Association Between Mobilization Level And Activity of Daily Living Independence in Critically Ill Patients

Overview

Journal Ann Rehabil Med

Specialty Rehabilitation Medicine

Date 2023 Nov 22

PMID 37990499

Authors

Shinichi Watanabe

Keibun Liu

Ryo Kozu

Daisetsu Yasumura

Kota Yamauchi

Hajime Katsukawa

Keisuke Suzuki

Takayasu Koike

Yasunari Morita

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70.

Methods: This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL.

Results: Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07-1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69).

Conclusion: These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.

References

Watanabe S, Liu K, Nakamura K, Kozu R, Horibe T, Ishii K . Association between Early Mobilization in the ICU and Psychiatric Symptoms after Surviving a Critical Illness: A Multi-Center Prospective Cohort Study. J Clin Med. 2022; 11(9). PMC: 9099642. DOI: 10.3390/jcm11092587. View

Watanabe S, Morita Y, Suzuki S, Kochi K, Ohno M, Liu K . Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients. Prog Rehabil Med. 2022; 6:20210054. PMC: 8710675. DOI: 10.2490/prm.20210054. View

Watanabe S, Kotani T, Taito S, Ota K, Ishii K, Ono M . Determinants of gait independence after mechanical ventilation in the intensive care unit: a Japanese multicenter retrospective exploratory cohort study. J Intensive Care. 2019; 7:53. PMC: 6880493. DOI: 10.1186/s40560-019-0404-2. View

Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C . Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678):1874-82. PMC: 9906655. DOI: 10.1016/S0140-6736(09)60658-9. View

Skinner E, Berney S, Warrillow S, Denehy L . Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc. 2009; 11(2):110-5. View

Tymkew H, Norris T, Arroyo C, Schallom M . The Use of Physical Therapy ICU Assessments to Predict Discharge Home. Crit Care Med. 2020; 48(9):1312-1318. DOI: 10.1097/CCM.0000000000004467. View

Denehy L, Lanphere J, Needham D . Ten reasons why ICU patients should be mobilized early. Intensive Care Med. 2016; 43(1):86-90. DOI: 10.1007/s00134-016-4513-2. View

Shiroiwa T, Ikeda S, Noto S, Igarashi A, Fukuda T, Saito S . Comparison of Value Set Based on DCE and/or TTO Data: Scoring for EQ-5D-5L Health States in Japan. Value Health. 2016; 19(5):648-54. DOI: 10.1016/j.jval.2016.03.1834. View

Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C . Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2011; 45(1):18-25. DOI: 10.1002/mus.22219. View

10.

Watanabe S, Liu K, Morita Y, Kanaya T, Naito Y, Suzuki S . Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study. Prog Rehabil Med. 2022; 7:20220013. PMC: 8938413. DOI: 10.2490/prm.20220013. View

11.

Kayambu G, Boots R, Paratz J . Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013; 41(6):1543-54. DOI: 10.1097/CCM.0b013e31827ca637. View

12.

Katsukawa H, Ota K, Liu K, Morita Y, Watanabe S, Sato K . Risk Factors of Patient-Related Safety Events during Active Mobilization for Intubated Patients in Intensive Care Units-A Multi-Center Retrospective Observational Study. J Clin Med. 2021; 10(12). PMC: 8231849. DOI: 10.3390/jcm10122607. View

13.

Nishida O, Ogura H, Egi M, Fujishima S, Hayashi Y, Iba T . The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016). Acute Med Surg. 2018; 5(1):3-89. PMC: 5797842. DOI: 10.1002/ams2.322. View

14.

Huang M, Chan K, Zanni J, Parry S, Neto S, Neto J . Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference. Crit Care Med. 2016; 44(12):e1155-e1164. PMC: 5292321. DOI: 10.1097/CCM.0000000000001949. View

15.

Tipping C, Harrold M, Holland A, Romero L, Nisbet T, Hodgson C . The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2016; 43(2):171-183. DOI: 10.1007/s00134-016-4612-0. View

16.

Denehy L, de Morton N, Skinner E, Edbrooke L, Haines K, Warrillow S . A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther. 2013; 93(12):1636-45. DOI: 10.2522/ptj.20120310. View

17.

Harrold M, Salisbury L, Webb S, Allison G . Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care. 2015; 19:336. PMC: 4570617. DOI: 10.1186/s13054-015-1033-3. View

18.

Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M . Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung. 2013; 43(1):19-24. DOI: 10.1016/j.hrtlng.2013.11.003. View

19.

Watanabe S, Iida Y, Ito T, Mizutani M, Morita Y, Suzuki S . Effect of Early Rehabilitation Activity Time on Critically Ill Patients with Intensive Care Unit-acquired Weakness: A Japanese Retrospective Multicenter Study. Prog Rehabil Med. 2020; 3:20180003. PMC: 7365179. DOI: 10.2490/prm.20180003. View

20.

Watanabe S, Liu K, Morita Y, Kanaya T, Naito Y, Arakawa R . Changes in barriers to implementing early mobilization in the intensive care unit: a single center retrospective cohort study. Nagoya J Med Sci. 2021; 83(3):443-464. PMC: 8437998. DOI: 10.18999/nagjms.83.3.443. View