Association between Early Mobilization in the ICU and Psychiatric Symptoms after Surviving a Critical Illness: A Multi-Center Prospective Cohort Study

Watanabe, Shinichi; Liu, Keibun; Nakamura, Kensuke; Kozu, Ryo; Horibe, Tatsuya; Ishii, Kenzo; Yasumura, Daisetsu; Takahashi, You; Nanba, Tomoya; Morita, Yoko; Kanaya, Takahiro; Suzuki, Shinichi; Lefor, Alan Kawarai; Katsukawa, Hajime; Kotani, Toru

doi:10.3390/jcm11092587

Cited by 12 publications

(11 citation statements)

References 64 publications

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“…The physiotherapist intervened only on weekdays, and the nurse rehabilitated the patient in bed on weekends. The protocol established five levels of rehabilitation (level 1: passive exercise and respiration physiotherapy; level 2: active exercise; level 3: sitting; level 4: standing; and level 5: walking) based on the patient's medical condition [7,[20][21][22]. At each participating hospital, ICU practitioners or physiotherapists made the final determination concerning the degree of rehabilitation based on the patient's status and by referring to the protocol.…”

Section: Rehabilitationmentioning

confidence: 99%

Association Between Intensive Care Unit-Acquired Weakness and Early Nutrition and Rehabilitation Intensity in Mechanically Ventilated Patients: A Multicenter Retrospective Observational Study

Watanabe¹,

Hirasawa²,

Naito³

et al. 2023

Cureus

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Background: Muscle weakness in the intensive care unit (ICU), referred to as ICU-acquired weakness (ICUAW), is a common complication observed in patients receiving mechanical ventilation. This study aimed to investigate whether rehabilitation intensity and nutrition during ICU admission are associated with the incidence of ICUAW.Materials and methods: Consecutive patients aged ≥18 years who were admitted to the ICU between April 2019 and March 2020 and who received mechanical ventilation for >48 h were eligible. The included patients were divided into two groups: the ICUAW group and the non-ICUAW group. ICUAW was designated by a Medical Research Council score of less than 48 during discharge from the ICU. Patient characteristics, time to achieve ICU mobility scale (IMS) 1 and IMS 3, calorie and protein deliveries, and blood creatinine and creatine kinase levels were evaluated as study data. In this study, the target dose for the first week after admission to the ICU at each hospital was set at 60-70% of the energy requirement calculated by the Harris-Benedict formula. Univariate and multivariate analyses were used to determine the odds ratios (OR) for each factor and to explain the risk factors for the occurrence of ICUAW at ICU discharge.Results: During the study period, 206 patients were enrolled; 62 of the 143 included patients (43%) had ICUAW. The results of multivariate regression analysis showed that low time to IMS 3 achievement (OR 1.19, 95% confidence interval (CI) 1.01-1.42, p=0.033), and high mean calorie (OR 0.83, 95% CI 0.75-0.93, p<0.001) and protein deliveries (OR 0.27, 95% CI 0.13-0.56, p<0.001) were independently associated with the occurrence of ICUAW.Conclusions: Increase in rehabilitation intensity and mean calorie and protein deliveries were associated with a decrease in the occurrence of ICUAW at ICU discharge. Further research is required to validate our results. Our observations, increasing the intensity of physical rehabilitation and the average calorie and protein delivery levels during ICU stay, appear to be the preferred strategies for achieving non-ICUAW.

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Section: Rehabilitationmentioning

confidence: 99%

Association Between Intensive Care Unit-Acquired Weakness and Early Nutrition and Rehabilitation Intensity in Mechanically Ventilated Patients: A Multicenter Retrospective Observational Study

Watanabe¹,

Hirasawa²,

Naito³

et al. 2023

Cureus

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“…PICS causes physical disability, cognitive dysfunction, and psychiatric disorders that develop or worsen in patients after recovery from severe acute conditions, such as severe sepsis and acute respiratory distress syndrome [ 2 , 3 ]. Early rehabilitation is one of the preventive methods; however, further investigation into the specific clinical strength and activity time is needed [ 4 - 6 ]. In addition, in Japan, variations in early rehabilitation programs based on the hospital environment and the experience of the therapist still exist, and many hospitals have not created evidence-based protocols [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Watanabe¹,

Yamauchi²,

Yasumura³

et al. 2023

Cureus

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Background The mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU) and predict functional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activities of daily living (ADL) dependence has been shown. We created and validated the Japanese version of the MQS using the endpoint ADL in a mixed population of patients in the ICU. Materials and methods In this prospective study, consecutive patients who were admitted to one of three ICUs of a tertiary care hospital in Japan, aged ≥18 years, and who received mechanical ventilation for >48 hours were enrolled. The Japanese version of the MQS was applied twice daily by an ICU physiotherapist and data recorded for analysis. The primary outcome was ADL dependence at hospital discharge, defined as a Barthel index (BI) of <70 or in-hospital death. The reliability among assessors was verified by calculating the interclass correlation coefficient (ICC) (2.1) for the average daily MQS. We performed a multiple logistic regression analysis to examine and identify a binary cutoff point for high-/low-dose rehabilitation. Results Of the 340 target patients, eight were aged <18 years, 109 had neurological complications, 11 had a BI <70 before admission, 79 had a lack of communication skills, 16 were terminally ill, eight did not complete the assessment during their ICU stay, 18 died in the ICU, and 53 denied consent. After 302 patients were excluded, 38 were included in the study. Six assessors, two at each hospital, measured the MQS in 38 patients. The ICC (2.1) for the MQS mean value was 0.98 (0.96-0.99) during the ICU stay. Logistic regression analysis using the mean MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at discharge (odds ratio (OR): 0.76, confidence interval (CI): 0.61-0.96, adjusted p = 0.009). Logistic regression analysis using a high MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at hospital discharge (OR: 0.14, CI: 0.03-0.66, adjusted p = 0.013). Conclusions We present a validated version of the Japanese MQS with a high inter-rater reliability that predicts ADL dependence at hospital discharge. The instrument can be used in future clinical trials in the ICU to control for the mobilization level in the ICU. The increased utilization of mobilization acutely in the ICU setting as quantified by the MQS may improve patient outcomes.

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“…The effects of early rehabilitation are widely reported, including the prevention of delirium [7], shortening the length of mechanical ventilation [8] and shortening the length of stay in the ICU [9,10]. Although relatively short-term results have been increasingly reported recently, data on the relationship between the mobilization level in critically ill patients and activity of daily living (ADL) independence at hospital discharge are still lacking [11][12][13]. Previous studies examined the mobilization level of ICU patients and reported that patients discharged home had higher ICU mobility score (IMS) scores at discharge from the ICU than patients discharged to the facility.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, this study investigated the relationship between the mobilization level during ICU admission and independence in ADL at hospital discharge. A post-hoc analysis of the EMPICS study [11], a multicenter prospective study of psychiatric symptoms in ICU patients three months after hospital discharge, was performed to investigate the association between the mobilization level during the ICU stay and ADL independence at hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Association Between Mobilization Level And Activity of Daily Living Independence in Critically Ill Patients

Watanabe,

Liu,

Kozu

et al. 2023

Ann Rehabil Med

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Objective: To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70. Methods: This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL. Results: Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07–1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69). Conclusion: These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.

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Association between Early Mobilization in the ICU and Psychiatric Symptoms after Surviving a Critical Illness: A Multi-Center Prospective Cohort Study

Cited by 12 publications

References 64 publications

Association Between Intensive Care Unit-Acquired Weakness and Early Nutrition and Rehabilitation Intensity in Mechanically Ventilated Patients: A Multicenter Retrospective Observational Study

Association Between Intensive Care Unit-Acquired Weakness and Early Nutrition and Rehabilitation Intensity in Mechanically Ventilated Patients: A Multicenter Retrospective Observational Study

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

Association Between Mobilization Level And Activity of Daily Living Independence in Critically Ill Patients

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