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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

Keywords

Physical Performance Grip Strength Rehabilitation Programme Functional Dependency Specific Field 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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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