Physical outcome measure for critical care patients following intensive care discharge

Devine, H., MacTavish, P., Quasim, T. , Kinsella, J., Daniel, M. and McPeake, J. (2016) Physical outcome measure for critical care patients following intensive care discharge. Critical Care, 20(2), p. 166. P416. (doi: 10.1186/s13054-016-1208-6)

Abstract

Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures used following ICU discharge (2). Methods: Discharged ICU patients attended a five week multidisciplinary programme. Patients’ physical function was assessed during the programme, at 6 months and 12 months post discharge. Three outcome measures were included in the initial two cohorts. The Six Minute Walk Test (6MWT) and the Incremental Shuttle Walk test (ISWT) were chosen as they have been used within the critical care follow up setting (2). The Chester Step Test (CST) is widely thought to be a good indicator of ability to return to work (one of the programmes primary aims). Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected for the initial patients attending the programme (n = 13), median age was 52 (IQR = 38-72), median ICU LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41) and 11 were men. One patient was so physically debilitated that the CST or ISWT could not be completed however a score was achieved using the 6MWT. Another patient almost failed to achieve level 1 of the ISWT. Subsequent patients for this project (total n = 47) have all therefore been tested using the 6MWT. Good inter-rater and intrarater reliability and validity have been reported for the 6MWT (3). Conclusions: Exercise capacity measurement is not achievable for some patients with either the ISWT or the CST due to the severity of their physical debilitation. Anxiety, post-traumatic stress disorder and depression are common psychological problems post discharge (4), therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used with critical care patients post discharge.

• Item Type: Articles
• Status: Published
• Refereed: No
• Glasgow Author(s) Enlighten ID: Quasim, Professor Tara and Kinsella, Professor John and McPeake, Dr Jo
• Authors: Devine, H., MacTavish, P., Quasim, T., Kinsella, J., Daniel, M., and McPeake, J.
• Subjects: R Medicine > R Medicine (General); R Medicine > RT Nursing
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Critical Care
• Publisher: BioMed Central Ltd.
• ISSN: 1466-609X
• ISSN (Online): 1466-609X
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Critical Care 20(2):166-166
• Publisher Policy: Reproduced under a Creative Commons License