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Physical capacities assessment in critically ill patients: An exploratory study

Published:December 10, 2021DOI:https://doi.org/10.1016/j.aucc.2021.11.001

      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.

      Keywords

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      References

        • Vanhorebeek I.
        • Latronico N.
        • Van den Berghe G.
        ICU-acquired weakness.
        Intensive Care Med. 2020; 46: 637-653
        • Hermans G.
        • Van den Berghe G.
        Clinical review: intensive care unit acquired weakness.
        Crit Care. 2015; 19: 274
        • Hermans G.
        • Van Mechelen H.
        • Clerckx B.
        • Vanhullebusch T.
        • Mesotten D.
        • Wilmer A.
        • et al.
        Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis.
        Am J Respir Crit Care Med. 2014; 190: 410-420
        • Rousseau A.F.
        • Prescott H.C.
        • Brett S.J.
        • Weiss B.
        • Azoulay E.
        • Creteur J.
        • et al.
        Long-term outcomes after critical illness: recent insights.
        Crit Care. 2021; 25: 108
        • Piva S.
        • Fagoni N.
        • Latronico N.
        Intensive care unit-acquired weakness: unanswered questions and targets for future research.
        F1000Research. 2019; 8
        • Blanjean A.
        • Kellens I.
        • Misset B.
        • Joris J.
        • Croisier J.L.
        • Rousseau A.F.
        Quadriceps strength in intensive care unit survivors: variability and influence of preadmission physical activity.
        Aust Crit Care. 2020 Jul; 34: 311-318
        • Parry S.M.
        • Nydahl P.
        • Needham D.M.
        Implementing early physical rehabilitation and mobilisation in the ICU: institutional, clinician, and patient considerations.
        Intensive Care Med. 2018; 44: 470-473
        • Parry S.M.
        • Granger C.L.
        • Berney S.
        • Jones J.
        • Beach L.
        • El-Ansary D.
        • et al.
        Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties.
        Intensive Care Med. 2015; 41: 744-762
        • Braganca R.D.
        • Ravetti C.G.
        • Barreto L.
        • Ataide T.
        • Carneiro R.M.
        • Teixeira A.L.
        • et al.
        Use of handgrip dynamometry for diagnosis and prognosis assessment of intensive care unit acquired weakness: a prospective study.
        Heart Lung. 2019; 48: 532-537
        • Ali N.A.
        • O'Brien Jr., J.M.
        • Hoffmann S.P.
        • Phillips G.
        • Garland A.
        • Finley J.C.
        • et al.
        Acquired weakness, handgrip strength, and mortality in critically ill patients.
        Am J Respir Crit Care Med. 2008; 178: 261-268
        • Rousseau A.F.
        • Kellens I.
        • Freycenon G.
        • Dardenne N.
        • Bruyere O.
        • Damas P.
        • et al.
        Highly standardized quadriceps dynamometry of critically ill adults at bedside: a step towards individualized rehabilitation.
        Acta Anaesthesiol Belg. 2018; 69: 159-164
        • Parry S.M.
        • Huang M.
        • Needham D.M.
        Evaluating physical functioning in critical care: considerations for clinical practice and research.
        Crit Care. 2017; 21: 249
        • Tipping C.J.
        • Bailey M.J.
        • Bellomo R.
        • Berney S.
        • Buhr H.
        • Denehy L.
        • et al.
        The ICU mobility scale has construct and predictive validity and is responsive. A multicenter observational study.
        Ann Am Thorac Soc. 2016; 13: 887-893
        • Tipping C.J.
        • Hodgson C.L.
        Clinimetrics: the intensive care unit mobility scale.
        J Physiother. 2020; 66: 271
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel index.
        Md State Med J. 1965; 14: 61-65
        • Roberson A.R.
        • Starkweather A.
        • Grossman C.
        • Acevedo E.
        • Salyer J.
        Influence of muscle strength on early mobility in critically ill adult patients: systematic literature review.
        Heart Lung. 2018; 47: 1-9
        • Manini T.M.
        • Visser M.
        • Won-Park S.
        • Patel K.V.
        • Strotmeyer E.S.
        • Chen H.
        • et al.
        Knee extension strength cutpoints for maintaining mobility.
        J Am Geriatr Soc. 2007; 55: 451-457
        • Mak M.K.
        • Pang M.Y.
        • Mok V.
        Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson's disease.
        Parkinsons Dis. 2012; 2012: 901721
        • Sommers J.
        • Engelbert R.H.
        • Dettling-Ihnenfeldt D.
        • Gosselink R.
        • Spronk P.E.
        • Nollet F.
        • et al.
        Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations.
        Clin Rehabil. 2015; 29: 1051-1063
        • Spies C.
        • Krampe H.
        • Paul N.
        • Denke C.
        • Kiselev J.
        • Piper S.
        • et al.
        Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – results of an expert consensus and feasibility field test.
        J Intensive Care Soc. 2021 May; 22: 159-174
        • Hodgson C.
        • Needham D.
        • Haines K.
        • Bailey M.
        • Ward A.
        • Harrold M.
        • et al.
        Feasibility and inter-rater reliability of the ICU mobility scale.
        Heart Lung. 2014; 43: 19-24
        • Schilling B.K.
        • Karlage R.E.
        • LeDoux M.S.
        • Pfeiffer R.F.
        • Weiss L.W.
        • Falvo M.J.
        Impaired leg extensor strength in individuals with Parkinson disease and relatedness to functional mobility.
        Park Relat Disord. 2009; 15: 776-780
        • Iwakura M.
        • Wakasa M.
        • Okura K.
        • Kawagoshi A.
        • Sugawara K.
        • Takahashi H.
        • et al.
        Functionally relevant threshold of quadriceps muscle strength in patients with chronic obstructive pulmonary disease.
        Prog Rehabil Med. 2021; 6: 20210008
        • Dubb R.
        • Nydahl P.
        • Hermes C.
        • Schwabbauer N.
        • Toonstra A.
        • Parker A.M.
        • et al.
        Barriers and strategies for early mobilization of patients in intensive care units.
        Ann Am Thorac Soc. 2016; 13: 724-730