The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients

Piva, Simone; Dora, Giancarlo; Minelli, Cosetta; Michelini, Mariachiara; Turla, Fabio; Mazza, Stefania; d'Ottavi, P.; Moreno-Duarte, Ingrid; Sottini, Caterina; Eikermann, Matthias; Latronico, Nicola

doi:10.1016/j.jcrc.2015.08.002

Cited by 28 publications

(9 citation statements)

References 30 publications

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“…The results of this evaluation should be compared to similar evaluations of other published ICU-specific physical function measures, including: the Physical Function in Intensive care Test scored (PFIT-s),(13;24;37) Chelsea Critical Care Physical Assessment tool (CPAx),(38-40) Perme mobility scale,(41;42) Acute Care Index of Function (ACIF) score,(43) Surgical intensive care unit Optimal Mobilization score (SOMS),(25;26;44) and the IMS. (23) With respect to floor and ceiling effects, for the FSS-ICU, we detected a minimal floor effect (≤0.5%), but some ceiling effects at hospital discharge (≤21%), which may limit the instrument’s ability to detect improvement.…”

Section: Discussionmentioning

confidence: 99%

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Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference

Huang

Chan

Zanni

et al. 2016

Critical Care Medicine

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Objective To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the Intensive Care Unit (FSS-ICU), a physical function measure designed for the intensive care unit (ICU). Design Clinimetric analysis. Settings Five international data sets from the United States, Australia, and Brazil. Patients 819 ICU patients. Intervention None. Measurements and Main Results Clinimetric analyses were initially conducted separately for each data source and time point to examine generalizability of findings, with pooled analyses performed thereafter to increase power of analyses. The FSS-ICU demonstrated good to excellent internal consistency. There was good convergent and discriminant validity, with significant and positive correlations (r = 0.30 to 0.95) between FSS-ICU and other physical function measures, and generally weaker correlations with non-physical measures (|r| = 0.01 to 0.70). Known group validity was demonstrated by significantly higher FSS-ICU scores among patients without ICU-acquired weakness (Medical Research Council sumscore ≥48 versus <48) and with hospital discharge to home (versus healthcare facility). FSS-ICU at ICU discharge predicted post-ICU hospital length of stay and discharge location. Responsiveness was supported via increased FSS-ICU scores with improvements in muscle strength. Distribution-based methods indicated a minimal important difference of 2.0 to 5.0. Conclusions The FSS-ICU has good internal consistency and is a valid and responsive measure of physical function for ICU patients. The estimated minimal important difference can be used in sample size calculations and in interpreting studies comparing the physical function of groups of ICU patients.

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Section: Discussionmentioning

confidence: 99%

“…As done in prior research,(13;24;25) we used two sample t-tests, and linear and logistic regression models to test the association of FSS-ICU at ICU discharge with post-ICU hospital LOS and hospital discharge location. In addition, the area under a Receiver Operating Characteristic (ROC) curve (i.e.…”

Section: Methodsmentioning

confidence: 99%

Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference

Huang

Chan

Zanni

et al. 2016

Critical Care Medicine

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“…In stroke patients, early mobilization was demonstrated to reduce the odds of a favorable outcome at 3 months 78 ; however, the adoption of optimized session frequencies with increased daily frequency of mobilization sessions may be associated with improved outcome 79 . Moreover, data in stroke patients may not apply to critically ill neurological patients admitted to the ICU; indeed, early mobilization is safe in this setting and might be beneficial 80, 81 because immobility is a common consequence of neurological impairments. A recent post-hoc analysis of a randomized controlled trial also showed that early, goal-directed mobilization is not harmful in patients with impaired consciousness and might be effective in achieving higher mobility levels and better functional status at hospital discharge 82 .…”

Section: Early Mobilization and Icu-awmentioning

confidence: 99%

Intensive care unit–acquired weakness: unanswered questions and targets for future research

2019

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Intensive care unit–acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient’s ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

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“…We identified five articles that had used the SOMS in trauma patients: one RCT 47 and four prospective observational studies. [53][54][55][56] The trauma patients were a subgroup comprising between 6% and 26% (or n ¼ 4 to 52) of the surgical ICU cohorts which were the main focus of all the studies. The most common timepoint for completion of the SOMS was day 1 of ICU admission with the assessment carried out by physiotherapists and/or nurses.…”

Section: Surgical Intensive Care Unit Optimal Mobility Scorementioning

confidence: 99%

Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties

Calthorpe

Kimmel

Webb

et al. 2019

Trauma

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Introduction It is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear. Methods A systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness. Results Fourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures. Conclusion Evidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.

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The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients

Cited by 28 publications

References 30 publications

Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference

Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference

Intensive care unit–acquired weakness: unanswered questions and targets for future research

Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties

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