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Original Article
Factors associated with functional decline in an intensive care unit: a prospective study on the level of physical activity and clinical factors
Rev Bras Ter Intensiva. 2021;33(4):565-571
Abstract
Original ArticleFactors associated with functional decline in an intensive care unit: a prospective study on the level of physical activity and clinical factors
Rev Bras Ter Intensiva. 2021;33(4):565-571
DOI 10.5935/0103-507X.20210073
Views1See moreABSTRACT
Objective:
To identify the factors associated with functional status decline in intensive care unit patients.
Methods:
In this prospective study, patients in an intensive care unit aged 18 years or older without neurological disease or contraindications to mobilization were included. The exclusion criteria were patients who spent fewer than 4 days in the intensive care unit or died during the study period. Accelerometry was used to assess the physical activity level of patients. We recorded age, SAPS 3, days on mechanical ventilation, drugs used, comorbidities, and functional status after intensive care unit discharge. After intensive care unit discharge, the patients were assigned to a dependent group or an independent group according to their Barthel index. Logistic regression and the odds ratio were used in the analyses.
Results:
Sixty-three out of 112 included patients were assigned to the dependent group. The median Charlson comorbidity index was 3 (2 – 4). The mean SAPS 3 score was 53 ± 11. The patients spent 94 ± 4% of the time spent in inactivity and 4.8 ± 3.7% in light activities. The odds ratio showed that age (OR = 1.08; 95%CI 1.04 – 1.13) and time spent in inactivity (OR = 1.38; 95%CI 1.14 – 1.67) were factors associated with functional status decline. Time spent in light activity was associated with a better functional status (OR = 0.73; 95%CI 0.60 – 0.89).
Conclusions:
Age and time spent in inactivity during intensive care unit stay are associated with functional status decline. On the other hand, performing light activities seems to preserve the functional status of patients.
Views1
Abstract
Original ArticleFactors associated with functional decline in an intensive care unit: a prospective study on the level of physical activity and clinical factors
Rev Bras Ter Intensiva. 2021;33(4):565-571
DOI 10.5935/0103-507X.20210073
Views1See moreABSTRACT
Objective:
To identify the factors associated with functional status decline in intensive care unit patients.
Methods:
In this prospective study, patients in an intensive care unit aged 18 years or older without neurological disease or contraindications to mobilization were included. The exclusion criteria were patients who spent fewer than 4 days in the intensive care unit or died during the study period. Accelerometry was used to assess the physical activity level of patients. We recorded age, SAPS 3, days on mechanical ventilation, drugs used, comorbidities, and functional status after intensive care unit discharge. After intensive care unit discharge, the patients were assigned to a dependent group or an independent group according to their Barthel index. Logistic regression and the odds ratio were used in the analyses.
Results:
Sixty-three out of 112 included patients were assigned to the dependent group. The median Charlson comorbidity index was 3 (2 – 4). The mean SAPS 3 score was 53 ± 11. The patients spent 94 ± 4% of the time spent in inactivity and 4.8 ± 3.7% in light activities. The odds ratio showed that age (OR = 1.08; 95%CI 1.04 – 1.13) and time spent in inactivity (OR = 1.38; 95%CI 1.14 – 1.67) were factors associated with functional status decline. Time spent in light activity was associated with a better functional status (OR = 0.73; 95%CI 0.60 – 0.89).
Conclusions:
Age and time spent in inactivity during intensive care unit stay are associated with functional status decline. On the other hand, performing light activities seems to preserve the functional status of patients.
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Original Articles
Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit
Rev Bras Ter Intensiva. 2019;31(4):521-528
Abstract
Original ArticlesAssessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit
Rev Bras Ter Intensiva. 2019;31(4):521-528
DOI 10.5935/0103-507X.20190065
Views1See moreABSTRACT
Objective:
To compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain).
Methods:
In this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach’s alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson’s correlation).
Results:
The FSS-ICU and FIM presented adequate internal consistency (Cronbach’s alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM).
Conclusion:
The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.
Views1Abstract
Original ArticlesAssessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit
Rev Bras Ter Intensiva. 2019;31(4):521-528
DOI 10.5935/0103-507X.20190065
Views1See moreABSTRACT
Objective:
To compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain).
Methods:
In this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach’s alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson’s correlation).
Results:
The FSS-ICU and FIM presented adequate internal consistency (Cronbach’s alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM).
Conclusion:
The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis