Dataset Information

Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study.

ABSTRACT:

Objective

To describe predictors for health-related quality of life, participation, physical activity and cognitive function in patients with intensive care unit (ICU)-acquired muscle weakness 1 year after discharge from rehabilitation.

Design

This is a cohort study.

Participants

We included 150 chronic critically ill individuals with ICU-acquired muscle weakness.

Setting

Postacute ICU and rehabilitation units in Germany.

Measures

We measured health-related quality of life using the EQ-5D, participation using the Reintegration of Normal Living Index, physical activity using the Physical Activity Scale for Individuals With Physical Disabilities, and basal cognitive function using the Montreal Cognitive Assessment (MoCA) at 6?months, and the Clock Drawing Test 6 and 12 months after discharge from postacute treatment. We described the predictors of the results at 12 months.

Results

The best predictors for good health-related quality of life 1?year after discharge were the time until regaining walking ability (OR=0.96, OR per day, 95% CI 0.93 to 0.99) and the mean MoCA score on admission to our postacute ICU and rehabilitation units (OR=1.25,95% CI 1.02 to 1.52).The best predictor for good participation 1?year after discharge was the MoCA sum score on admission to our postacute ICU and rehabilitation units (OR=0.85,95% CI 0.72 to 1.00). The best predictor for good physical activity 1?year after discharge was the Apache sum score on admission to our postacute ICU and rehabilitation units (OR=1.68,95% CI 0.89 to 3.13). The best predictor for normal cognitive function 1?year after discharge was regaining walking function in rehabilitation (OR=8.0,95% CI 0.49 to 13.69).

Conclusion

Recovery of health-related quality of life, participation, physical activity and basal cognitive function was still not complete 12 months after discharge from postacute treatment. We described the predictors for these important outcomes in participants with ICU-acquired muscle weakness 1?year after discharge from rehabilitation.

Trial registration number

DRKS00007181.

SUBMITTER: Thomas S

PROVIDER: S-EPMC6082458 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study.

Thomas Simone S Mehrholz Jan J

BMJ open 20180713 7

<h4>Objective</h4>To describe predictors for health-related quality of life, participation, physical activity and cognitive function in patients with intensive care unit (ICU)-acquired muscle weakness 1 year after discharge from rehabilitation.<h4>Design</h4>This is a cohort study.<h4>Participants</h4>We included 150 chronic critically ill individuals with ICU-acquired muscle weakness.<h4>Setting</h4>Postacute ICU and rehabilitation units in Germany.<h4>Measures</h4>We measured health-related qu ...[more]

PMID: 30007926

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Project description:Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient's ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

Project description:BACKGROUND:The relationship between aminoglycoside use and intensive care unit (ICU)-acquired weakness remains controversial. In the present study, we performed a systematic review and meta-analysis to examine the relationship between aminoglycoside use and ICU-acquired weakness in critically ill patients. METHODS:The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature databases were searched from the earliest available date to July 10, 2019. Randomized controlled trials and prospective cohort studies examining the relationship between aminoglycosides and ICU-acquired weakness in adult ICU patients were included. Two authors independently screened titles/abstracts, reviewed full text and extracted data from the included studies. We performed the Meta-analysis using Stata version 15.0 and used the DerSimonian-Laird random effects model for data analyses. Heterogeneity was evaluated using the χ2 statistic and I2 statistic. Publication bias was evaluated with funnel plots qualitatively, the Begg's test and Egger's test quantitatively. RESULTS:Ten prospective cohort studies were included and analysed in this review. The overall effect sizes of the studies revealed a statistically significant relationship between aminoglycoside use and ICU-acquired weakness (OR, 2.06; 95%CI, 1.33-3.21; I2 = 56%). Subgroup and sensitivity analyses suggested a significant association between aminoglycoside use and studies limited to patients with clinical weakness (OR, 2.74; 95%CI, 1.83-4.10; I2 = 0%), and not to studies limited to patients with abnormal electrophysiology (OR, 1.78; 95%CI, 0.94-3.39; I2 = 59%), a large sample size (OR, 1.81; 95%CI, 0.97-3.39; I2 = 75%), or low risk of bias (OR, 1.59; 95%CI, 0.97-2.60; I2 = 56%); however, statistical heterogeneity was obvious. There were no significant publication biases found in the review. CONCLUSIONS:The review revealed a significant relationship between aminoglycoside use and ICU-acquired weakness.

Dataset Information

Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study.

Objective

Design

Participants

Setting

Measures

Results

Conclusion

Trial registration number

Publications

Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study.

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