A 3 months follow-up of functional dependency, muscle strength, balance and endurance in long-stay icu patients; association with rehabilitation programmes

  • CM de Jager
  • A van Wieren
  • NA Bruins
  • EC Boerma
Open Access
Poster presentation
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Keywords

Physical Performance Grip Strength Rehabilitation Programme Functional Dependency Specific Field 

Introduction

Over the last decades ICU survival is increasing. As a consequence, post ICU sequelae with (persistent) functional dependency in long-stay ICU patients become a topic of interest. However data on specific fields of physical performance and the potential influence of rehabilitation programmes remain scarce [1].

Objectives

To establish the course of functional dependency and specific fields of physical performance in patients with and without a (non ICU-specific) rehabilitation programme in long-stay ICU patients.

Methods

We performed a single centre prospective observational study in mixed ICU patients with a length of stay ICU > 48 hours. Patients were evaluated at ICU discharge and re-evaluated after a 3-months period in a specific post-ICU outpatient clinic. At both time points a Barthel score (BS) and grip strength (GS) were recorded. Additionally the 6 minutes walking test (6MWT), the Berg balance scale (BBS) and characteristics of individual rehabilitation programmes were assessed in the outpatient setting. Non-parametric tests for comparison between dependent and independent datasets were used. A Bonferroni correction was used for multiple comparison.

Results

In a 1-year period during 2014 80 patients were included. Baseline characteristics are provided in Table 1. Overall there was a statistical improvement over time in all functional fields (Table 2). At 3 month 5 patients (6%) remained fully/severely functionally dependent, 3 (4%) were partially functionally dependent, 16 (20%) became functionally independent with help and 56 (70%) became functionally independent. At this time point grip strength returned to normal in at least 1 hand in 90%, and in both hands in 81% of patients. The BBS at three months indicated a low fall risk in 97% of patients. However, the 6MWT at three months was only normalized in 19% of patients. 52% of patients participated in any form of (non ICU-specific) rehabilitation program, 48% did not take part in any form of rehabilitation programme. There was no statistical difference in any outcome variable of physical performance between patients with and without a rehabilitation program.
Table 1

Baseline characteristics.

 

All (N = 80)

Non-rehab (N = 36)

Rehab (N = 39)

p-value

Age (years)

65[56-73]

65[57-73]

65[56-72]

0.89

APACHE II score

22[16-30]

21[15-24]

29[24-33]

0.001

Admission type

    

-elective(%)

16

17

15

0.88

-non-elective(%)

84

83

85

 

Ventilator days

4[3-9]

4[2-6]

5[3-10]

0.044

LOS ICU (days)

23[15-35]

20[13-37]

27[19-34]

0.33

Data are presented as median [IQR]. APACHE Acute physiology and chronic health evaluation, LOS Length of stay, Rehab Rehabilitation programme. P value between subgroups (rehab versus non-rehab)

Table 2

Results.

 

ICU discharge

3 Month all

Without rehab

With rehab

p-value

Barthel score, AU

12[8-16]

20[18-20]

20[20-20]

20[18-20]

a0.006 b0.84

Grip strength L, KPa, (%)

18[14-23],(36)

29[23-40], (90)

32[26-40]

26[21-37]

a0.006 b0.90

Grip strength R, KPa, (%)

19[14-29], (28)

34[24-44], (84)

38[27-46]

28[22-39]

a0.006 b0.16

6MWT, m, (%)

NA

420[350-550], 86[68-93]

460[360-554], 87[73-93]

395[338-538], 84[63-93]

b1.0

Berg Balance Scale, AU

NA

54[52-56]

54[52-56]

54[50-56]

b1.0

Data are presented as median [IQR] or in percentage of normal values. 6 MWT 6 minutes walking test, Rehab Rehabilitation programme.a comparison between ICU discharge and 3 months after ICU discharge, b comparison between subgroups with and without rehabilitation programme

Conclusions

In long-stay ICU patients overall physical performance considerably improved in 3 months from ICU discharge. However, there are large differences in the recovery of specific fields of physical performance, irrespective of participation in non ICU-specific rehabilitation programmes. Further research to unravel the specific rehabilitation needs of long-stay ICU patients is needed.

References

  1. 1.
    Jackson JC, et al: Cognitive and physical rehabilitation of intensive care unit survivors: Results of the RETURN randomized controlled pilot investigation. Crit Care Med. 2012, 40: 1088-1097. 10.1097/CCM.0b013e3182373115.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© de Jager et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • CM de Jager
    • 1
  • A van Wieren
    • 1
  • NA Bruins
    • 1
  • EC Boerma
    • 1
  1. 1.Medical Centre Leeuwarden, Intensive Care MedicineLeeuwardenthe Netherlands

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