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危重症患者身体康复过程中年龄与活动水平与临床结局的关系。

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness.

作者信息

Mayer Kirby P, Silva Susan, Beaty Amanda, Davenport Anne, Minniti Melissa, Dorn Sara Uribe, White Lane S, Sabol Valerie K, Pastva Amy M

机构信息

Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY.

Duke University School of Nursing, Duke University, Durham, NC.

出版信息

Arch Rehabil Res Clin Transl. 2023 Oct 10;5(4):100305. doi: 10.1016/j.arrct.2023.100305. eCollection 2023 Dec.

Abstract

OBJECTIVE

To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.

DESIGN

Retrospective, observational cohort study.

SETTING

Medical Intensive Care Unit (MICU).

PARTICIPANTS

Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, <.001), were less likely to be discharged to home (30.6% vs 55.0%, =.005), and were more likely to die within 12 months (41.7% vs 25.0%, =.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all <.03).

CONCLUSION

Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.

摘要

目的

确定年龄、活动能力水平以及在前3次物理康复治疗期间活动能力水平的变化是否与危重症患者的临床结局相关。

设计

回顾性观察队列研究。

地点

医学重症监护病房(MICU)。

参与者

在MICU接受3次或更多次连续康复治疗的住院成人(n = 132)。

干预措施

不适用。

测量指标和主要结果

样本包括132例患者,其中60例(45%)为年轻患者(18 - 59岁),72例(55%)为老年患者(60岁及以上)。最常见的诊断是脓毒症/败血症(32.6%)。与年轻患者相比,老年患者在整个康复治疗期间重症监护病房活动量表(IMS)评分的改善速度明显较慢(平均斜率系数为0.3分对0.6分,P <.001),出院回家的可能性较小(30.6%对55.0%,P =. .005),并且在12个月内死亡的可能性更大(41.7%对25.0%,P =.046)。协变量调整模型表明,IMS评分的早期更大改善与出院回家相关(P =.005)。首次康复治疗的时间较长、初始IMS评分较低以及IMS评分改善较慢与重症监护病房住院天数增加相关(均P <.03)。

结论

年龄较大以及未达到床边坐立的活动能力里程碑或各治疗期间活动能力进展有限与患者预后不良相关。我们的研究结果表明,年龄和活动能力水平有助于预后预测,并可辅助临床表型分析和康复服务分配。

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