Title |
A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study
|
---|---|
Published in |
Critical Care, December 2015
|
DOI | 10.1186/s13054-015-0780-5 |
Pubmed ID | |
Authors |
Selina M Parry, Sue Berney, Catherine L Granger, Danielle L Dunlop, Laura Murphy, Doa El-Ansary, René Koopman, Linda Denehy |
Abstract |
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. 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. The incidence of ICU-AW was 42% (n = 25/60) 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 = 0.90: kappa = 0.72 respectively). Differences existed between isometric and through-range scores (mean difference = 1.76 points, P = 0.005). 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. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 3 | 25% |
Puerto Rico | 2 | 17% |
United States | 2 | 17% |
Turkey | 1 | 8% |
Unknown | 4 | 33% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 8 | 67% |
Practitioners (doctors, other healthcare professionals) | 3 | 25% |
Science communicators (journalists, bloggers, editors) | 1 | 8% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Chile | 1 | <1% |
Russia | 1 | <1% |
Brazil | 1 | <1% |
Unknown | 162 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 28 | 17% |
Student > Bachelor | 18 | 11% |
Student > Ph. D. Student | 17 | 10% |
Student > Postgraduate | 12 | 7% |
Student > Doctoral Student | 11 | 7% |
Other | 31 | 19% |
Unknown | 48 | 29% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 42 | 25% |
Nursing and Health Professions | 38 | 23% |
Engineering | 4 | 2% |
Social Sciences | 4 | 2% |
Sports and Recreations | 3 | 2% |
Other | 15 | 9% |
Unknown | 59 | 36% |