Medical Research Council Sum Score Research Articles

Association between language function and body composition characteristics in patients with subacute left hemispheric stroke

Background & Objectives: Stroke-related sarcopenia and language disorder are main sequelae of stroke. The aim of this study is to evaluate the association between language function and body composition characteristics in patients with subacute left hemiplegic stroke. Methods: Body mass index, skeletal muscle index (SMI), and body fat percentage using bioimpedance analysis, hand grip strength, and Medical Research Council (MRC) sum score were evaluated. Language function was evaluated using the Western Aphasia Battery (WAB). A partial correlation analysis was used to assess the relationship between body composition and language function. Results: A total of 54 patients with subacute left hemispheric stroke were enrolled in the study. The aphasia quotient (AQ) of WAB was significantly correlated with SMI, body fat percentage, MRC-sum score, MRC-sum score of unaffected side and hand grip strength. In the multiple regression analysis after adjusting for age and sex, the AQ of WAB was significantly correlated with SMI. Conclusions: Skeletal muscle index showed highest correlation with language function in patients with left hemispheric stroke.

High-dose pharmaceutical-grade biotin in patients with demyelinating neuropathies: a phase 2b open label, uncontrolled, pilot study

BackgroundWe proposed to investigate high-dose pharmaceutical-grade biotin in a population of demyelinating neuropathies of different aetiologies, as a proof-of-concept.MethodsPhase IIb open label, uncontrolled, single center, pilot study in 15 patients (three groups of five patients) with chronic demyelinating peripheral neuropathy, i.e. chronic inflammatory demyelinating polyradiculoneuropathy, anti-myelin-associated glycoprotein neuropathy and Charcot-Marie-Tooth 1a or 1b. The investigational product was high-dose pharmaceutical-grade biotin (100 mg taken orally three times a day over a maximum of 52 weeks.The primary endpoint was a 10% relative improvement in 2 of the following 4 electrophysiological variables: motor nerve conduction velocity, distal motor latency, F wave latency, duration of the compound muscle action potential. The secondary endpoints included Overall Neuropathy Limitations Scale (ONLS) score, Medical Research Council (MRC) sum score, Inflammatory Neuropathy Cause and Treatment (INCAT) sensory sum score, 10-m walk test, 6-min walk test, posturography parameters, and nerve excitability variables.ResultsThe primary endpoint was reached in one patient. In the full population analysis, some secondary endpoints parameters improved: MRC score, INCAT sensory sum score, 6-min walk distance, strength-duration time constant, and rheobase. There was a positive correlation between the improvement in the 6-min walk distance and the strength-duration time constant. Regarding the safety results, 42 adverse events occurred, of which three were of severe intensity but none was considered as related to the investigational product.ConclusionsEven if the primary endpoint was not met, administration of high-dose pharmaceutical-grade biotin led to an improvement in various sensory and motor parameters, gait abilities, and nerve excitability parameters. The tolerance of the treatment was satisfactory.Trial registrationClinicalTrials.gov Identifier: NCT02967679; date 2016/12/05.

Predictors of long-term health-related quality of life in Guillain-Barré syndrome: A hospital-based study

ObjectiveThis study aimed to determine the impact of patients’ baseline clinical, neurophysiological data, and management plan of Guillain-Barré syndrome (GBS) on long-term quality of life (QoL) and to identify its potential predictors. MethodsSeventy-nine GBS patients were recruited. On admission, participants were evaluated using the Medical Research Council (MRC) sumscore, GBS disability scale (GDS), and Erasmus GBS Respiratory Insufficiency Score (EGRIS). Neurophysiological data were collected, and a management plan was devised. MRC sumscore was repeated at nadir. MRC, GDS and Short Form Survey (SF-36) were assessed at first-year follow-up. ResultsThe mean age was 37.84 ± 17.26 years, with 43 male patients (54.4%). QoL at one year correlated significantly with baseline clinical variables (age, number of days between weakness and admission, MRC sumscore at onset and nadir, high GDS, and EGRIS scores). Antecedent events, especially diarrhoea, neck muscle weakness, autonomic dysfunction, cranial nerve involvement, and mechanical ventilation (MV), associated with worse QoL. Axonal GBS patients had lower QoL than AIDP patients, and PE patients exhibited lower QoL than IVIG patients. Multiple regression analysis showed that older age, diarrhoea, number of days between weakness and admission, neck muscle weakness, cranial nerve involvement, autonomic dysfunction, early MV, and MRC at onset and nadir and high GDS could predict poor QoL. ConclusionOlder age, more days between weakness and admission, neck muscle weakness, cranial nerve involvement, autonomic dysfunction, early MV, diarrhoea, low MRC at onset and nadir, high GDS at onset, axonal type, and PE treatment were potential predictors of poor QoL in GBS.

Efficacy of Teleconsultation-Based Rehabilitation in Children with Landry-Guillain-Barré Syndrome: An Open Label Randomized Controlled Trial (Tele Rehab-LGBS Trial).

To evaluate the feasibility and efficacy of teleconsultation-based rehabilitation in children with Landry-Guillain-Barré syndrome(LGBS), measured with Medical Research Council (MRC) sum score and Hughes score. A pragmatic, prospective, parallel open label randomized controlled trial was conducted among a total of 50 childrenwith LGBS. The children were randomized using computer generated block randomization into 2 groups (25 in each group): Standard ofcare (Group A) and teleconsultation-based rehabilitation (Group B). Primary and secondary outcomes were measured with MRC sum scoreand Hughes score at 12- and 24-wkfollow-up. The mean age was 6.4 ± 3.3 y; 29 (58%) were boys. Baseline MRC sum score (median, IQR), and Hughes score (median, IQR) in group A was 24 (7-31) and 5 (4-5) respectively; and in group B was 18 (9-24) and 4 (4-5) respectively. At discharge, median (IQR) MRC sum score in group A and B was 34 (28-41), and 30 (25-43) (p value = 0.31) respectively. Tele-rehabilitation was provided to group B for 24 wk with 96% compliance. At 12 wk, median MRC sum score in group A and group B were similar [48 (IQR 44-54) vs. 52 (IQR 46-60), p value = 0.08]. At 12 wk and 24 wk, median Hughes score in group A and B were similar. At 24 wk, 15 out of 23 subjects of group A and 18 out of 25 subjects of group B were ambulatory (p value = 0.61). Teleconsultation-based rehabilitation was feasible with a high compliance rate. The functional outcomes measured with MRC sum score and Hughes score were similar in both the groups at 12 and 24 wk follow-up. Teleconsultation-based rehabilitation has similar efficacy as physical rehabilitation.

Proximity extension assay-based discovery of biomarkers for disease activity in chronic inflammatory demyelinating polyneuropathy

BackgroundObjective disease activity biomarkers are lacking in chronic inflammatory demyelinating polyneuropathy (CIDP), impacting treatment decisions in clinical care and outcomes in clinical trials. Using a proximity extension assay, we aimed...

Prognosis and outcome in patients with chronic inflammatory demyelinating polyradiculoneuropathy in a tertiary center in Oman.

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated condition with variable clinical characteristics and different treatment modalities. We aim to present different clinical and demographic features of all patients with CIDP presented to the neuromuscular clinic within four years and their follow-up results. Methods: A retrospective study from a hospital database of 23 patients met the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria for CIPD. Complete demographic and clinical data were collected. Progress and outcome were assessed using two clinical score systems at regular intervals at 6, 12, and 18 months. Results: Mean age of patients was 43.4 ± 20.9 years (male-to-female ratio was 1.6:1). Age of onset was 39.7 ± 18.0 years. At the presentation, the Medical Research Council sum score (MRCss) was 50 (39.7-51.3), and the modified Rankin Scale (mRS) was 3 (2.2-3.4). There was a significant improvement in MRCss during four periods (P < 0.001). Multiple comparisons revealed a significant difference in MRCss between the baseline and 12 and 18 months but no significant change between the baseline and 6 months. Likewise, mRS showed a significant improvement between the baseline and 18 months (no significant change between the baseline and 6 months or 12 months). Conclusion: The clinical characteristics of CIDP in our cohort were similar to other reported studies, and most of the studied patients had good outcomes. Our results could be utilized as baseline data for a better understanding of the characteristics of CIDP in Oman and, consequently, for better management of the disease.

Neuroprognostication: Guillain-Barré Syndrome.

Guillain-Barré syndrome is an immune-mediated disease of the peripheral nerves characterized by rapidly progressing symmetric weakness, areflexia, and albuminocytological dissociation. Most patients reach their nadir within 2 weeks. Disease severity can be mild to severe, with 20% of patients requiring mechanical ventilation. Intravenous immunoglobulin and plasma exchange are equally effective treatments. Monitoring strength, respiratory function, blood pressure, and heart rate, as well as pain management and rehabilitative therapy are important aspects of management. About 20% of patients require assistance to walk at 6 months. Older age, preceding diarrhea, and lower Medical Research Council (MRC) sum scores predict poor outcome. Death from cardiovascular and respiratory complications can occur in the acute or recovery phases of the illness in 3 to 7% of the patients. Risk factors for mortality include advanced age and disease severity at onset. Neuropathic pain, weakness, and fatigue can be residual symptoms; risk factors for these include axonal loss, sensory involvement, and severity of illness.

Efgartigimod beyond myasthenia gravis: the role of FcRn-targeting therapies in stiff-person syndrome.

Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder characterized by high titers of antibodies against glutamic acid decarboxylase (GAD) causing impaired GABAergic inhibitory neurotransmission. To date, there is not a defined therapy for such condition, but immunomodulating therapies, such as plasma exchange, intravenous immunoglobulins, and rituximab, have been widely used in clinical practice. However, the efficacy and tolerability of these treatments is not well established. Efgartigimod, a new neonatal Fc receptor (FcRn) blocker, is a human IgG1 antibody Fc fragment engineered with increased affinity for FcRn binding, leadingto areduction in IgGs levels, includingpathogenic IgG autoantibody showing promising results in neurological autoimmune disorders and has been approved for the treatment of AChR-seropositive generalizedmyasthenia gravis (MG). In this study, we report and describe the first data on treatment with efgartigimod in three patients affected by both AChR-seropositive generalized MG and anti-GAD-seropositive SPS. Patients were followed since the start of efgartigimod and for the whole treatment period (12weeks). MG symptoms were assessed with the "MG activity of daily living score" and the Quantitative Myasthenia Gravis score, while SPS ones were assessed with the "SPS activity of daily living score"; muscle strength was assessed with the Medical Research Council Sum score; the overall disability from MG and SPS was assessed by the modified Rankin Scale. All patients showed an improvement in symptoms of both SPS and MG after 2 cycles of treatment. Our data suggest that efgartigimod may be considered as a candidate drug for SPS and other autoantibody-mediated neurological disorders.

Physical function and mental health trajectories in COVID-19 patients following invasive mechanical ventilation: a prospective observational study

This prospective observational cohort study was performed to investigate the physical function and mental health trajectories of novel coronavirus disease 2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after discharge from the intensive care unit (ICU). The study population consisted of 64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum score < 48 points, and prolonged IMV was significantly associated with lower MRC sum score and handgrip strength. Symptoms were similar between groups at ICU discharge, and the symptoms most commonly reported as moderate-to-severe were impaired well-being (52%), anxiety (43%), tiredness (41%), and depression (35%). Although muscle strength and mobility status were significantly improved after ICU discharge, Edmonton Symptom Assessment System score did not improve significantly in the prolonged IMV group. EuroQol five-dimension five-level summary index was significantly lower in the prolonged than short IMV group at 6 months after ICU discharge. We found substantial negative physical function and mental health consequences in the majority of surviving COVID-19 patients requiring IMV, with prolonged period of IMV showing greater negative effects not only immediately but also at 6 months after discharge from the ICU.

Excitability of somatosensory cortex is increased in ALS: A SEP recovery function study

ObjectiveNeuronal loss in the somatosensory, as well as the motor cortex in amyotrophic lateral sclerosis (ALS), indicative of a structural abnormality has been reported. Previously we have shown that afferent inhibition was impaired in ALS, suggestive of sensory involvement. In this study, we aimed to evaluate excitability changes in the somatosensory cortex of ALS patients. MethodsALS patients underwent a paired pulse somatosensory evoked potential (SEP) paradigm at various interstimulus intervals (ISI). The amplitude ratio obtained by dividing the amplitude of paired pulse SEP stimulation S2 (paired pulse stimulation) to S1 (the single pulse stimulation) was considered the somatosensory cortex excitability parameter. Findings were compared to the results obtained from healthy controls. Resting motor threshold (RMT) was also assessed in the ALS group. ResultsAn increased S2/S1 ratio was found in the ALS group in every ISI examined. Additionally, the reduced inhibition correlated negatively with forced vital capacity, Medical Research Council sum score, median nerve compound muscle action potential amplitude, while there was a positive association with Penn upper motor neuron score and sural nerve conduction velocity. No correlation existed with RMT. ConclusionsOur findings demonstrated increased somatosensory cortical excitability in ALS, which was associated with clinical parameters such as reduced pulmonary function and motor strength. SignificanceSomatosensory cortical excitability is impaired in ALS. Whether this is associated with increased motor cortical excitability requires further studies.

Functional Capacity in COVID-19 related Acute Respiratory Distress Syndrome Survivors

Background/Purpose:: The aim of this retrospective study is to determine the functional capacity, global muscle weakness and quality of life in COVID-19 survivors. Acute respiratory distress syndrome survivors frequently develop impaired physical function, quality of life, and muscle weakness.&#x0D; Methods: Acute respiratory distress syndrome survivors related to COVID-19 underwent standardized physical clinical evaluation, Medical Research Council-sumscore, hand-grip strength, 6-minute walk test, 5 repetition-chair-stand test, timed up and go test and Short form-36 evaluation following 4-6 weeks after hospital discharge in Physical Medicine and Rehabilitation Outpatient Clinic.&#x0D; Results: Fifteen patients (10 men, 5 women) with median age 69 years and length of intensive care unit stay 10 days were analyzed. There were impairments in 6-minute walk test, 5 repetition-chair-stand test, hand-grip strength and, Role-physical, Role-emotional and Social functioning domains of Short form-36. 6-minute walk distance was negatively correlated with timed up and go. SF-physical functioning was positively correlated with hand-grip strength, Medical Research Council-sumscore and 5 repetition-chair-stand. SF-general health was positively correlated with hand-grip strength.&#x0D; Conclusion: There were varying degrees of functional impairment in survivors. Therefore, it could add advantage to assess these patients after nearly 4-6 weeks following discharge in order to ascertain rehabilitation needs and giving appropriate therapies.

Early electrophysiological study variants and their relationship with clinical presentation and outcomes of patients with Guillain-Barré syndrome

This study compared the clinical outcomes of the two main neurophysiological types of Guillain-Barré Syndrome (GBS). Sixty-two GBS patients were examined clinically at onset using Medical Research Council (MRC), Hughes disability scales (HDS), and nerve conduction studies were evaluated in four limbs. The Modified Erasmus GBS outcome score (MEGOS) was assessed 2 weeks after onset. Outcomes were measured after 3 months using MRC and HDS scores. According to electrophysiological data two main groups identified acute inflammatory demyelinating polyneuropathy (AIDP = 31 cases) or acute axonal GBS including inexcitable forms (26 cases). The number of days between onset of weakness and admission was significantly shorter, and gastrointestinal symptoms were significantly higher among the axonal type than AIDP. MRC sum scores at onset and at nadir were significantly worse in the axonal type than in AIDP. Neck muscle weakness, impaired cough reflex, the need for mechanical ventilation, hypoalbuminemia, and hypernatremia were more common in the axonal type. At outcome, 74% of the AIDP were healthy/minor symptoms versus 38.46% of the axonal type. There was a high prevalence of the axonal variant (41.9%) compared with European and North American populations. The axonal type had a significantly worse outcome than AIDP type.

Muscle strength and mobility of individuals with COVID-19 compared with non-COVID-19 in intensive care

BackgroundCritical illness may affect muscle strength and mobility. ObjectivesTo compare muscle strength, mobility, and in intensive care unit (ICU)-acquired weakness (ICUAW) prevalence among individuals with COVID-19 and other critical illnesses; to identify factors associated with muscle strength, mobility, and length of stay in COVID-19; and to determine the Perme Intensive Care Unit Mobility Score (PICUMS) cut-off point for ICUAW. MethodsWe included individuals aged ≥18 in ICU who require mechanical ventilation. We excluded those diagnosed with neuromusculoskeletal diseases or who did not understand the study procedures. The Medical Research Council - sum score (MRC-SS) and the PICUMS were applied before ICU and hospital discharge. Analysis of covariance, Quade´s test, and Fisher's exact test compared groups. Partial correlations were analized between the MRC-SS and PICUMS with clinical variables. Regression models identified the predictors of hospital length of stay. The ROC curve verified the PICUMS related to ICUAW. Significance was set as P<.05. Results25 individuals were included in the COVID-19 group and 23 in the non-COVID-19 group. No between-groups difference was observed in MRC-SS and PICUMS at discharge from ICU or hospital. The MRC-SS and PICUMS at ICU discharge predicted the length of hospital stay in the COVID-19 group. The PICUMS cut-off related to ICUAW was 18. ConclusionsMuscle strength, mobility, and ICUAW are similar between COVID-19 and non-COVID-19. However, muscle strength and mobility at ICU discharge are associated with the length of stay during COVID-19. A PICUMS<18 at ICU discharge may indicate impaired physical functioning due to ICUAW.

Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach

BackgroundThere are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients.MethodsPilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient.ResultsThe ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832).ConclusionsThis study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.

Intensive care unit-acquired weakness-Diagnostic value of neuromuscular ultrasound

Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular complications in intensive care medicine. The clinical diagnosis and assessment of the severity using established diagnostic methods (e.g., clinical examination using the Medical Research Council Sum Score or electrophysiological examination) can be difficult or even impossible, especially in sedated, ventilated and delirious patients. Neuromuscular ultrasound (NMUS) has increasingly been investigated in ICUAW as an easy to use noninvasive and mostly patient compliance-independent diagnostic alternative. It has been shown that NMUS appears to be apromising tool to detect ICUAW, to assess the severity of muscular weakness and to monitor the clinical progression. Further studies are needed to standardize the methodology, to evaluate the training effort and to optimize outcome predication. The formulation of an interdisciplinary neurological and anesthesiological training curriculum is warranted to establish NMUS as acomplementary diagnostic method of ICUAW in daily clinical practice.

Demographic and clinical determinants of the quality of life in adults with inherited and acquired myopathies.

Measuring health-related quality of life (QOL) is vital for understanding the disease impact, but the complex relationship between clinical parameters and QOL remains unclear. The objective was to determine the demographic and clinical factors that influence the QOL in adults with inherited and acquired myopathies. The study was of cross-sectional design. Detailed demographic and clinical details were collected. Patients answered Neuro-QOL and Patient-Reported Outcomes Measurement Information System short-form questionnaires. Data was collected from 100 consecutive in-person patient visits. Mean age of the cohort was 49.5 ± 20.1 (18-85) years, and the majority were male (53, 53%). Bivariate analysis between the various demographic and clinical features with the QOL scales revealed single simple question (SSQ), handgrip strength, Medical Research Council (MRC) sum score, female gender, and age to be nonuniformly associated with the QOL scales. There was no difference between inherited and acquired myopathies for any of the QOL scores, except for the poorer lower limb function domain in inherited myopathies (36.7 ± 7.3 vs. 40.9 ± 11.2, p = 0.049). Linear regression models revealed lower SSQ, lower handgrip strength, and lower MRC sum score to independently predict poor QOL. Handgrip strength and SSQ serve as novel predictors of QOL in myopathies. Handgrip strength has a significant impact on physical, mental, and social domains and deserves special attention with respect to rehabilitation. SSQ correlates well with QOL and can be employed as a quick and global assessment of a patient's well-being. Differences in QOL scores between patients with inherited and acquired myopathies were minimal.

Clinical and neurophysiological description of patients with POEMS syndrome.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) is a monoclonal gammopathy with polyneuropathy as a mandatory criterion. To describe potential associations between clinical expression and electrodiagnostic patterns in POEMS syndrome. Observational, retrospective, cross-sectional study of cases cared for in a referral center, diagnosed with POEMS syndrome from 2009 to 2019. Eleven patients (8 men) were analyzed. Median age at diagnosis was 40 years (range: 31-51; mean: 37.19 ± 15.67 years). Mean latency at diagnosis was 9.7 ± 8.37 months. In all subjects, initial clinical manifestation was polyneuropathy. Most patients had an axonal pattern (n = 5), followed by demyelinating (n = 4) and mixed patterns (n = 2). Monoclonal gammopathy was observed in all (6 l and 5 k cases; immunoglobulin [Ig] G: 72 %; IgA: 18 %; IgM: 9 %). Medical Research Council sum score was lower in the axonal pattern (median: 37.00 vs. 45.5; p = 0.024). There were no differences in systemic involvement between electrophysiological patterns. Electrophysiological patterns are unlikely to have a clear extra-neurological clinical correspondence; however, this will have to be definitively proven with a larger sample size.

Evolución de la funcionalidad y la fuerza muscular desde cuidado intensivo a hospitalización en sobrevivientes por COVID-19

IntroductionThe critically ill patient hospitalized in intensive care unit (ICU), has a higher risk of deterioration in physical function. One way to counteract its related to early physiotherapy intervention, but there are few reports in patients with severe disease from COVID-19. ObjectiveTo describe the compromise and change in functionality and muscle strength in patients with COVID-19 who received early physiotherapy intervention in ICU until hospital discharge and compare the evolution according to whether or not they received invasive mechanical ventilation. MethodologyRetrospective study of patients with COVID-19 admitted to the ICU between March and September 2020 and received physiotherapy intervention. Functionality was assessed with the Barthel Index (BI) and muscle strength with the Medical Research Council Sum Score (MRC-SS), which were measured by the physiotherapist at two moments, upon discharge from ICU and from hospitalization. For the correlations, a value P<.05 was considered significant. ResultsSixty-six records were reviewed; the mean age was 53.3 (32±11.5) years; 32 (48.5%) required mechanical ventilation. Compromise in functionality and muscle strength was observed, with progressive improvement before hospital discharge: IB [64.1 (± 34.7) vs. 87.7 (± 18.4), P = .000], MRC-SS [40.5 (± 11) vs. 48 (± 9), P = .000]. The group of ventilated patients presented greater compromise: IB [34.2 (± 24.7) vs. 76.7 (± 21.2), P = .000] and MRC-SS [31.5 (± 7.2) vs. 42.3 (± 8.3), P = .000]. The days of mechanical ventilation, relaxation, and higher APACHE II showed a significant negative correlation with the outcome variables (P = .000). ConclusionsPatients with severe disease from COVID-19 who received physiotherapy intervention, showed significant changes in functionality and muscle strength. The patients who required mechanical ventilation presented greater functional compromise.

Validation of the Medical Research Council sum score (MRCss) for use in Russian-speaking patients with chronic inflammatory demyelinating polyneuropathy

Background. The use of rating scales and questionnaires is essential in an evaluation of disease course, treatment response, the disability level and quality of life in patients with chronic inflammatory demyelinating polyneuropathy. The Medical Research Council (MRC) scale and its modification Medical Research Council sum score (MRCss) are widely used for measurement of motor deficit in patients with neuromuscular disorders. However, its usage is limited by the absence of the validated version for Russian-speaking patients.Aim. To validate MRCss scale in patients with chronic inflammatory demyelinating polyneuropathy with development of a Russian version.Materials and methods. We enrolled 50 patients with chronic inflammatory demyelinating polyneuropathy (25 with typical chronic inflammatory demyelinating polyneuropathy and 25 with Lewis–Sumner syndrome). At the first step we conducted linguocultural ratification according to the standard protocol. At the second step the psychometric parameters were evaluated, such as reliability, validity and sensitivity.Results. The developed Russian version of MRCss scale demonstrated the high level of reliability, validity and sensitivity.Conclusion. As a result, we developed a validated Russian version of MRCss scale, recommended for clinical practice and research.

Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19

BackgroundPatients with critical COVID-19 often require invasive mechanical ventilation (IMV) and admission to the intensive care unit (ICU), resulting in a higher incidence of ICU-acquired weakness (ICU-AW) and functional decline. ObjectiveThis study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV. MethodsThis prospective, single-center, observational study included COVID-19 patients who required IMV for ≥48 h in the ICU between July 2020 and July 2021. ICU-AW was defined as a Medical Research Council sum score <48 points. The primary outcome was functional independence during hospitalization, defined as an ICU mobility score ≥9 points. ResultsA total of 157 patients (age: 68 [59–73] years, men: 72.6%) were divided into two groups (ICU-AW group; n = 80 versus non-ICU-AW; n = 77). Older age (adjusted odds ratio [95% confidence interval]: 1.05 [1.01–1.11], p = 0.036), administration of neuromuscular blocking agents (7.79 [2.87–23.3], p < 0.001), pulse steroid therapy (3.78 [1.49–10.1], p = 0.006), and sepsis (7.79 [2.87–24.0], p < 0.001) were significantly associated with ICU-AW development. In addition, patients with ICU-AW had significantly longer time to functional independence than those without ICU-AW (41 [30–54] vs 19 [17–23] days, p < 0.001). The development of ICU-AW was associated with delayed time to functional independence (adjusted hazard ratio: 6.08; 95% CI: 3.05–12.1; p < 0.001). ConclusionsApproximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.