USING PHYSICAL FUNCTIONING MEASUREMENT INSTRUMENTS IN CRITICAL CARE: A NATIONAL SURVEY IN OVER 90 CHILEAN CENTERS DURING THE COVID-19 PANDEMIC

F. González-Seguel¹, C. Cáceres-Parra¹, J.L. Sufán², R. Adasme³

¹Clínica Alemana Universidad del Desarrollo, School of Physiotherapy, Facultad de Medicina, Santiago, Chile, ²Clínica INDISA, Unidad de Paciente Crítico Adulto, Santiago, Chile, ³Faculty of Rehabilitation Sciences, Universidad Andres Bello, Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Santiago, Chile

Background: Evaluating physical functioning in intensive care units (ICUs) is valuable for identifying rehabilitation requirements and monitoring response to interventions. There are more than 60 instruments to measure physical functioning in the ICU. Selecting the most appropriate instrument depend on available clinical resources/expertise, and the reason for assessment.

Purpose: To identify the usage rate of physical functioning measurement instruments in Chilean ICUs during the COVID-19 pandemic.

Methods: This study is part of the National Survey on Critical Care Physiotherapy Practices during the COVID-19 Pandemic answered by a lead physiotherapist representing each Chilean ICU at the beginning (T1) and at the first year of pandemic (T2). Questions were asked on the usage rate (“always”/“almost always”/“almost never”/“never”) of the most outstanding instruments for the ICU setting: two instruments for muscular strength, one for muscular mass, five for mobility, and one for physical performance. In addition, the reasons for selecting instruments were requested.

Results: Out of 111 eligible ICUs, we received responses from 94 at T1 and 93 at T2; where 55% were public. The report of usage rate of instruments was lower at T1, and only significant for the Medical Research Sum-Score (MRC-SS) (p=0.038) and handgrip dynamometry (p=0.049). Considering the answers “always”, “almost always” and “almost never”, between 89% and 91% of the ICUs reported use of the MRC-SS; between 70% and 73% of the Functional Status Score for the ICU; and between 5% and 35% of the ICUs reported use of the rest of mobility scales. The majority answered “never used” (at T1 and T2) for handgrip dynamometry (83% and 68%), muscle ultrasound (55% and 54%), Chelsea Critical Care Physical Assessment tool (91% and 83 %), Perme ICU Mobility Score (90% and 88%), Physical Function ICU test–scored (89% and 84%), ICU Mobility Scale (68% and 61%), and Short Physical Performance Battery (91% and 80%). There were 20 (21%) and 16 (17%) centers that reported not using any of the five mobility scales at T1 and T2, respectively. Only 43% of the centers reported measuring muscle strength, muscle mass, and mobility at T2. The main reasons reported for selecting instruments were due to “quick use”, “clinimetric properties”, and “comprehensive evaluation”.

Conclusions: The usage rate of muscle strength assessment was very frequent, while the use of mobility and muscle mass instruments recommended by the literature was poorly reported, which was lower at the beginning of the pandemic.

Implications: This is the first report on the use of physical functioning instruments in the ICU setting. Future efforts should aim to promote and standardize the use of ICU physical functioning instruments.

Funding acknowledgements: None

Keywords:
Physical Functioning
Critical Care
Measure

Topics:
Critical care
COVID-19
Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Clínica Alemana Universidad del Desarrollo, Santiago, Chile

Committee: Ethics Committee of the Clínica Alemana Universidad del Desarrollo

Ethics number: #2020-93 (on August 31, 2020)