To describe the supine bridging performance and its association with functional outcomes during the hospitalization of adults with critical illness.
This prospective observational study was conducted in a Chilean medical ICU. Patients who were mechanically ventilated for more than 48 hours and were physically independent prior to admission were assessed on awakening, ICU discharge, and high dependency unit (HDU) discharge. We evaluated supine bridging as the ability to lift the pelvis from the supine position to maximal hip extension with the knees flexed. We evaluated the lifting time and the performance of supine bridging was scored from 0 to 5, with higher scores indicating better physical performance. Limb muscle strength (Medical Research Council Sum Score), mobility (Functional Status Score for the ICU), and physical performance (Short Physical Performance Battery) were also evaluated for correlations. The association between supine bridging and walking ability at HDU discharge was analyzed using logistic regression.
Thirty-three patients had a median [IQR] age of 61 [42−68] years old, were mainly males (73%), with common admission diagnoses of sepsis (39%) and pneumonia (21%). We evaluated 33, 27, and 26 adults on awakening, ICU discharge, and HDU discharge, respectively; totaling 86 supine bridging assessments. Supine bridging scores improved significantly over time, with a median [IQR] of 2 [1−4] on awakening, 3 [1−5] at ICU discharge, and 5 [2−5] at HDU discharge (p0.009). Significant correlations were found for the supine bridging performance on awakening with limb muscle strength (rho=0.74), and mobility (rho=0.69). All patients who achieved supine bridging scored ≥3 on awakening were able to walk and sit-to-stand at HDU discharge. Higher supine bridging scores on awakening were associated to higher probabilities to walk at HDU discharge (OR [95% CI] =12[1–109]; p=0.025). Supine bridging on awakening revealed moderate predictability of walking ability at HDU discharge (AUC=0.75) with 14.5 seconds of supine bridging lifting time as cutoff (sensitivity=0.68, specificity=0.86).
Supine bridging assessed on patient’s awakening showed high associations with walking ability at HDU discharge, with positive correlations with limb muscle strength and mobility. Further research should determine clinimetric properties and clinical utility of the supine bridging in the ICU.
Postural muscles evaluated clinically, in bed, and early in the ICU could enhance the identification of patients at risk of walking inability across the hospitalization. By incorporating supine bridging as a complementary assessment for clinical practice, clinicians could anticipate individualized rehabilitation interventions.
Physical Rehabilitation
Muscle weakness
