Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

Fan, Eddy; Ciesla, Nancy; Truong, A.; Bhoopathi, Vinodh; Zeger, Scott L.; Needham, Dale M.

doi:10.1007/s00134-010-1796-6

Cited by 138 publications

(104 citation statements)

References 21 publications

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“…Of these patients, 20% died before hospital discharge, 7% died after discharge and before initial follow-up, and 25% met exclusion criteria ( Figure 1). For the 203 survivors who consented and were eligible for follow-up in this study (29 At 6-month follow-up, the mean (6 SD) muscle strength, as a percentage of maximum MRC sum-score, was 92% (6 8%), with 8% (13 of 169) having ICUacquired weakness, and the mean (6 SD) percent-predicted values for 6MWT and SF-36 PF were 64% (6 22%) and 61% (6 36%), respectively. There was relatively small improvement observed in mean physical outcome measures between 6 and 12 months (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Needham

Wozniak

Hough

et al. 2014

Am J Respir Crit Care Med

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168

133

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Rationale: Existing studies of risk factors for physical impairments in acute lung injury (ALI) survivors were potentially limited by single-center design or relatively small sample size.Objectives: To evaluate risk factors for three measures of physical impairments commonly experienced by survivors of ALI in the first year after hospitalization.Methods: A prospective, longitudinal study of 6-and 12-month physical outcomes (muscle strength, 6-minute-walk distance, and Short Form [SF]-36 Physical Function score) for 203 survivors of ALI enrolled from 12 hospitals participating in the ARDS Network randomized trials. Multivariable regression analyses evaluated the independent association of critical illness-related variables and intensive care interventions with impairments in each physical outcome measure, after adjusting for patient demographics, comorbidities, and baseline functional status.Measurements and Main Results: At 6 and 12 months, respectively, mean (6 SD) values for strength (presented as proportion of maximum strength score evaluated using manual muscle testing) was 92% (6 8%) and 93% (6 9%), 6-minute-walk distance (as percent-predicted) was 64% (6 22%) and 67% (6 26%), and SF-36 Physical Function score (as percent-predicted) was 61% (6 36%) and 67% (6 37%). After accounting for patient baseline status, there was significant association and statistical interaction of mean daily dose of corticosteroids and intensive care unit length of stay with impairments in physical outcomes.Conclusions: Patients had substantial impairments, from predicted values, for 6-minute-walk distance and SF-36 Physical Function outcome measures. Minimizing corticosteroid dose and implementing existing evidence-based methods to reduce duration of intensive care unit stay and associated patient immobilization may be important interventions for improving ALI survivors' physical outcomes.

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Section: Resultsmentioning

confidence: 99%

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Needham

Wozniak

Hough

et al. 2014

Am J Respir Crit Care Med

Self Cite

168

133

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“…ICUAW was defined as MRC sum score for muscle strength to be Ͻ48, provided no other cause of weakness could be identified (147). Since then, many other publications have used the MRC sum score to diagnose ICUAW (10,44,51,143,144,149,189,273,305,325,413,499,536,598,623,632) without referring to the precise underlying disease entity (FIGURE 1B). This clinical approach revealed that weakness affects proximal muscles more than distal muscles (147,305,413).…”

Section: B Aspects Of Clinical Evaluation and Diagnosticsmentioning

confidence: 99%

“…The MRC sum score was proposed as a routine and first line screening tool in the ICU for patients at risk for developing ICUAW (268,402,622,661). As reported in various clinical settings [mechanically ventilated patients with acute stroke (267), Guillain-Barré syndrome (369), stimulants (189), post ICU (40, 325)], inter-rater reproducibility was found to be good in a large study of critically ill patients (301), and one smaller series (10), but not in two other small studies (129,325). Methodological issues such as judging the adequate awakening and cooperation of the patient required to perform the test may be very important.…”

Section: B Aspects Of Clinical Evaluation and Diagnosticsmentioning

confidence: 99%

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Friedrich

Reid

Berghe

et al. 2015

Physiological Reviews

291

329

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Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca 2ϩ dysregulation is present through altered Ca 2ϩ homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models.

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“…Th ese include the 4-m timed walk speed (in meters per second), [24][25][26] manual muscle testing using the Medical Research Council sum score 27,28 (range, 0-60, with , 48 indicating ICU-acquired weakness 29 ), and spirometry 30 (reported as FEV 1 % predicted based on normative values 31 ). Patient-reported measures included the Medical Outcomes Survey 36-Item Short Form (SF-36) 32 PF domain, the Functional Performance Inventory 33 overall score, and the Euro-QOL (EQ-5D) 34 mobility subscale.…”

Section: Study Measuresmentioning

confidence: 99%

Construct Validity and Minimal Important Difference of 6-Minute Walk Distance in Survivors of Acute Respiratory Failure

Chan

Pfoh

Denehy

et al. 2015

Chest

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OBJECTIVE: Th e 6-min walk distance (6MWD), a widely used test of functional capacity, has limited evidence of construct validity among patients surviving acute respiratory failure (ARF) and ARDS. The objective of this study was to examine construct validity and responsiveness and estimate minimal important diff erence (MID) for the 6MWD in patients surviving ARF/ARDS . METHODS:For this secondary data analysis of four international studies of adult patients surviving ARF/ARDS (N 5 641), convergent and discriminant validity, known group validity, predictive validity, and responsiveness were assessed. MID was examined using anchor-and distribution-based approaches. Analyses were performed within studies and at various time points aft er hospital discharge to examine generalizability of fi ndings. RESULTS:Th e 6MWD demonstrated good convergent and discriminant validity, with moderate to strong correlations with physical health measures (| r | 5 0.36-0.76) and weaker correlations with mental health measures (| r | 5 0.03-0.45). Known-groups validity was demonstrated by diff erences in 6MWD between groups with diff ering muscle strength and pulmonary function (all P , .01). Patients reporting improved function walked farther, supporting responsiveness. 6MWD also predicted multiple outcomes, including future mortality, hospitalization, and health-related quality of life. Th e 6MWD MID, a small but consistent patient-perceivable effect, was 20 to 30 m. Findings were similar for 6MWD % predicted, with an MID of 3% to 5%. CONCLUSIONS:In patients surviving ARF/ARDS, the 6MWD is a valid and responsive measure of functional capacity. Th e MID will facilitate planning and interpretation of future group comparison studies in this population.

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Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

Cited by 138 publications

References 21 publications

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill

Construct Validity and Minimal Important Difference of 6-Minute Walk Distance in Survivors of Acute Respiratory Failure

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