A 3 months follow-up of functional dependency, muscle strength, balance and endurance in long-stay icu patients; association with rehabilitation programmes

Introduction

Over the last decades ICU survival is increasing. As a consequence, post ICU sequelae with (persistent) functional dependency in long-stay ICU patients become a topic of interest. However data on specific fields of physical performance and the potential influence of rehabilitation programmes remain scarce [1].

Objectives

To establish the course of functional dependency and specific fields of physical performance in patients with and without a (non ICU-specific) rehabilitation programme in long-stay ICU patients.

Methods

We performed a single centre prospective observational study in mixed ICU patients with a length of stay ICU > 48 hours. Patients were evaluated at ICU discharge and re-evaluated after a 3-months period in a specific post-ICU outpatient clinic. At both time points a Barthel score (BS) and grip strength (GS) were recorded. Additionally the 6 minutes walking test (6MWT), the Berg balance scale (BBS) and characteristics of individual rehabilitation programmes were assessed in the outpatient setting. Non-parametric tests for comparison between dependent and independent datasets were used. A Bonferroni correction was used for multiple comparison.

Results

In a 1-year period during 2014 80 patients were included. Baseline characteristics are provided in Table 1. Overall there was a statistical improvement over time in all functional fields (Table 2). At 3 month 5 patients (6%) remained fully/severely functionally dependent, 3 (4%) were partially functionally dependent, 16 (20%) became functionally independent with help and 56 (70%) became functionally independent. At this time point grip strength returned to normal in at least 1 hand in 90%, and in both hands in 81% of patients. The BBS at three months indicated a low fall risk in 97% of patients. However, the 6MWT at three months was only normalized in 19% of patients. 52% of patients participated in any form of (non ICU-specific) rehabilitation program, 48% did not take part in any form of rehabilitation programme. There was no statistical difference in any outcome variable of physical performance between patients with and without a rehabilitation program.

Table 1 Baseline characteristics.

Table 2 Results.

Conclusions

In long-stay ICU patients overall physical performance considerably improved in 3 months from ICU discharge. However, there are large differences in the recovery of specific fields of physical performance, irrespective of participation in non ICU-specific rehabilitation programmes. Further research to unravel the specific rehabilitation needs of long-stay ICU patients is needed.