Study of the determining factors of muscle strength and functionality of critically ill patients under physiotherapeutic intervention: retrospective cohort

Abstract

Introduction: Since immobilization is one of the main causes of peripheral muscle deconditioning and functional deterioration, several studies have demonstrated the benefits of early mobilization on clinical and functional outcomes. The possibility of predicting patients' functional progress through their clinical profile may provide more realistic expectations regarding results, in addition to contributing to individualized clinical and rehabilitation interventions. Objective: To identify the factors associated with the functional progress in a cohort of hospitalized patients that underwent a mobilization protocol, from the Intensive Care Unit to the hospital discharge. Methods: Retrospective cohort study including medical record data from 198 hospitalized patients undergoing a mobilization protocol. Generalized linear modeling was used to identify the main effects of clinical and demographic variables on functional outcomes (Katz Index of Independence in Activities of Daily Living - Katz ADL) and muscle strength (Medical Research Council - MRC Scale) during hospitalization. Covariates identified as independent predictors were analyzed using Receiver Operating Characteristic (ROC). The study was approved by the Institutional Research Board and Ethics Committee. Results: Considering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P<0.05) were the Katz and MRC at admission, age, sepsis (no), and total length of stay. Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC at admission, Simplified Acute Physiology Score III (SAPS3), previous stroke, total length of stay, and sex (female).
Conclusion: Better functional and muscle strength patient condition and low severity score at admission, absence of sepsis and stroke, longer total length of stay, male gender and younger age are predictors of favourable patients’ functional progress during hospitalization following an intensive care admission.