Volitional rehabilitative assessments in patients admitted in a post-intensive care step down unit. A feasibility study

https://doi.org/10.4081/monaldi.2017.764

Authors

  • Mara Paneroni | mara.paneroni@fsm.it Respiratory Rehabilitation Division Fondazione Salvatore Maugeri, IRCCS Lumezzane (Brescia) - Italy, Italy.
  • Francesco D' Abrosca Department of Neurosciences, Unit of Neurology, IRCCS Ca’Granda Foundation Ospedale Maggiore Policlinico, Milano, Italy, Italy.
  • Georges Fokom Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (BS), Italy., Italy.
  • Laura Comini Health Directorate, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (BS), Italy., Italy.
  • Michele Vitacca Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane (BS), Italy., Italy.

Abstract

A high variability in functional tests and activities used during the pulmonary rehabilitation has been observed in post-intensive care unit (ICU) patients, and the best battery of tests to adopt has not been described yet. We tested in patients admitted in a post-ICU Step Down Unit the ability to perform the more frequent functional volitional tests. The relations of each single volitional test with general disability and dyspnea at discharge were also evaluated. Ten volitional tests including: bedside spirometry test (ST: FEV1%, FVC%), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Peak Expiratory Flow during Cough (PCEF), Quadriceps Muscle Strength (QMS), latissimus Dorsi and teres Major Strength (DMS), Brachial biceps Muscle Strength (BMS), effort tolerance measured by sit-to-stand test, Takahashi test and 6-Min Walking Test (6MWT), were evaluated in post-ICU patients at entry and discharge from in-hospital rehabilitation. General disability was assessed by Barthel Index, while dyspnea by Borg scale. At admission, >70% of subjects performed muscle strength test, while <25% performed respiratory and effort tolerance tests. At discharge, feasibility of spirometry, respiratory muscle strength and effort tolerance tests improved (all, p<0.001); 6MWT was the least feasible. At discharge, cardiorespiratory patients were more capable to perform tests compared to neurological ones. All outcome measures, with exception of FEV1%, and FVC%, were significantly related to the disability score. Peripheral muscle exercises showed the highest feasibility, spirometry and leg effort tolerance the lowest. Motor disability was explained mainly by the peripheral muscle strength. The study of non-volitional outcome measures and tests linked to a protocol-driven intervention should be performed in this specific population.

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Published
2017-05-18
Info
Issue
Section
Pneumology - Original Articles
Keywords:
Weaning, mechanical ventilation, assessment, physical therapy, disability.
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How to Cite
Paneroni, Mara, Francesco D’ Abrosca, Georges Fokom, Laura Comini, and Michele Vitacca. 2017. “Volitional Rehabilitative Assessments in Patients Admitted in a Post-Intensive Care Step down Unit. A Feasibility Study”. Monaldi Archives for Chest Disease 87 (1). https://doi.org/10.4081/monaldi.2017.764.

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