Long-term recovery of sensorimotor functions and prediction of participation in survivors of critical illness: a prospective cohort study.

IF 4.7 2区 医学 Q1 CRITICAL CARE MEDICINE
Johanna Weghorn, Melanie Finsterhölzl, Franziska Wippenbeck, Klaus Jahn, Marion Egger, Jeannine Bergmann
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引用次数: 0

Abstract

Background: Survivors of critical illness frequently face physical, cognitive and psychological impairments after intensive care. Sensorimotor impairments potentially have a negative impact on participation. However, comprehensive understanding of sensorimotor recovery and participation in survivors of critical illness is limited. Therefore, the aims of this study were to quantify long-term sensorimotor recovery in survivors of critical illness, to examine participation in daily life 1.5 years after illness onset, and to assess the predictive capacity of sensorimotor assessments for future participation.

Methods: Survivors of critical illness who were mechanically ventilated ≥ 5 days on the ICU and who were admitted with weakness to neurorehabilitation were included in this single-center prospective cohort study. Time effects on sensation, muscle strength, balance, walking and dexterity were described at admission to and at discharge from rehabilitation, and 1.5 years after critical illness onset. Participation was assessed with the Reintegration to Normal Living Index. A multiple linear regression with sensorimotor outcomes at rehabilitation admission was conducted to find predictive associations with participation. The model was compared to an extended regression model containing demographic variables and factors known to be associated with participation or quality of life.

Results: All sensorimotor outcomes among participants (n = 250, median age 63 (54-73) years) improved over time. However, in most patients some deficits remained after rehabilitation and on long-term follow-up. Good participation (≥ 75%) was achieved by 60.2% of survivors 1.5 years after critical illness onset. Concerning participation, the Mini Balance Evaluation Systems Test (Mini-BESTest) together with the Box-and-Block-Test, the Five-Times-Sit-to-Stand-Test, and the Medical Research Council score at rehabilitation admission formed a predictive model (R2 = 0.157, p < 0.001). The extended regression analysis resulted in a model (R2 = 0.357, p < 0.001) with the variables depression, duration of mechanical ventilation, cognitive function, Mini-BESTest, comorbidities, sex and cerebral lesion.

Conclusions: We observed significant improvements in sensorimotor function, albeit with lingering deficits in sensation, strength, balance, dexterity and participation. Sensorimotor functions at rehabilitation start have limited explanatory power in predicting participation 1.5 years after disease onset. Trial registration German Clinical Trial Register, DRKS00021753. Date of registration: September 03, 2020.

Abstract Image

Abstract Image

危重疾病幸存者感觉运动功能的长期恢复和参与预测:一项前瞻性队列研究。
背景:重症幸存者在重症监护后经常面临身体、认知和心理障碍。感觉运动障碍对参与有潜在的负面影响。然而,对感觉运动恢复和参与危重疾病幸存者的全面了解是有限的。因此,本研究的目的是量化危重疾病幸存者的长期感觉运动恢复,检查疾病发作后1.5年的日常生活参与情况,并评估感觉运动评估对未来参与的预测能力。方法:将ICU机械通气≥5天且因神经康复虚弱入院的危重患者纳入本单中心前瞻性队列研究。时间对感觉、肌肉力量、平衡、行走和灵活性的影响分别在康复入院和出院时以及危重疾病发作后1.5年进行描述。通过回归正常生活指数对参与情况进行评估。对康复入院时的感觉运动结果进行多元线性回归,以发现参与的预测关联。将该模型与包含人口变量和已知与参与或生活质量相关的因素的扩展回归模型进行比较。结果:参与者(n = 250,中位年龄63(54-73)岁)的所有感觉运动结果随着时间的推移而改善。然而,大多数患者在康复后和长期随访中仍然存在一些缺陷。60.2%的幸存者在危重疾病发生1.5年后达到了良好的参与率(≥75%)。在参与方面,迷你平衡评估系统测试(Mini- bestest)与盒块测试、五次坐立测试和康复入院时医学研究委员会评分形成预测模型(R2 = 0.157, p 2 = 0.357, p)。结论:我们观察到感觉运动功能有显著改善,尽管感觉、力量、平衡、灵巧和参与方面仍存在缺陷。康复开始时的感觉运动功能在预测疾病发病1.5年后的参与方面解释力有限。德国临床试验注册,DRKS00021753。注册日期:2020年9月3日。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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