Saturday, December 16, 2017

Early mobilization in ICU


The use of outcome measures by physical therapists to assess mobility status and functional performance of patients is a vital element of clinical and research practice in ICU.

Parry et al. (Intensive Care Med (2015) 41:744–762) addressed the assessment of impairment and activity limitations in the critically ill. This manuscript is a systematic review and identified 26 measurement instruments and their clinometric properties. Interestingly, only six were ICU-specific instruments. On that same year, McWilliams et al. (2015) published the “Manchester Mobility Score”, which is also considered an ICU-specific tool.

Each one of the available ICU-specific tools have their strengths and also their weaknesses. When deciding which tool to use for patients in ICU, it is important to consider the clinometric analysis to determine the best tool for an institution or individual clinician.

Here is a list of the available ICU-specific tools and some references:

1.     Perme ICU Mobility Score ( Perme Score)

a.     Nydahl P et al. The German translation of the Perme ICU Mobility Score and inter-rater reliability between physiotherapists and nurses. European Journal of Physiotherapy. Pages1-7. Published online: 24 Nov 2017. DOI: 10.1080/21679169.2017.1401660
b.    Kawaguchi YMF et al. Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil. J Bras Pneumol. 2016;42(6):429-431. PMID: 28117473
c.     Perme C et al. A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score. Methodist Debakey Cardiovasc J. 2014 Jan-Mar; 10(1):41-9. PMID: 24932363
d.    Nawa RK et al. Initial interrater reliability for a novel measure of patient mobility in a cardiovascular intensive care unit. J Crit Care. 2014 Jun;29(3):475. PMID: 24630690

2.     Chelsea Critical Care Physical Assessment Tool (CPAx)

a.     Corner EJ, et al. The Chelsea critical care physical assessment tool (cpax): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy 99 (2013) 33–41. PMID: 23219649
b.    Corner EJ et al. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Crit Care. 2014 Mar 27; 18(2):R55. PMID: 24669784
c.     Corner EJ et al. The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: an observational study. Burns. 2015 Mar; 41(2):241-7 PMID: 25554262.

3.     Functional Status Score for ICU (FSS-ICU)

a.      Huang M et al. Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference. Crit Care Med. 2016 Aug 3. PubMed PMID: 27488220.
b.    Thrush et al. The clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a longterm acute care hospital: a prospective cohort study. Phys Ther. 2012;92. PMID: 22956427
c.     Zanni et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care2010 Jun;25(2):254-6

4.     ICU Mobility Scale (IMS)

a.     Hodgson C et al. Feasibility and inter-rater reliability of the ICU mobility scale. Heart lung. 2014 jan-feb; 43(1):19-24. PMID: 24373338

5.     Manchester Mobility Score ( MMS)

a.     McWilliams D et al. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project. J Crit Care. 2015 Feb; 30(1):13-8.
PMID: 25316527.

6.     Physical function outcome measure (PFIT)

a.     Skinner EH et al. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc. 2009 Jun;11(2):110-5. PMID: 19485874
b.    Denehy L et al .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 dec;93(12):1636-45. PMID: 23886842

7.     Surgical Optimal Mobilisation Score (SOMS)

a.   Kasotakis G et al. The surgical intensive care unit optimal mobility score predicts mortality and length of stay. Crit Care Med. 2012 Apr; 40(4):1122-8. PMID: 22067629.
b.    Meyer MJ et al. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open. 2013 Aug 19; 3(8):e003262. PMID: 23959756
c.     Piva S et al. The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients. J Crit Care. 2015 Dec;30(6):1251-7.PMID: 26315654 

1 comment:

  1. Interesting article! Thank you for sharing them! I hope you will continue to have similar posts to share with everyone.

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