ICU 活动能力量表具有结构效度、预测效度且具有反应性。一项多中心观察性研究。

The ICU Mobility Scale Has Construct and Predictive Validity and Is Responsive. A Multicenter Observational Study.

作者信息

Tipping Claire J, Bailey Michael J, Bellomo Rinaldo, Berney Susan, Buhr Heidi, Denehy Linda, Harrold Meg, Holland Anne, Higgins Alisa M, Iwashyna Theodore J, Needham Dale, Presneill Jeff, Saxena Manoj, Skinner Elizabeth H, Webb Steve, Young Paul, Zanni Jennifer, Hodgson Carol L

机构信息

1 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine.

2 Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.

出版信息

Ann Am Thorac Soc. 2016 Jun;13(6):887-93. doi: 10.1513/AnnalsATS.201510-717OC.

DOI:10.1513/AnnalsATS.201510-717OC

PMID:27015233

Abstract

RATIONALE

The ICU Mobility Scale (IMS) is a measure of mobility milestones in critically ill patients.

OBJECTIVES

This study aimed to determine the validity and responsiveness of the IMS from a prospective cohort study of adults admitted to the intensive care unit (ICU).

METHODS

Construct and predictive validity were assessed by comparing IMS values at ICU discharge in 192 patients to other variables using Spearman rank correlation coefficient, Mann-Whitney U tests, and logistic regression. Responsiveness was assessed using change over time, effect size, floor and ceiling effects, and percentage of patients showing change.

MEASUREMENTS AND MAIN RESULTS

The IMS at ICU discharge demonstrated a moderate correlation with muscle strength (r = 0.64, P < 0.001). There was a significant difference between the IMS at ICU discharge in patients with ICU-acquired weakness (median, 4.0; interquartile range, 3.0-5.0) compared with patients without (median, 8.0; interquartile range, 5.0-8.0; P < 0.001). Increasing IMS values at ICU discharge were associated with survival to 90 days (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.14-1.66) and discharge home (OR, 1.16; 95% CI, 1.02-1.32) but not with return to work at 6 months (OR, 1.09; 95% CI, 0.92-1.28). The IMS was responsive with a significant change from study enrollment to ICU discharge (d = 0.8, P < 0.001), with IMS values increasing in 86% of survivors during ICU admission. No substantial floor (14% scored 0) or ceiling (4% scored 10) effects were present at ICU discharge.

CONCLUSIONS

Our findings support the validity and responsiveness of the IMS as a measure of mobility in the ICU.

摘要

理论依据

重症监护病房活动能力量表（IMS）是衡量重症患者活动能力里程碑的指标。

目的

本研究旨在通过对入住重症监护病房（ICU）的成年患者进行前瞻性队列研究，确定IMS的有效性和反应性。

方法

通过使用Spearman等级相关系数、Mann-Whitney U检验和逻辑回归，将192例患者在ICU出院时的IMS值与其他变量进行比较，评估结构效度和预测效度。使用随时间的变化、效应大小、地板效应和天花板效应以及显示变化的患者百分比来评估反应性。

测量指标和主要结果

ICU出院时的IMS与肌肉力量呈中度相关（r = 0.64，P < 0.001）。与没有ICU获得性肌无力的患者相比，有ICU获得性肌无力的患者在ICU出院时的IMS存在显著差异（中位数为4.0；四分位间距为3.0 - 5.0），而没有的患者中位数为8.0；四分位间距为5.0 - 8.0；P < 0.001）。ICU出院时IMS值的增加与90天生存率（优势比[OR]，1.38；95%置信区间[CI]，1.14 - 1.66）和出院回家（OR，1.16；95% CI，1.02 - 1.32）相关，但与6个月时重返工作岗位无关（OR，1.09；95% CI，0.92 - 1.28）。从研究入组到ICU出院，IMS有显著变化（d = 0.8，P < 0.001），在ICU住院期间，86%的幸存者IMS值增加，具有反应性。在ICU出院时，没有明显的地板效应（14%得分为0）或天花板效应（4%得分为10）。