Use of functional independence measure in rehabilitation of inpatients with respiratory failure

Abstract

Most outcomes do not deeply express the degree of disability in patients with respiratory failure (RF) following inpatient pulmonary rehabilitation (IPR). The aim of our study was to evaluate the efficacy of an IPR in patients with confirmed COPD and RF using functional independence measure (FIM) that determines the degree of disability experienced by patients and the progress they make during rehabilitation. This scale includes several items: self care, mobility, locomotion, communication and social recognition. Twenty-two patients (age 70+/-2 years, PO(2) 58.18+/-7.63mmHg, PCO(2) 46.82+/-9.11mmHg) were prospectively observed and studied. IPR included respiratory and peripheral muscle training, mucus evacuation techniques, and energy conservation techniques. FIM, Medical Research Council dyspnoea scale (MRC), St. George's Respiratory Questionnaire (SGRQ), and 6-min walking distance (6-MWD) were assessed on admission (pre) and discharge (post) from IPR. After IPR there was a statistically significant improvement (p<0.01) in all the FIM items (total score in self care, mobility, locomotion, social recognition) except for communication. Changes of MRC (pre 4.32+/-0.84; post 3.00+/-1.15, p<0.001), SGRQ (%) (pre 69.86+/-4.62; post 46.50+/-11.94, p<0.001), and 6-MWD (pre 164.54+/-98.63; post 214.32+/-97.64, p<0.001) paralleled those improvements. An inverse correlation between MRC and FIM (r=-0.5042, p=0.016) was observed. Our preliminary study has shown that the benefits of IPR in COPD with RF do not only translate in dyspnoea, exercise capacity and quality of life but also within neuromotor disabilities as assessed by FIM. Our results warrant future studies in pulmonary rehabilitation using FIM as an outcome measure.

Physical training is beneficial to functional status and survival in patients with prolonged mechanical ventilation

“…In our opinion, early physical exercise leads to significant benefits in cognitive function in the PMV patients. Our results were consistent with those of Pasqua et al, 20 who found that, after inpatient pulmonary rehabilitation, there was a significant improvement in all the FIM items except for communication. One difference between their study and ours is that all our patients underwent tracheostomy, whereas only four of 22 patients underwent tracheostomy in the study of Pasqua et al 20 Despite wide variation in the days of PMV, the survival rate has remained rather consistent for 10e15 years.…”

“…The FIM score changes associated with the minimal clinically important difference (MCID) in stroke patients were 22, and 17 and 3 for the total FIM, and motor and cognitive domain, respectively, 19 whereas our PMV patients study found the score changes to be 44 (34e78), 32.5 (14.5e47), and 13.5 (19.5e33) in the Rehab group, a much higher change than the MCID of stroke. It has been shown previously that FIM in the PMV patients and the chronic obstructive pulmonary disease patients with respiratory failure significantly improved after an inpatient rehabilitation program in the studies of Martin et al 3 and Pasqua et al 20 However, our baseline total FIM scores 31.5 in the Ctrl group and 34 in the Rehab group were much lower than those of chronic obstructive pulmonary disease patients, who had a mean of 92. 18.…”

Effects of Exercise Training on Pulmonary Mechanics and Functional Status in Patients With Prolonged Mechanical Ventilation

“…The authors also found that there is an inverse correlation between dyspnea level and FIM scores, and thus suggested that the improvement of functional status may be related to symptom relief. 31 As suggested by the report of Casaburi et al, exercise training might improve physical functional status in patients with chronic respiratory diseases, through multiple mechanisms: improving skeletal muscle function and thus deceasing production of blood lactate and ventilatory demand during exercise; improving aerobic capacity by increasing efficiency of oxygen delivery and ventilatory demand; and improving ventilatory efficiency by decreasing respiratory rate and depth of breath during exercise. With the benefits of exercise training, patients are capable of performing a higher level of ADL with lower ventilation demand and fewer symptoms of dyspnea and/or fatigue.…”

Independência Funcional E Tolerância Ao Exercício Físico Em Portadores De Dpoc

“…O questionário para realizar a medida da independência funcional (MIF) é uma ferramenta útil e validada para aferir a independência em níveis cognitivos e motor (PASQUA et al, 2009). Segundo Radosavljevic et al (2014), a possível melhora da funcionalidade está associada a fatores como idade, sexo, comorbidade e raça.…”

“…O ingresso em PRP ocorre mediante a realização de uma avaliação completa e adequada, utilizando testes máximos, submáximos e questionários que avaliem a qualidade de vida e a independência funcional (SPRUIT et al, 2013;PASQUA et al, 2009).…”