A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study

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• 作者：Selina M Parry (1)
  Sue Berney (2) (3)
  Catherine L Granger (1) (3)
  Danielle L Dunlop (2)
  Laura Murphy (2)
  Doa El-Ansary (1)
  Ren茅 Koopman (4)
  Linda Denehy (1) (3)
  
  1. School of Health Sciences ; Physiotherapy Department ; The University of Melbourne ; Level 7 Alan Gilbert Building ; 161 Barry Street ; Parkville ; 3010 ; VIC ; Australia
  2. Department of Physiotherapy ; Austin Health ; 145 Studley Road ; Heidelberg ; 3084 ; VIC ; Australia
  3. Institute for Breathing and Sleep ; Austin Health ; 145 Studley Road ; Heidelberg ; 3084 ; VIC ; Australia
  4. Department of Physiology ; The University of Melbourne ; Grattan Street ; Parkville ; 3010 ; VIC ; Australia
  
• 关键词：鈻犫枲鈻?/li>
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：505 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is currently widespread variability in the methods used for manual muscle testing and handgrip dynamometry (HGD) to diagnose ICU-AW. This study was conducted in two parts. The aims of this study were: to determine the inter-rater reliability and agreement of manual muscle strength testing using both isometric and through-range techniques using the Medical Research Council sum score and a new four-point scale, and to examine the validity of HGD and determine a cutoff score for the diagnosis of ICU-AW for the new four-point scale. Methods Part one involved evaluation of muscle strength by two physical therapists in 29 patients ventilated >48 hours. Manual strength testing was performed by both physical therapists using two techniques: isometric and through range; and two scoring systems: traditional six-point Medical Research Council scale and a new collapsed four-point scale. Part two involved assessment of handgrip strength conducted on 60 patients. A cutoff score for ICU-AW was identified for the new four-point scoring system. Results The incidence of ICU-AW was 42% (n鈥?鈥?5/60) in this study (based on HGD). In part one the highest reliability and agreement was observed for the isometric technique using the four-point scale (intraclass correlation coefficient鈥?鈥?.90: kappa鈥?鈥?.72 respectively). Differences existed between isometric and through-range scores (mean difference鈥?鈥?.76 points, P鈥?鈥?.005). In part two, HGD had a sensitivity of 0.88 and specificity of 0.80 for diagnosing ICU-AW. A cutoff score of 24 out of 36 points was identified for the four-point scale. Conclusions The isometric technique is recommended with reporting on a collapsed four-point scale. Because HGD is easy to perform and sensitive, we recommend a new two-tier approach to diagnosing ICU-AW that first tests handgrip strength with follow-up strength assessment using the isometric technique for muscle strength testing if handgrip strength falls below cutoff scores. Whilst our results for the four-point scale are encouraging, further research is required to confirm the findings of this study and determine the validity of the four-point scoring system and cutoff score developed of less than 24 out of 36 before recommending adoption into clinical practice.