PTs when performed by PTs during clinical care across surgical, medical and neurological ICUs.
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Affiliation(s)
- Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Toonstra
- Department of Physical Therapy, Concordia University, St. Paul, Minnesota
| | - Lisa A. Friedman
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Curci C, Pisano F, Negrini F, de Sire A. Authors' reply to: Rivera-Lillo et al. comment on: Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 rehabilitation unit and proposal of a treatment protocol. Eur J Phys Rehabil Med 2020; 57:172-173. [PMID: 32935958 DOI: 10.23736/s1973-9087.20.06579-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Claudio Curci
- Neurorehabilitation Unit, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | - Fabrizio Pisano
- Neurorehabilitation Unit, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy
| | | | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
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