Critical Illness Myopathy, Critical Illness Polyneuromyopathy, Critical Illness Polyneuropathy, Muscle Weakness, Physical Inactivity
Conditions
Keywords
Physiotherapy, Physical function and activity, Early rehabilitation, Measurement instrument, Critical illness, Critical care outcomes
Brief summary
Intensive care unit (ICU) acquired weakness is a common complication associated with long-term physical impairments in survivors of a critical illness. The Chelsea Critical Care Physical Assessment tool (CPAx) is a valid and reliable instrument for physical function and activity in critically ill patients at risk for muscle weakness. However, its ability to measure change over time (responsiveness) and the minimal clinically important difference (MCID) have not yet been rigorously investigated. This multi-centre, mixed-methods, longitudinal cohort study therefore aims to establish responsiveness and the MCID of the CPAx in the target population from ICU baseline to ICU and hospital discharge. The study uses routine data from standard physiotherapy sessions like mobility, function and activity with no additional burden for critically ill adults. The investigators expect the CPAx to be responsive allowing its use as a primary outcome in future effectiveness trials for the treatment of ICU-acquired weakness using the newly established MCID for sample size calculation. A high quality, rigorously tested measurement tool for physical function and activity in the ICU should benefit researchers, clinicians and patients.
Detailed description
The use of invasive life support in critically ill patients clearly saves lives but carries substantial risks, including intensive care unit (ICU) acquired weakness and long-term disability. The investigators urgently need a valid, reliable, and responsive measurement tool for this population to use in clinical practice and trials. The Chelsea Critical Care Physical Assessment tool (CPAx) is a promising measurement instrument to measure change in critically ill patients' physical function and activity. After several studies have confirmed its validity and excellent reliability, it is time to confirm responsiveness and to establish the MCID in a large, international sample of the target population. This multi-centre, mixed-methods, longitudinal cohort study will include critically ill, mechanically ventilated (\>72h) adults at risk for muscle weakness and collect their mobility, physical function and activity with the CPAx and other relevant measures at ICU baseline, to ICU and hospital discharge. Responsiveness will be determined by the ability of the CPAx to identify change according to a prespecified anchor (criterion validity) and by testing prospective hypotheses about the expected magnitude of change between the CPAx and other relevant measures (construct validity). The MCID will be established with anchor- and distribution-based methods, whereby a seven-point global rating of change scale obtained from treating ICU physiotherapists will serve as anchor to distinguish improved from unchanged patients.
Interventions
None listed
Sponsors
Insel Gruppe AG, University Hospital Bern
Monash University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Mechanical ventilation ≥ 72 hours * Expected to remain for ≥ 48 hours in the ICU * Physiotherapy referral
Exclusion criteria
* Not expected to survive to hospital discharge (imminent to death) * Second or subsequent ICU admission for this hospital stay * Transfer from external ICU (with an ICU stay of \>72 hours) * Primary neurological admission diagnosis (i.e., of the central nervous system including stroke, intracerebral haemorrhage, traumatic brain injury) * Known pregnancy * Living in a care facility pre-admission (severe pre-existing mental or physical disability) * Local regulations (i.e. Switzerland: refusal of general consent)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chelsea Critical Care Physical Assessment tool (CPAx) change score | Assessed at ICU discharge (within 24 hours before or after ICU discharge) | CPAx change score for ICU period (ICU baseline to ICU discharge); CPAx ranges from 0 (worst score) to 50 (best score) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CPAx change score | Assessed at hospital discharge (last value before discharge) | CPAx change score for hospital period (ICU to hospital discharge); CPAx ranges from 0 (worst score) to 50 (best score) |
| Global rating of change scale | ICU and hospital discharge (change for ICU and hospital period) | Seven-point global rating of change scale (GRC): (1) very much improved; (2) much improved; (3) little improved; (4) no change; (5) little deterioration; (6) much deterioration; (7) very much deterioration for 'physical function and activity' (rated by treating physiotherapist) |
| ICU Mobility Scale | ICU baseline (within 72-144h after ICU admission), ICU and hospital discharge | To evaluate mobility level, the score ranges from 0 (worst) to 10 (best) |
| Medical Research Council Sum Score | ICU baseline (within 72-144h after ICU admission), ICU and hospital discharge | To assess muscle strength, the minimal score is 0 (worst), the maximal score 60 (best), ICUAW is defined as \<48 points |
| Richmond Agitation-Sedation Scale | ICU baseline (within 72-144h after ICU admission), ICU and hospital discharge | To assess the level of sedation and/or cooperation, score ranges from -5 (unarousable) to +4 (combative) |
| Modified Iowa Level of Assistance Scale | ICU baseline (within 72-144h after ICU admission), ICU and hospital discharge | To determine assistance in functional tasks, the score ranges from 0 (worst) to 36 (best) |
| ICU and discharge destinations | ICU and hospital discharge | Categorical variable (death, external/internal hospital ward, external ICU/hospital, rehabilitation, home, other) to assess the predictive validity of the CPAx score |
Countries
Australia, Switzerland
Contacts
PRINCIPAL_INVESTIGATORSabrina Eggmann, PhD
Inselspital, Bern University Hospital, Switzerland; Monash University, Australia
Outcome results
None listed