Functional Status Score For The Intensive Care Unit Research Articles

Prediction of Physical Frailty at Hospital Discharge in Critically Ill Older Patients

Aim To investigate predicting factors for physical frailty development at hospital discharge in older patients admitted to the intensive care unit (ICU). Methods This case–control study focused on ICU-admitted patients aged ≥ 65 years. This study assessed several independent variables, including functional status score for the ICU, Medical Research Council (MRC) sum score, and handgrip strength at ICU discharge. Physical frailty was the primary outcome of this study. Results In total, 61 participants were included: 29 in the non-frailty group and 32 in the frailty group. Logistic regression analysis was used to extract only the MRC sum score at ICU discharge, with a cutoff score of 46 to predict physical frailty onset at hospital discharge. The functional status score for the ICU and handgrip strength were not extracted. Conclusions An MRC sum score ≤46 at hospital discharge can predict physical frailty in critically ill older patients admitted to the ICU.

Clinical Outcomes and Prevalence of Sarcopenia in Patients with Moderate to Severe COVID-19.

The purpose of this study was to investigate the effectiveness and clinical outcomes of inpatient rehabilitation for patients with severe COVID-19 in Japan. Patients with severe COVID-19 who underwent rehabilitation during hospitalization were included. The Medical Research Council (MRC) score and short physical performance battery (SPPB), such as physical function assessment and the intensive care unit (ICU) mobility scale, the functional status score for the ICU, and Barthel index as activities of daily living (ADLs) were evaluated at admission and discharge or transfer from the hospital. The correlation between SPPB at discharge and each factor at admission were also analyzed. Furthermore, the prevalence of sarcopenia was evaluated by defining SPPB of <9 points at discharge as sarcopenia. The median age of the total of 23 patients was 59 years (interquartile range (IQR): 47-67), 73.9% were male, and the median PaO2/FiO2 at admission was 172.0 (IQR: 123.0-209.0). All physical function and ADL parameters were significantly improved from the time of admission to discharge (p = 0.014 for the MRC score and p < 0.001 for all others). Moreover, SPPB at discharge significantly correlated with WBC (Spearman's rho = -0.473, p = 0.041), C-reactive protein (Spearman's rho = -0.468, p = 0.044), and exhibited a significant trend with PaO2/FiO2 (Spearman's rho = 0.429, p = 0.067) and age (Spearman's rho = 0.409, p = 0.083). Although the median Barthel index at discharge was 90 points, 47% of patients had sarcopenia as defined by an SPPB of <9 points. Early rehabilitation for patients with severe COVID-19 improved physical function and ADLs during hospitalization. However, 47% of patients had the same level of sarcopenia at discharge.

Clinical Properties of the 6-Clicks and Functional Status Score for the ICU in a Hospital in the United Arab Emirates

ObjectiveTo determine measurement properties of the Activity Measure for Post-Acute Care Inpatient Mobility Short Form (6-clicks) and Functional Status Score for the Intensive Care Unit (FSS-ICU). DesignRetrospective analysis of scores from a cohort of patients over 24 months. Outcome measures were administered to patients referred to physical therapy on admission and discharge. SettingTertiary care hospital in the United Arab Emirates. Participants2793 adults referred to physical therapy; 62% were male, with a median age of 58 (interquartile range=44-70) and the median length of stay was 14 days (interquartile range=8-28). InterventionsNot applicable. Main Outcome MeasureInstruments’ clinical measurement properties: (1) responsiveness as per mean change and effect size; (2) floor and ceiling effects; and (3) minimal important difference. Results were analyzed for the whole group as well as 3 subgroups: patients with stroke as primary diagnosis (n = 644), discharged from heart and vascular floors (n = 642), and discharged from medical floors (n = 554). ResultsThe mean change and effect size (Cohen's d) for the 6-clicks were +8.3 (±8.6) and 0.97, and for the FSS-ICU they were +6.8 (±7.8) and 0.87, respectively. 6-Clicks had a floor effect on admission among patients with stroke (16.9%) and patients discharged from medical floors (19.3%), as well as a ceiling effect on discharge (25.5% in the whole group). The FSS-ICU had a ceiling effect on discharge (23.2% in whole group). The estimated minimal important difference for the 6-clicks was 4.3, and for the FSS-ICU it was 3.9. ConclusionBoth instruments demonstrate good responsiveness in adults hospitalized in the United Arab Emirates. The FSS-ICU exhibited several advantages in performance that suggest greater clinical utility than the 6-clicks. Minimal important differences were generated, which has not been previously reported for the 6-clicks.

Mechanical Ventilator Liberation of Patients With COVID-19 in Long-term Acute Care Hospital

BackgroundMechanical ventilation (MV) via tracheostomy is performed commonly for patients who are in long-term acute care hospitals (LTACHs) after respiratory failure. However, the outcome of MV in COVID-19-associated respiratory failure in LTACHs is not known.Research QuestionWhat is the ventilator liberation rate of patients who have received tracheostomy with COVID-19-associated respiratory failure compared with those with respiratory failure unrelated to COVID-19 in LTACHs?Study Design and MethodsIn this retrospective cohort study, we examined mechanically ventilated patients discharged between June 2020 and March 2021. Of 242 discharges, 165 patients who had undergone tracheostomy arrived and were considered for ventilator liberation. One hundred twenty-eight patients did not have COVID-19 and 37 patients were admitted for COVID-19.ResultsThe primary outcome of the study was ventilator liberation; secondary outcomes were functional recovery, length of stay (LOS) at the LTACH, and discharge disposition. After controlling for demographics, the number of comorbidities, hemodialysis, vasopressor need, thrombocytopenia, and the LOS at the short-term acute care hospital, our results indicated that patients with COVID-19 showed a higher adjusted ventilator liberation rate of 91.4% vs 56.0% in those without COVID-19. Functional ability was assessed with the change of Functional Status Score for the Intensive Care Unit (FSS-ICU) between admission and discharge. The adjusted mean change in FSS-ICU was significantly higher in the COVID-19 group than in the non-COVID-19 group: 9.49 (95% CI, 7.38-11.6) vs 2.08 (95% CI, 1.05-3.11), respectively (P < .001). Patients with COVID-19 experienced a shorter adjusted LOS at the LTACH with an adjusted hazard ratio of 1.57 (95% CI, 1.0-2.46; P = .05) compared with patients without COVID-19. We did not observe significant differences between the two groups regarding discharge location, but a trend toward need for lower level of care was found in patients with COVID-19.InterpretationOur study suggests that patients with COVID-19 requiring MV and tracheostomy have a higher chance for recovery than those without COVID-19.

Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery.

Following cardiovascular surgery, patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Predicting the risk of HAD during the postoperative course is important to prevent susceptibility to cardiovascular events. Assessment of physical function during the ICU stay may be useful as a prediction index but has not been established. This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. HAD was defined as a decrease in the discharge Barthel index (BI) score of at least 5 points relative to the preadmission BI score. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. HAD occurred in 58 (24.6%) of the 236 patients following cardiovascular surgery. The cut-off points for HAD were 7.5 points for the PFIT-s (sensitivity 0.80, specificity 0.59), 24.5 points for the FSS-ICU (sensitivity 0.57, specificity 0.66), and 59.5 points for the MRC-sumscore (sensitivity 0.93, specificity 0.66). Multivariate logistic regression analysis revealed a PFIT-s of >7.5 points (odds ratio [OR], 4.84; 95% CI, 2.39-9.80; p < 0.001) and an MRC-sumscore of >59.5 points (OR, 2.43; 95% CI, 1.22-4.87; p = 0.012) as independent associated factors. We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery.

Association between postextubation dysphagia and physical function in survivors of critical illness: A retrospective study.

Dysphagia following endotracheal intubation, also known as postextubation dysphagia (PED), is generally observed in survivors of critical illness. However, its association with physical function remains relatively unexplored. This study aimed to investigate the association between PED and physical function in patients after intensive care. This is a single-center retrospective observational study. Medical records of adult patients who required emergency admission and were intubated and mechanically ventilated were retrospectively reviewed. Swallowing and physical function were assessed using the Food Intake Level Scale (FILS) and functional status score for the intensive care unit (FSS-ICU) at discharge, respectively. Multivariable linear and logistic regression analyses were used to analyze the association between dysphagia and physical dysfunction at discharge. A total of 103 patients (63 men and 40 women) with a mean age of 67.3 years were enrolled. PED was observed in 20 patients (19.4%) at hospital discharge. The FILS score at hospital discharge was significantly and independently associated with the FSS-ICU (β=0.458, p<0.001); however, the FILS score was not an independent risk factor for non-home discharge (95% confidence interval, 0.547-1.160). PED is significantly associated with physical dysfunction at discharge in survivors of critical illness. PED should be considered as a component of post-intensive care syndrome, and early intervention to prevent and improve swallowing dysfunction may be necessary.

Reliability and validity of the Korean version of the Functional Status Score for the ICU after translation and cross-cultural adaptation

Purpose The Functional Status Score for the Intensive Care Unit (FSS-ICU) evaluates the physical function of ICU patients. The objective of the study was to translate and cross-culturally adapt the FSS-ICU into Korean and assess its reliability and validity. Methods An expert committee supervised the forward and backward translation process and the final translated version. Experienced physiotherapists assessed patients (n= 31) from a medical ICU using the Korean version of FSS-ICU. Intra-class correlation coefficients (ICCs) and Bland–Altman’s plots were used to evaluate reliability, and Cronbach’s alpha for internal consistency. Construct validity was evaluated using Spearman’s correlation coefficients. Results Two physiotherapists in each of the two university hospitals independently assessed 31 medical ICU patients, with a mean FSS-ICU total score of 23 (range: 4–35). The FSS-ICU Korean version demonstrated excellent internal consistency, with Cronbach’s alpha of 0.897 for the total FSS-ICU score, and a range of 0.844–0.892 with deletion of each individual activity within the FSS-ICU. Intra-rater and inter-rater reliability were excellent for all of five FSS-ICU activities and the total score, with an ICC range of 0.930–0.993. Bland–Altman’s plots revealed a mean difference in FSS-ICU total score of 0.2 (95% limits of agreement: −1.9 to 2.3) between two physiotherapists. The Korean version of FSS-ICU had good convergent and divergent validity with moderate to strong correlation with mobility and muscle strength measures, and poor correlation with unrelated measures. Conclusions The Korean version of the FSS-ICU showed excellent intra-rater and inter-rater reliability, internal consistency, and construct validity for medical ICU patients. The results of this study, along with prior publications, support that the FSS-ICU Korean version is a valid and reliable assessment tool for the ICU environment. Implications for rehabilitation Intensive care unit patients usually experience decreased muscle strength and physical function. The Korean version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) is suitable for use with Korean speakers and has a valid, reliable measurement tool for physical function of intensive care unit patients. A well-standardized training with videos and written materials is important to ensure correct implementation of the Korean version of the FSS-ICU.

The association of macronutrient deficit with functional status at discharge from the intensive care unit: a retrospective study from a single-center critical illness registry.

Nutrition is often thought to influence outcomes in critically ill patients. However, the relationship between macronutrient delivery and functional status is not well characterized. Our goal was to investigate whether caloric or protein deficit over the course of critical illness is associated with functional status at the time of intensive care unit (ICU) discharge. We performed a retrospective analysis of surgical ICU patients at a teaching hospital in Boston, MA. To investigate the association of caloric or protein deficit with Functional Status Score for the ICU (FSS-ICU), we constructed linear regression models, controlling for age, sex, race, body mass index, Nutritional Risk in the Critically Ill score, and ICU length of stay. We then dichotomized caloric as well as protein deficit, and performed logistic regressions to investigate their association with functional status, controlling for the same variables. Linear regression models (n = 976) demonstrated a caloric deficit of 238 kcal (237.88; 95%CI 75.13-400.63) or a protein deficit of 14 g (14.23; 95%CI 4.46-24.00) was associated with each unit decrement in FSS-ICU. Logistic regression models demonstrated a 6% likelihood (1.06; 95%CI 1.01-1.14) of caloric deficit ≥6000 vs. <6000 kcal and an 8% likelihood (1.08; 95%CI 1.01-1.15) of protein deficit ≥300 vs. <300 g with each unit decrement in FSS-ICU. In our cohort of patients, macronutrient deficit over the course of critical illness was associated with worse functional status at discharge. Future studies are needed to determine whether optimized macronutrient delivery can improve outcomes in ICU survivors.

Analysis of functional status and muscle strength in adults and older adults in an intensive care unit: a prospective cohort study.

The aim of this study was to analyze and assess the association between functional status (FS) and muscle strength (MS) in young adults, adults and older adults in an intensive care unit (ICU). We conducted a prospective cohort study with 48 patients. FS was assessed using the Functional Status Score for the Intensive Care Unit (FSS-ICU) and MS was measured using the Medical Research Council Sum-Score (MRC-SS) and by testing handgrip strength (HS). The assessments were performed on awakening and ICU discharge. The data were analyzed using the Kruskall-Wallis, chi-squared, Wilcoxon and Spearman's correlation tests. FS and MRC-SS scores were higher on ICU discharge in all groups. Gains were lowest in the older adult group. HS was greater in both hands on ICU discharge in all groups except the adults. FSS-ICU on both awakening and ICU discharge was highest in the adults; HS-R was lowest in the older adults. There was a strong association between FS and MS in the young adults and adults. FS and MS showed progressive improvement during ICU stay. Gains in FS and MS on awakening and ICU discharge were lowest among the older adults. Important associations were found between these variables in all groups except the older adults. This can be explained by the multifactorial nature of illness and incapacity in this group.

FSS-ICU Scores at ICU Discharge Differ Across Postacute Care Dispositions

Purpose: To determine whether Functional Status Score for the Intensive Care Unit (FSS-ICU) scores acquired within 24 hours of medical-surgical intensive care unit (MSICU) discharge differ among postacute care discharge dispositions in a nonsurgical patient population. Methods: A retrospective medical record review for data collection was conducted over 12 months for patients in an MSICU. FSS-ICU scores were collected within 24 hours of MSICU discharge. Subjects were categorized into 4 postacute care discharge dispositions: home, subacute rehabilitation (SAR), inpatient rehabilitation (IP), or other. A 1-way analysis of variance and post hoc analyses were performed. Results: One hundred fifteen subjects were included. FSS-ICU scores acquired within 24 hours of MSICU discharge were significantly different (P &lt; .001) between postacute care discharge dispositions. Post hoc analysis showed a statistically significant difference between home and SAR (P &lt; .001), home and IP (P &lt; .001), and home and other (P = .005). Conclusions: A difference was found in FSS-ICU scores acquired within 24 hours of MSICU discharge between home and all other postacute care discharge dispositions in a nonsurgical patient population. An FSS-ICU score less than 27 at MSICU discharge indicates that discharge planning to a postacute care discharge disposition other than home may be warranted.

Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study

BackgroundLower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function.MethodsIn this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU).ResultsSixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge.ConclusionsUpper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words)Trial registrationUMIN 000031316. Retrospectively registered on 15 February 2018.

Construct Validity of the Chilean-Spanish Version of the Functional Status Score for the Intensive Care Unit: A Prospective Observational Study Using Actigraphy in Mechanically Ventilated Patients

ObjectiveTo evaluate the construct validity (hypotheses testing) of the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) using continuous actigraphy from intensive care unit (ICU) admission to ICU discharge. DesignThe Chilean-Spanish version of the FSS-ICU was used in a prospective observational study to mainly evaluate its correlation with actigraphy variables. The FSS-ICU was assessed on awakening and at ICU discharge, while actigraphy variables were recorded from ICU admission to ICU discharge. SettingA 12-bed academic medical-surgical ICU. ParticipantsMechanically ventilated patients (N=30), of 92 patients screened. InterventionsNot applicable. Main Outcome MeasuresConstruct validity of the FSS-ICU Chilean-Spanish version was assessed by testing 12 hypotheses, including the correlation with activity counts, activity time (>99 counts/min), inactivity time (0-99 counts/min), muscle strength, ICU length of stay, and duration of mechanical ventilation. ResultsThe median FSS-ICU was 19 points (interquartile range [IQR], 10-26 points) on awakening and 28.5 points (IQR, 22-32 points) at ICU discharge. There was no floor/ceiling effect of the FSS-ICU at awakening (0%/0%) and only a ceiling effect at ICU discharge that was acceptable (0%/10%). Less activity time was associated with better mobility on the FSS-ICU at both awakening (ρ=−0.62, P<.001) and ICU discharge (ρ=−0.79, P<.001). Activity counts and activity time were not correlated as expected with the FSS-ICU. ConclusionsThe Chilean-Spanish FSS-ICU had a strong correlation with inactivity time during the ICU stay. These findings enhance the available clinimetric properties of the FSS-ICU.

Impact of a Rehabilitation Protocol and a Dedicated Therapist in the Intensive Care Unit on Physical Function and Activities of Daily Living.

ABSTRACTObjectives:The goal of this study was to determine the effects of an intensive care unit (ICU) rehabilitation protocol with dedicated therapists on the physical function and activities of daily living (ADL) of patients on discharge from the ICU.Methods:This retrospective study included patients who started rehabilitation during their ICU stay. Patients were divided into three groups: the Usual Care group (before the introduction of the rehabilitation protocol), the Protocol group (after the introduction of the rehabilitation protocol), and the PT + Protocol group (with a dedicated therapist in addition to the rehabilitation protocol). The standard interventions in the Protocol group and the PT + Protocol group were set according to the protocol based on the level of consciousness and strength of each individual patient. Patients’ age, APACHE II score, length of ICU stay, length of hospital stay, and the Functional Status Score for the ICU (FSS-ICU) and Medical Research Council score (MRC score) on discharge from the ICU were compared among the three groups.Results:There were no significant differences among the three groups in age and APACHE II score. The MRC and FSS-ICU scores were significantly higher in the PT + Protocol and Protocol groups than in the Usual Care group. Furthermore, the lengths of ICU stay and hospital stay were lower in the PT + Protocol group than in the Usual Care group.Conclusions:Introduction of the rehabilitation protocol improved the limb strength and ADL of patients. Moreover, the presence of dedicated therapists in addition to the protocol reduced the lengths of ICU and hospital stays.

Chilean version of the Functional Status Score for the Intensive Care Unit: a translation and cross-cultural adaptation.

The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a valid and reliable instrument to measure physical functioning in the intensive care unit setting. Translation and cross-cultural adaptation in Chile has not been published for the FSS-ICU. To translate and cross-culturally adapt all associated documents of the original FSS-ICU for Chile. The Spanish version of FSS-ICU, available at www.ImproveLTO.com, was used as the starting point. This version was previously translated, with the original FSS-ICU developers, following established guidelines for this process. The Chilean pocket card version was newly developed based on the English version at www.ImproveLTO.com. Cognitive interviews were conducted for the adaptation of the FSS-ICU and pocket card version to assess understanding of relevant stakeholders (i.e., Chilean intensive care unit physiotherapists). Adaptations to the translation were made when agreement among the physiotherapists was less than 80%. Cognitive interviews of the Chilean FSS-ICU (85 items) and pocket card version (18 items) were performed with 30 Chilean physiotherapists from 18 hospitals (14 public and 4 private). During the interviews, modest adaptations mainly made in the general guidelines and specific instructions for three items of the FSS-ICU and two items of the pocket card. Finally, the frequently asked questions, pocket card and full version of the FSS-ICU were developed. The original developers accepted all adaptations. The Chilean version of the FSS-ICU was easy to understand by the physiotherapists. The FSS-ICU is freely available for non-commercial clinical and research use by Chilean Spanish-speakers.

[Diagnostic tools of intensive care unit acquired weakness: a systematic review].

To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status. There were 19 literatures including 14 assessment scales and ultrasound diagnosis. The 14 assessment scales were medical research council score (MRC-Score), Barthel index (BI), 6-minute walk test (6MWT), clinical outcome variables scale (COVS), the Chelsea critical care physical assessment tool (CPAx), functional independence measure (FIM), functional status score for the intensive care unit (FSS-ICU), the ICU mobility scale (IMS), rivermead mobility index (RMI), the Perme ICU score (PERME), the physical function ICU test (PFIT), the physical function ICU test score (PFIT-s), the surgical ICU optimal mobility score (SOMS), and the Manchester mobility score (MMS). Nine scales (60%) were tested reliability and the rang of inter-rater reliability was 0.600-0.996, and the test reliability was 0.970, and the range of internal consistency reliability was 0.680-0.992. Validity of 6 scales (40%) were evaluated, and the range of structure validity was 0.57-0.94, the range of content validity was 0.830-0.988, the range of concurrent validity was 0.730-0.823. It was shown that the reliability of ICUAW assessment scale was relatively good at present, but the degree of accurate assessment of ICUAW was relatively low. The evaluation content of ICUAW can be divided into three categories: in the first, they measured the muscles strength of body just like MRC-Score; in the second, they evaluated the physical function and mobility, such as COVS, CPAx, FIM, FSS-ICU, IMS, PERME, PFIT, RMI, SOMS and MMS; in the third, they evaluated daily activity and physiology parameter just as 6MWT, BI and ultrasound. Different scales were correlated with the length of ICU stay (ICU-LOS), the hospital discharge, and the mortality. For example: COVS, CPAx, FSS-ICU, PFIT, PFIT-s and SOMS could predict the ICU-LOS and hospital discharge, RMI and SOMS can predict patient mortality. However, there was no evidence to testify the consistency between them. Now, the specialist consensus about the observation nodes of threshold and electrophysiological records were the complex action potential (CMAP) range < 0.43-0.65 mV and the sensory nerve action potential (SNAP) range < 17.6 μV. There are many diagnostic tools in ICUAW, and the reliability of each scale is relatively good. In future studies, we should collect the advantages of each scale, explore the specific indicators to evaluate ICUAW and improve the accuracy and validity of diagnostic ICUAW.

Interrater Reliability of the Functional Status Score for the Intensive Care Unit

Background: A decline in physical functioning is common during an intensive care unit (ICU) stay. The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a performance-based measure designed to evaluate aspects of physical functioning in the ICU setting. While existing data support validity of the FSS-ICU, further investigation is needed regarding its interrater reliability. Objective: Evaluate interrater reliability of the FSS-ICU when completed by physical therapists (PTs), as part of routine clinical practice, across a wide range of patients with critical illness. Design: Prospective observational evaluation. Methods: Across patients in surgical, medical, and neurological ICUs, 8 PTs with 6 months of experience or more using the FSS-ICU (median [range] years of ICU experience = 2 [1-3]) administered the FSS-ICU. One of 2 reference rater PTs observed the FSS-ICU evaluation, and simultaneously scored it, with a minimum of 10 assessments per clinical PT. Reference rater and clinical PTs were blinded to each other's scores. Bland-Altman plots were constructed and intraclass correlation coefficients were computed using a random intercept (PT session and rater) model. Results: Eighty-one assessments on 76 different patients were observed by a reference rater PT. Bland-Altman plots revealed a mean difference in FSS-ICU scoring of 0.0 (95% limits of agreement: −4.0 to +4.0), with an intraclass correlation coefficient (95% confidence interval) of 0.985 (0.981-0.987). The intraclass correlation coefficients for patients in surgical, medical, and neurological ICUs were very similar: 0.984 (0.973-0.988), 0.987 (0.979-0.990), and 0.977 (0.963-0.983), respectively. Limitations: Single-center evaluation. Conclusions: The FSS-ICU evaluations, performed by PTs as part of routine clinical care across a variety of patients with critical illness, have excellent reliability compared with reference rater PTs.

Psychometric Properties of Physical Function Measures Used in the Intensive Care Unit: A Systematic Review

Background: A comprehensive physical function outcome measure provides information that assists and guides the therapist in developing a plan of care and in decision making for disposition. Since physical therapists are held accountable for using evidence-based practice, the use of measures appropriate to their settings is paramount in providing those skilled recommendations. Objective: The purpose of this systematic review was to appraise and synthesize psychometric properties of outcome measures used in the intensive care unit that assess physical function and to identify gaps in those psychometric properties and their overall assessment of function. Methods: Eight electronic databases were systematically searched. Studies were considered eligible if (1) the setting was adult intensive care unit (ICU), (2) the measure was a physical functional measure, (3) psychometric properties were reported, (4) written in English, and (5) published in a peer-reviewed journal. The initial search was conducted by a single reviewer and then 2 reviewers independently reviewed the articles to score them according to the COnsensus-based Standards for the selection of health Measurements INstruments. Results: Review of the 34 articles revealed 14 physical function measures that had psychometric testing completed in the ICU setting. The Chelsea Critical Care Physical Assessment tool, Perme mobility score, De-Morton Mobility Index, Functional Status Score for the ICU, and Acute Care Index of Function are the most comprehensive. However, none of these measures examine all aspects of physical function. COnsensus-based Standards for the selection of health Measurements INstruments scores for these measures were classified in the range of poor to fair with few obtaining a score of good or excellent. Limitations: The limitations are sole inclusion of English articles and the exclusion of abstracts, conference presentations, thesis, or dissertation papers. Conclusion: This study identified 14 physical function measures currently in use, with psychometric testing available within the ICU setting. More testing is needed on many of these measures to further validate their use. The current lack of a clearly comprehensive outcome measure tool limits the validity and reliability of assessment and guidance for appropriate recommendations.

Brazilian version of the Functional Status Score for the ICU: translation and cross-cultural adaptation.

ObjectiveThe aim of the present study was to translate and cross-culturally adapt the Functional Status Score for the intensive care unit (FSS-ICU) into Brazilian Portuguese.MethodsThis study consisted of the following steps: translation (performed by two independent translators), synthesis of the initial translation, back-translation (by two independent translators who were unaware of the original FSS-ICU), and testing to evaluate the target audience's understanding. An Expert Committee supervised all steps and was responsible for the modifications made throughout the process and the final translated version.ResultsThe testing phase included two experienced physiotherapists who assessed a total of 30 critical care patients (mean FSS-ICU score = 25 ± 6). As the physiotherapists did not report any uncertainties or problems with interpretation affecting their performance, no additional adjustments were made to the Brazilian Portuguese version after the testing phase. Good interobserver reliability between the two assessors was obtained for each of the 5 FSS-ICU tasks and for the total FSS-ICU score (intraclass correlation coefficients ranged from 0.88 to 0.91).ConclusionThe adapted version of the FSS-ICU in Brazilian Portuguese was easy to understand and apply in an intensive care unit environment.

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial.

BackgroundCritical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living. Therefore, the aim of our study is to compare the effects of an additional physiotherapy programme with systematically augmented levels of mobilisation with additional in-bed cycling (as the parallel group) on walking and other activities of daily living.Methods/designWe will conduct a prospective, rater-masked RCT of people with ICUAW with a defined diagnosis of CIM and/or CIP in our post-acute hospital. We will randomly assign patients to one of two parallel groups in a 1:1 ratio and will use a concealed allocation. One intervention group will receive, in addition to standard ICU treatment, physiotherapy with systematically augmented levels of mobilisation (five times per week, over 2 weeks; 20 min each session; with a total of 10 additional sessions). The other intervention group will receive, in addition to standard ICU treatment, in-bed cycle sessions (same number, frequency and treatment time as the intervention group).Standard ICU treatment includes sitting balance exercise, stretching, positioning, and sit-to-stand training, and transfer training to get out of bed, strengthening exercise (in and out of bed), and stepping and assistive standing exercises.Primary efficacy endpoints will be walking ability (defined as a Functional Ambulation Category (FAC) level of ≥3) and the sum score of the Functional Status Score for the Intensive Care Unit (FSS-ICU) (range 0–22 points) assessed by a blinded tester immediately after 2 weeks of additional therapy.Secondary outcomes will include assessment of sit-to-stand recovery, overall limb strength (Medical Research Council, MRC) and grip strength, the Physical Function for the Intensive Care Unit Test-Scored (PFIT-S), the EuroQol 5 Dimensions (EQ-5D) questionnaire and the Reintegration to Normal Living Index (RNL-Index) assessed by a blinded tester.We will measure primary and secondary outcomes with blinded assessors at baseline, immediately after 2 weeks of additional therapy, and at 3 weeks and 6 months and 12 months after the end of the additional therapy intervention.Based on our sample size calculation 108 patients will be recruited from our post-acute ICU in the next 3 to 4 years.DiscussionThis will be the first RCT comparing the effects of two physical rehabilitation interventions for people with ICUAW due to defined CIP and/or CIM to improve walking and other activities of daily living. The results of this trial will provide robust evidence for physical rehabilitation of people with CIP and/or CIP who often require long-term care.Trial registrationWe registered the study on 6 April 2016 before enrolling the first patient in the trial at the German Clinical Trials Register (www.germanctr.de) with the identifier DRKS00010269. This is the first version of the protocol (FITonICU study protocol).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1687-4) contains supplementary material, which is available to authorized users.

The Functional Status Score for the Intensive Care Unit Scale: Is It Reliable in the Intensive Care Unit? Can It Be Used to Determine Discharge Placement?

Purpose: To date there is little available information about the reliability of the Functional Status Score for the Intensive Care Unit (FSS-ICU) scale in the intensive care unit (ICU) environment. The purpose of this study is 2-fold: first to determine the FSS-ICU scale's interrater reliability; second to examine whether a relationship exists between a patient's FSS-ICU score on the day of ICU-to-regular ward transfer and the patient's ultimate discharge destination. Methods: The interrater reliability of the FSS-ICU scale was tested among 6 physical therapists who routinely worked in the ICU. The FSS-ICU scores on the day of ICU-to-ward transfer and final discharge destination were collected prospectively from 26 patients who received physical therapy intervention. Discharge destinations were divided into 5 categories: home, acute rehabilitation unit (ARU), skilled nursing facility (SNF), assisted living facility (ALF), and others. Results: Interrater reliability of the FSS-ICU scale was high (intraclass correlation coefficient = 0.992, 95% confidence interval) among the physical therapists who routinely worked in the ICU settings, and the median cumulative FSS-ICU scores on the day of ICU-to-ward transfer were significantly different among each of the discharge categories. Conclusions: Interrater reliability of the FSS-ICU scale was high among physical therapists who routinely worked in the ICU and who were familiar with the scale. This scale may have potential value to discriminate between different discharge destinations in a hospital setting, but further research is warranted.