Evaluating physical functioning in critical care: considerations for clinical practice and research

Selina M Parry, Minxuan Huang, Dale M Needham, Selina M Parry, Minxuan Huang, Dale M Needham

Abstract

The evaluation of physical functioning is valuable in the intensive care unit (ICU) to help inform patient recovery after critical illness, to identify patients who may require rehabilitation interventions, and to monitor responsiveness to such interventions. This viewpoint article discusses: (1) the concept of physical functioning with reference to the World Health Organization International Classification of Functioning, Disability and Health; (2) the importance of measuring physical functioning in the ICU; and (3) methods for evaluating physical functioning in the ICU. Recommendations for clinical practice and research are made, along with discussion of future directions.

Keywords: Critical illness; Early mobility; Outcome measurement; Physical function; Physical rehabilitation.

Conflict of interest statement

Ethics approval and consent to participate

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Consent for publication

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Competing interests

A potential conflict of interest may exist for DMN who is a co-creator of the Functional Status Score for the ICU instrument, which is one of the measurement instruments discussed in this article. The Functional Status Score for the ICU is freely available for non-commercial use as indicated by its Creative Commons licensing. Moreover, DMN is a principal investigator on a NIH-funded, multi-centered randomized trial evaluating nutrition and exercise in acute respiratory failure and, related to this trial, is currently in receipt of an unrestricted research grant and donated amino acid product from Baxter Healthcare Corporation and an equipment loan from Reck Medical Device. DMN and MH received funding from the National Heart, Lung, and Blood Institute (NHLBI) (grant #R24HL111895). SMP reports National Health and Medical Research Council fellowship funding during conduct of this study. SMP and MH declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Impact of pre-ICU, critical illness and hospital/ICU factors on body systems related to physical functioning. Pre-ICU, critical illness, environmental factors, and body-system impairments, have interdependent effects on physical functioning (e.g., ICU culture regarding sedation may lead to neurological impairment resulting in immobility and musculoskeletal impairment)
Fig. 2
Fig. 2
Factors to consider when selecting an outcome measure
Fig. 3
Fig. 3
Recommendations for Clinical Practice – Measurement of Physical Functioning. Abbreviations: ADL activities of daily living; BPS Behavioural Pain Scale; CAM-ICU Confusion assessment method for the ICU; CPAx Chelsea Physical assessment Tool; CPOT Critical Care Pain Observation Tool; FSS-ICU Functional Status Score for the ICU; IADL instrumented activities of daily living; ICU intensive care unit; ICDSC Intensive Care Delirium Screening Checklist; IMS ICU Mobility Scale; NRS Numerical rating scale; PFIT-s Physical Function in ICU Test-scored; RASS Richmond Agitation and Sedation Scale; SAS, Sedation Agitation Scale

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Source: PubMed

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