File
Gustafson O.1, Mckechnie S.1, Carpenter C.2, Igo S.2
1Oxford University Hospitals NHS Foundation Trust, Adult Intensive Care Unit, Oxford, United Kingdom, 2Coventry University, Coventry, United Kingdom
Background: The number of patients admitted to an intensive care unit and subsequently surviving a period of critical illness in increasing annually. Limitations in function and quality of life have been reported in intensive care unit survivors for many years after hospital discharge. Shoulder dysfunction is a cause of functional limitation in other patient populations, and has been suggested as a potential cause in intensive care unit survivors. Despite this, the prevalence of shoulder dysfunction, its impact on upper limb function and risk factors for its development are unknown in intensive care unit survivors.
Purpose: The primary purpose of the study was to identify the prevalence of shoulder dysfunction in adult intensive care unit survivors within 6 months of discharge from hospital. Secondary aims were to identify the risk factors for the development of shoulder dysfunction and identify the impact of shoulder dysfunction on upper limb function in adult intensive care unit survivors.
Methods: The study undertaken was an observational cohort study of intensive care unit survivors, who were consecutively recruited from a single general intensive care unit in the United Kingdom. Participants underwent a series of shoulder assessments up to 6 months after hospital discharge to identify shoulder dysfunction and upper limb impairment. The shoulder assessments consisted of a review of range of movement and pain, the Constant-Murley Score and the QuickDASH Upper Limb score. Multivariable analysis was used to investigate the risk factors for developing shoulder dysfunction.
Results: Of the 97 participants assessed, shoulder dysfunction was present in 76%, with 42% presenting with ongoing shoulder dysfunction at 6 months after hospital discharge. Functional impairment of the upper limb was present in 48% of participants and severe impairment in 18%. None of the risk factors analysed were independently associated with shoulder dysfunction.
Conclusion(s): Shoulder dysfunction is a common problem in intensive care unit survivors, and is a source of functional impairment. Further investigation addressing risk factors for its development, and therapeutic interventions to address this problem is required.
Implications: Physiotherapists working in intensive care units need to be aware of the potential long term shoulder dysfunction experienced by patients, and therefore ensure appropriate handling and positioning of patients upper limb while they are dependant. Clinicians involved in long term follow-up of intensive care unit survivors should include shoulder assessment as part of their review.
Funding acknowledgements: This study was funded by the Intensive Care Foundation, United Kingdom.
Topic: Critical care
Ethics approval: Ethical approval was obtained from the Coventry University ethics board, however approval from Oxford University Hospitals NHSFT was not required.
All authors, affiliations and abstracts have been published as submitted.
