Grip Strength Correlates with Mental Health and Quality of Life after Critical Care: A Retrospective Study in a Post-Intensive Care Syndrome Clinic

Abstract

Post-intensive care syndrome (PICS) is characterized by several prolonged symptoms after critical care, including physical and cognitive dysfunctions as well as mental illness. In clinical practice, the long-term follow-up of PICS is initiated after patients have been discharged from the intensive care unit, and one of the approaches used is a PICS clinic. Although physical dysfunction and mental illness often present in combination, they have not yet been examined in detail in PICS patients. Grip strength is a useful physical examination for PICS, and is reported to be associated with mental status in the elderly. We herein investigated the relationship between grip strength and the mental status using data from our PICS clinic. We primarily aimed to analyze the correlation between grip strength and the Hospital Anxiety and Depression Scale (HADS) score. We also analyzed the association between grip strength and the EuroQol 5 Dimension (EQ5D) score as quality of life (QOL). Subjects comprised 133 patients who visited the PICS clinic at one month after hospital discharge between August 2019 and December 2020. Total HADS scores were 7 (4, 13) and 10 (6, 16) (p = 0.029) and EQ5D scores were 0.96 (0.84, 1) and 0.77 (0.62, 0.89) (p ≤ 0.0001) in the no walking disability group and walking disability group, respectively. Grip strength negatively correlated with HADS and EQ5D scores. Correlation coefficients were r = −0.25 (p = 0.011) and r = −0.47 (p < 0.0001) for HADS and EQ5D scores, respectively. Grip strength was a useful evaluation that also reflected the mental status and QOL.

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“…Muscle strength was also independently correlated with mental status and HRQOL [60], while muscle weakness seemed to contribute to the cognitive and mental sequelae in PICS (Figure 1). There is no therapeutic intervention of proven efficacy for PICS-related muscle weakness; however, several interventions have been assessed for prevention and symptom management and are under investigation [51,61,62].…”

“…Physical dysfunction requires a multidisciplinary approach that includes exercise, physiotherapy, occupational therapy, and rehabilitation and requires the involvement of critical care physicians, neuropsychiatrists, physiotherapists, and respiratory therapists (Figure 4) [154]. New promising techniques that target recovery from PICS by combining objective lean body mass and metabolic assessments, novel nutrition and exercise inter-ventions can be applied in this setting [53,60,61]. For example, it has been shown that muscle glycogen stores are depleted early during critical illness [60].…”

“…New promising techniques that target recovery from PICS by combining objective lean body mass and metabolic assessments, novel nutrition and exercise inter-ventions can be applied in this setting [53,60,61]. For example, it has been shown that muscle glycogen stores are depleted early during critical illness [60]. This is important since muscle protein must then be broken down by the body for energy once glycogen stores are depleted.…”

“…New ultrasound technologies have been developed that measure muscle glycogen content, and when combined with appropriate nutritional interventions, may assist in restoring anabolic ability and reducing or reversing muscle loss [155]. Similar approaches aimed at personalized medicine also involve the design of appropriate personalized rehabilitation plans that combine aerobic and workload exercise with electrical muscle stimulation [60,142].…”

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“…The MRC score is mainly used to diagnose ICU-AW, but it can be feasible to follow the physical functional effects of PICS [29]. The grip strength is also valid to evaluate muscle strength associated with mental health and QOL [30]. The 6-min walk test is one of the most reliable physical functional tests in PICS although this is feasible in a limited number of patients [9,28].…”