Authors (including presenting author) :
Tse PY(1), Tam HY(1), Chan HC(1), Chan WY(1), Lee KW(1), Lui SR(1), Lee CY(1), Tsang HC(1), Lam KN(2), To YL(1), Sun TF(3)
Affiliation :
(1)Physiotherapy Department, (2)Intensive Care Unit, (3)Hospital Chief Executive Office, North District Hospital
Introduction :
Early mobilization (EM) has been implemented in the intensive care unit (ICU) of North District Hospital (NDH) since 2017. It has been shown to reduce ICU length of stay (ICULoS) and improve patients’ functional status.
The Medical Research Council scale (MRC scale) is known to be significantly associated with ICULoS. To evaluate the effectiveness of EM, MRC scale is routinely used to assess patient’s muscle strength in ICU. Yet measurement of MRC scale is often restricted by patients’ physical conditions and mentality. These limitations urged the exploration of alternate assessment tool. Previous study suggested handgrip strength as a surrogate for MRC scale. Hence, this study aims to explore the relationship between handgrip strength and clinical outcomes of ICU patients in local population.
Objectives :
To explore the relationship between handgrip strength and clinical outcomes in ICU patients.
Methodology :
This was a prospective cohort study conducted in ICU of NDH from August 2021 to November 2022. Handgrip strength has been included in routine assessment of ICU patients receiving EM since August 2021. Patients who were unable to perform handgrip strength assessment were excluded from this study.
Demographics and baseline data included age, gender, ICU mobility scale (ICUMS) and handgrip strength of dominant hand. Outcome measures included ICULoS and ICUMS upon discharge to general ward. Standard descriptive statistics were used to summarize patients’ characteristics. Data were processed using Spearmann’s rho and Mann-Whitney U test.
Result & Outcome :
A total of 155 patients (63.9% male, 36.6% female) were recruited. The mean age was 63.2. A significant correlation was found between initial hand grip strength and ICULoS (r= -0.237, p=0.003). Patients were classified into two groups for subgroup analysis according to the presence of muscle weakness. Initial handgrip strength of dominant hand less than 11 kg in male and 7 kg in female was adopted as cut-off based on the previously established definition of handgrip strength-derived ICU-acquired weakness. Patients with muscle weakness were found to have significantly longer ICULoS (mean 8.50 days vs 4.00 days, p=0.002) and significantly lower ICUMS upon ICU discharge (median 6 vs 8, p=0.007).
ICU patients with muscle weakness, as reflected by initial handgrip strength, demonstrated inferior clinical outcomes. Handgrip strength could be used as a screening tool to identify patients with potentially longer ICULoS and slower progression in functional status, thus guiding treatment direction in rehabilitation in critical care setting.
