Perme Intensive Care Unit Mobility Research Articles

Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Romanian and cross-cultural adaptation for use in Romani

Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Romanian and cross-cultural adaptation for use in Romani

Clinimetric properties of the Perme Intensive Care Unit Mobility Score

Background:The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective:To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods:This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by theHosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results:A total of 1.200 adult patient records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictivevalidity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusions:Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.

Short-term effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients: a randomized blinded clinical trial

Background: The effects of in-bed cycling on mobility and muscle strength is not well established, in parts due to the difficulty of measuring mobility. Objective: Investigate the effect of active lower limb cycle ergometry on mobility and muscle strength in critically ill patients evaluated by the Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Methods: Critically ill patients dependent on mechanical ventilation were randomized, determining the control group and the experimental group. A intervention was applied for eight consecutive days and a blind physiotherapists assessed mobility before and after interventions. The experimental group (EG) was an active lower limb in-bed cycle ergometry by 15 minutes (once a day), associated with routine physiotherapy intervention (twice a day). The control group (CG) had routine physiotherapy intervention. The two-factor mixed ANOVA with Bonferroni correction tested the mobility status and muscle strength, evaluated by Perme Intensive Care Unit Mobility Score and Medical Research Council, respectively. Results: Thirty-seven patients were eligible, but 24 completed the study (12 each group). There was an interaction between interventions (before and after) and groups for mobility (F=59.513, p=0.006). But there was no interaction for muscle strength (F=4.097 p=0.055). The groups were similar before intervention for mobility [(p=0.343); confidence interval: (CG: 8.239 to 10.761) and (EG: 7.405 to 9.928)], but only the experimental group demonstrated improvement in mobility post-intervention [(p=0.017); confidence interval: (15.807 to 21.193)]. Conclusion: Compared to routine physiotherapy, in-bed cycling improved the mobility level, but not in muscle strength. Perme score was sensible to measure the mobility evolution in critical patients.

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.

Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.

Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options. Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population. This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed. There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, -2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate. In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.

Assessment of psychometric properties, cross-cultural adaptation, and translation of the Turkish version of the ICU mobility scale

Background/aim The aim of the study was to carry out the cultural adaptation and translation of the ICU mobility scale (IMS) into Turkish and research the psychometric properties.Materials and methods This study was based on methodological design. The IMS was translated from English to the Turkish through a regularised translation process. Two physiotherapists assessed patients independently in the coronary intensive care unit. The measures such as construct validity, intra and interrater reliability, and internal consistency of the IMS Turkish version were assessed. Results A total of 70 intensive care patients were included in the study. The intrarater and interrater reliability of the IMS was excellent. The weighted Kappa value was 0.92 (0.87–0.96) for the intrarater reliability, and 0.87 (0.80–0.93) for the interrater reliability. There were significant correlations between the IMS and functional status score for the intensive care unit (r = 0.83), Perme intensive care unit mobility score (r = 0.84), Katz activities of daily living (r = 0.73), handgrip strength (r = 0.62), knee extension strength (r = 0.46), and age (r = –0.44).Conclusion This study suggests that the IMS Turkish version is a reliable and valid scale for assessing functional status and mobility level in ICU patients.

Impact of early ambulation on functionality in patients undergoing valve replacement surgery

Cardiac surgery is a highly complex procedure that aims to increase and prolong the quality of life of patients. The role of physiotherapy in early mobilization after cardiac surgery has shown several benefits to the patient when he presents impairments in terms of functionality. To evaluate the impact of early ambulation on the functionality of patients undergoing cardiac valve replacement surgery. Prospective cohort study in patients undergoing cardiac valve replacement surgery. Patients had their functionality assessed preoperatively using the Functional Independence Measurement (FIM) and Perme Intensive Care Unit (ICU) Mobility Score scales. At ICU discharge, they were divided into two groups: walking group (WG) and non-WG (NWG). At discharge, the two functional scales were reapplied in these patients. Pre- and postoperative values were assessed using the independent Student's t-test. It was considered statistically significant when P<0.05. One hundred and seventy patients were evaluated, 110 (65%) male, with a mean age of 48±2 years. In relation to Perme Score, the WG had a decrease of 11±2 and the NWG had a decrease of 13±2 (P=0.34). Regarding FIM, those who walked had a decrease of 27±3 against those who did not walk, which showed a reduction of 36±5, with a significance level of P<0.001. Based on the FIM data found, patients undergoing cardiac valve replacement surgery who underwent early mobilization had less decrease of functionality compared to patients who did not ambulate. Based on this article, we can demonstrate that walking while still in the ICU environment favors less loss of functionality for patients after valve replacement surgery.

Rehabilitation of Patients Presenting With Coronavirus Disease-19 and Hemiparesis: A Case Series

Introduction: The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19. Case Presentation: This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functional mobility, neurological re-education, and cognition. The mobility status was assessed with the Perme Intensive Care Unit Mobility Score. Conclusion: Patients who present with COVID-19 need careful screening for neurological impairment. Conventional means to diagnose stroke, such as radiological imaging, can be difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance.

Spanish version of the Perme Intensive Care Unit Mobility Score: Minimal detectable change and responsiveness.

The purpose of this study was to determine the minimal detectable change (MDC) and responsiveness of the Perme Score when used in the adult intensive care unit (ICU) population. This is a prospective longitudinal study which was conducted from November 2016 to July 2017 in Cali, Colombia. Four physical therapists with observer and evaluator roles, applied the Perme Score upon ICU admission and discharge. The Consensus-based Standards for the Selection of Health Measurement Instruments Protocol standards to analyze sensitivity to change were used. The sample size was defined considering the lowest concordance proportion reported (68.6%), and a Kappa Index of 0.2784 or higher to guarantee an adequate n, and a 95% reliability level. One hundred and forty-two patients were enrolled in the study. There were 51.4% men with an average age of 58 ± 17 years. Invasive mechanical ventilation was employed in 42.0% of the patients. The MDC for the Perme Score was 1.36, and 80% of patients demonstrated higher or equal values, detecting a significant difference in the type of weaning and the length of stay in the ICU (p < 0.005). The Perme Score has an MDC of 1.36 points and shows evidence of being sensitive to change. Therefore, the findings validate the responsiveness of the instrument.

Recovery Pattern and Barriers to Mobilization during Acute Rehabilitation Phase in Organophosphate Poisoning Patients

Organophosphate pesticide poisoning is a common clinical problem in developing countries, bringing with it significant morbidity and mortality. There is limited evidence on the mobility status in patients who survive acute intoxication by organophosphates. The purpose of this study is to assess the mobility patterns and barriers to mobilization in organophosphate poisoning survivors in the intensive care unit. This cross-sectional study looked at 37 patients with acute intoxication from organophosphate compounds. Patients with Acute Physiology and Chronic Health Evaluation scores of less than 93 and Richmond Agitation and Sedation scores between −2 and +2 were included. Potential mobility barriers, bed mobility, functional strength, transfers, and endurance were assessed using the Perme Intensive Care Unit Mobility score on alternative days for the first ten days of intensive care unit admission. Perme scores (2.50–6.0, p ≤ 0.01) improved significantly with improvement in the subcomponents of bed mobility score (1.83 ± 0.35 to 7.23 ± 3.84), transfers (0.37 ± 0.02 to 4.78 ± 3.84), and gait (1.83 ± 0.35 to 5.23 ± 1.27) from day 2 through day 10 of hospital admission. The endotracheal tube and continuous infusion were identified as major barriers to mobilization (66.6%) using Perme scores. Perme scores improved gradually in organophosphate poisoning patients in the intensive care unit. Identification of mobility barriers may help in the modification of rehabilitation goals.

The Effect of Speaking Valves on ICU Mobility of Individuals With Tracheostomy.

Early mobilization is part of the rehabilitation process for critically ill patients and is currently considered a means of preventing ICU-acquired muscle deterioration and worsening of physical function. We sought to determine whether the use of speaking valves in tracheostomized patients would improve their mobility. We evaluated the changes in mobility performance with the use of speaking valves in tracheostomized subjects. We performed a cohort study of a series of subjects who were tracheostomized and were being weaned from mechanical ventilation between April 2016 and May 2018. The subjects were those able to tolerate a speaking valve for a minimum of 30 min. Demographic data, comorbidities, cause of ICU admission, days in the ICU, duration of mechanical ventilation before tracheostomy, and days free from mechanical ventilation before tracheostomy were collected. Mobility status was evaluated using daily measurements of the Perme Intensive Care Unit Mobility Score. During the study period, 63 patients were tracheostomized. Patients with deficiencies in language (n = 2) or cognitive deficits (n = 36) and patients in exclusive palliative care (n = 7) were excluded. Eighteen subjects were enrolled in the study. The mean age of the subjects was 64.6 ± 14.2 y (55.5% were male), and the most common reason for ICU admission was pneumonia (n = 7; 38.8%). Perme scores increased from 11.3 (interquartile range 10.1-12.0) on the day before initiation of the speaking valve to 18.2 (IQR 16.2-20.1) immediately after the initiation of a speaking valve (P < .01). These changes were maintained during all periods of speaking valve use. The use of speaking valves in tracheostomized subjects improved mobility.

Turkish translation, cross-cultural adaptation, and assessment of psychometric properties of the Functional Status Score for the Intensive Care Unit

Purpose: To translate and cross-culturally adapt the Functional Status Score for the Intensive Care Unit instrument to Turkish and investigate its psychometric properties.Methods: An expert committee supervised forward and backward translation. Thirteen participants reviewed the pre-final version of Turkish Functional Status Score for the Intensive Care Unit instrument providing minor revisions to improve its readability. Two physiotherapists assessed patients (N = 50) from a coronary intensive care unit using the Turkish Functional Status Score for the Intensive Care Unit instrument.Results: Internal consistency was excellent (Cronbach's α = 0.949). Inter-rater reliability and intra-rater reliability were excellent for each of five functional tasks and total scores (intra-class correlation coefficient = 0.955–0.996). The Turkish Functional Status Score for the Intensive Care Unit score had moderate to high correlations with other functional measures as follows: Perme Intensive Care Unit Mobility Score (Spearman's r = 0.92), Katz Activities of Daily Living (r = 0.80), handgrip strength (r = 0.76–0.77), and knee extension strength (r = 0.70–0.71).Conclusion: The Functional Status Score for the Intensive Care Unit instrument was translated and culturally adapted to Turkish and demonstrated strong psychometric properties, including internal consistency, intra-rater and inter-rater reliability, construct validity, and floor and ceiling effects.Implications for rehabilitationRehabilitation professionals strive to assess and document patient status using validated and reliable outcome measures as part of good clinical practice.Longitudinal evaluation of physical function in the intensive care units is important.The Functional Status Score for the Intensive Care Unit is a validated and reliable physical functioning measurement instrument suitable for the intensive care units.The Functional Status Score for the Intensive Care Unit was translated and culturally adapted to Turkish, and demonstrated strong psychometric properties, including internal consistency, intra-rater reliability, inter-rater reliability, construct validity, and floor and ceiling effects.

Perme ICU Mobility Score (Perme Score) and the ICU Mobility Scale (IMS): translation and cultural adaptation for the Spanish language.

Introduction: The scales to measure functional mobility in critically ill patients were developed and validated in English, there is a need for these tools in Spanish speaking countries. Objective: To perform translation, cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Intensive Care Unit Mobility Score and IMS tools in ICU patients.Methods: Translation and validation study between November 2016 and July 2017, following the COSMIN Protocol's recommendations. Two couples of physiotherapists with the role of observer/rater applied both scales in 150 patients upon admission and discharge of a medical-surgical ICU from a private hospital in Colombia. The sample size was defined taking into account the lowest proportion of reported agreement (68.57%), a Kappa index of 0.2784 or higher to ensure that the calculated n was adequate, and a confidence level of 95% Results: Translation and cultural adaptation were performed, the final version of both scales in Spanish was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 63 (42%) of the cases. Inter-rater reliability of the ICU Mobility Scale was between 0.97 and 1.00, and for the Perme Intensive Care Unit the Mobility Score it was between 0.99 and 1 in the two moments of the measurements. Conclusions: Both scales were translated and culturally adapted and presented excellent inter-rater reliability in the two pairs of raters (rater/observer).

Perme ICU Mobility Score (Perme Score) and the ICU Mobility Scale (IMS): translation and cultural adaptation for the Spanish language

Introduction: The scales to measure functional mobility in critically ill patients were developed and validated in English, there is a need for these tools in Spanish speaking countries.&#x0D; Objective: To perform translation, cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Intensive Care Unit Mobility Score and IMS tools in ICU patients.&#x0D; Methods: Translation and validation study between November 2016 and July 2017, following the COSMIN Protocol's recommendations. Two couples of physiotherapists with the role of observer/rater applied both scales in 150 patients upon admission and discharge of a medicalsurgical ICU from a private hospital in Colombia. The sample size was defined taking into account the lowest proportion of reported agreement (68.57%), a Kappa index of 0.2784 or higher to ensure that the calculated n was adequate, and a confidence level of 95%&#x0D; Results: Translation and cultural adaptation were performed, the final version of both scales in Spanish was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 63 (42%) of the cases. Inter-rater reliability of the ICU Mobility Scale was between 0.97 and 1.00, and for the Perme Intensive Care Unit the Mobility Score it was between 0.99 and 1 in the two moments of the measurements.&#x0D; Conclusions: Both scales were translated and culturally adapted and presented excellent inter-rater reliability in the two pairs of raters (rater/observer).

Perme Intensive Care Unit Mobility Score: Analysis of mobility improvement in critical care patients admitted to a university hospital in Brazil

Solubility equilibria of solids in water are an integral part of the thermodynamic assessment of the long term behavior of nuclear waste in geological formations. In this paper, we do not provide new thermodynamic data on solubility of relevant solids but we show, under which conditions meaningful thermodynamic data can be derived from solubility data and under which conditions this is not the case. Application of isotopic exchange techniques shows that sometimes equilibrium is only established between the surface and the solution, in other cases equilibrium involves the overall solid/liquid phase system. In case of slow reaction rates of oxides of tetravalent radionuclides, bulk phase thermodynamic data cannot be obtained from such systems.

The German translation of the Perme Intensive Care Unit Mobility Score and inter-rater reliability between physiotherapists and nurses

Purpose: Patients in intensive care units (ICU)] are routinely mobilised by physiotherapists (PT) and registered nurses (RN), requiring multi-professional assessments. The Perme ICU Mobility Score (Perme Score) is a comprehensive tool to specifically describe the mobility status of patients in ICU. The aim of the study was to translate the Perme Score into German language and investigate the inter-rater reliability between PT and RN.Methods: Prospective, observational study for reporting reliability between PT and RN. The Perme Score was translated from English to the German language in a regularised translation process. PT and RN assessed patients independently in a cardio-vascular ICU (CVICU). Inter-rater reliability was calculated by intraclass correlation coefficient (ICC) with 95% confidence interval (95% CI).Results: The ICC for overall inter-rater reliability was 0.962 (95% CI: 0.934–0.978) in the assessment of 58 patients. Only two items were assessed with an ICC less than 0.8: ability to follow commands (0.738, 95% CI: 0.556–0.898) and pain (0.462, 95% CI: 0.099–0.680). Two items were constant variables (lines and infusions).Conclusions: The German version of the Perme Score presented a high inter-rater reliability between PT and RN in CVICU and is an inter-professional tool to assess the mobility status of patients in CVICU.

Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil.

ABSTRACTObjective:To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods:The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results:The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement (κ > 0.90) and reliability (α > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions:In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.

Initial interrater reliability for a novel measure of patient mobility in a cardiovascular intensive care unit

PurposeThe purpose of this study was to determine the interrater reliability of the Perme Intensive Care Unit Mobility Score. Materials and methodsThis was a prospective observational study. Data were collected from 20 patients admitted in a cardiovascular intensive care unit. The interrater reliability was tested using the intraclass correlation coefficient with 95% confidence interval and the Cohen κ coefficient of 0.9, using a 2-tailed α of .05 to provide a 90% power. ResultsThe 15 items of the Perme ICU Mobility Score were individually analyzed. Interrater reliability (Cohen κ coefficient) for items 2, 3, 5, 6, 7, 8, 13, and 15 was 1.0000; for item 1, 0.8276; item 4, 0.8000; item 9, 0.6000; item 10, 0.7297; item 11, 0.7260; item 12, 0.7872; and item 14, 0.9048; the intraclass correlation coefficient (95% confidence interval) was 0.9880 (0.97743-0.99859). ConclusionsThe Perme ICU Mobility Score is a reliable tool to assess mobility status of patients admitted to the cardiovascular intensive care unit in a specific moment in time, which can be an important tool for research and clinical practice.