Musculoskeletal complications following critical illness: A scoping review

Abstract

Purpose To explore the extent to which musculoskeletal (MSK) complications have been reported following critical illness, identifying evidence gaps and providing recommendations for future research. Materials and methods We searched five databases from January 1st 2000 to March 31st 2021. We included published original research reporting MSK complications in patients discharged from hospital following an admission to an intensive care unit (ICU). Two reviewers independently screened English language articles for eligibility. Data extracted included the MSK area of investigation and MSK outcome measures. The overall quality of study was evaluated against standardised reporting guidelines. Results 4512 titles were screened, and 32 met the inclusion criteria. Only one study included was interventional, with the majority being prospective cohort studies ( n = 22). MSK complications identified included: muscle weakness or atrophy, chronic pain, neuromuscular dysfunction, peripheral joint impairment and fracture risk. The quality of the overall reporting in the studies was deemed adequate. Conclusions We identified a heterogenous body of literature reporting a high prevalence of a variety of MSK complications extending beyond muscle weakness, therefore future investigation should include evaluations of more than one MSK area. Further investigation of MSK complications could inform the development of future post critical illness rehabilitation programs.

Musculoskeletal health state and physical function of intensive care unit survivors: protocol for a UK multicentre prospective cohort study (the MSK-ICU study)

“…A scoping review of MSK complications following critical illness highlighted a number of studies investigating MSK health after hospital discharge. 12 Most studies evaluated a single aspect of MSK health, with peripheral muscle weakness, chronic pain and abnormal neuromuscular function being the most commonly assessed and reported problems. A high prevalence of MSK complications were reported with the shoulder identified as the most commonly affected joint.…”

“…This potential source of long-term disability in ICU survivors is under-investigated. A scoping review of MSK complications following critical illness highlighted a number of studies investigating MSK health after hospital discharge 12. Most studies evaluated a single aspect of MSK health, with peripheral muscle weakness, chronic pain and abnormal neuromuscular function being the most commonly assessed and reported problems.…”

The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis

“…Complications including profound weakness, pain, agitation, and delirium are commonly experienced by patients admitted into the intensive care unit (Devlin et al, 2018;Gustafson et al, 2021). These physical and cognitive impairments associated with critical illness and treatments received in the intensive care unit negatively impact health-related quality of life following hospital discharge for many patients and their families (Rengel et al, 2019).…”

Mapping peripheral and abdominal sarcopenia acquired in the acute phase of COVID-19 during 7 days of mechanical ventilation

“…Studies show that prolonged bed rest is associated with multiple complications by inducing 25–33% muscle mass loss at an early stage of critical illness in the first week of hospitalization 3 – 6 . Furthermore, muscle impairment encompassing atrophy, weakness, or muscle function decrease has been widely reported (9–73%) in several studies and is persistent for approximately 6 months to 5 years after ICU discharge 7 .…”

“…Early detection of muscle changes is necessary for appropriate management of rehabilitation strategies 7 , 16 , but volitional tests are not applicable in this acute disease phase 17 , 18 . Nonvolitional assessment tools such as computed tomography and magnetic resonance imaging and invasive techniques such as biopsy, electromyography and nerve conduction studies are highly accurate for the diagnosis of muscle changes; however, these resources are limited in this specialized COVID-19 ICU scenario because of high cost, radiation exposure, and aerosol transmission-related health hazards 18 – 21 .…”