du Plessis I, Hanekom S D, Lupton-Smith A R
Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
South Afr J Crit Care. 2024 Jul 17;40(2):e1742. doi: 10.7196/SAJCC.2024.v40i2.1742. eCollection 2024.
Growing evidence is describing the long-term morbidity experienced by critical illness survivors, a major contributing factor being impaired physical function. Consensus is yet to be reached on which physical function measures should be included in this population. This review aimed to describe physical functioning measurement instruments used in longitudinal studies of critical illness survivors, based on the International Classification of Function (ICF).
An electronic database search of EbscoHost, Web of Science and Scopus was conducted from inception to November 2023. Two reviewers independently applied the inclusion and exclusion criteria to titles, abstracts and full text-studies. Extracted data included year of publication; country; participant age; follow-up timeframes and physical measurement instruments used. Instruments were classified according to ICF domains.
Eighty studies published between 1995 and November 2023 were included. Forty-four different outcome measures were identified. Most studies (68) included multiple followed-up points and were completed within a year, and few studies (12) follow-up beyond a year. Based on the ICF, 11 (25%) instruments measured impairments and 33 (75%) activity limitations. Muscle power functions were the most frequently measured impairment (65%), utilising manual muscle testing (37.3%). The six-minute walk test (6MWT) was the most frequently used instrument in the activity/participation domain (31.6%). Only one instrument addressed all five the physical activity/participation domains, while the majority focused on mobility domain.
Multiple tools are used to report on physical deficits experienced by ICU survivors, either measuring impairments or activity/ participation limitations. Most studies report on physical function within the first year of survival. The heterogeneity and inconsistency over time of instruments used prevents synthesis of data to determine intervention efficacy. The validity, predictive value and sensitivity of the reported measures within ICU survivors needs to be established, only then can intervention studies be designed to measure effectiveness.
This scoping review contributes to the existing literature and development of standardised core outcome measure sets (COMS) for critical illness research by providing a comprehensive and systematic mapping of physical function measurement instruments utilised in longitudinal studies of critical illness survivors. By categorising these instruments according to the International Classification of Functioning, Disability and Health (ICF) framework, the review offers a novel perspective on the current state of outcome measurement in this field.
越来越多的证据描述了危重症幸存者经历的长期发病率，身体功能受损是一个主要促成因素。对于该人群应纳入哪些身体功能测量指标，尚未达成共识。本综述旨在基于国际功能分类（ICF）描述危重症幸存者纵向研究中使用的身体功能测量工具。
对EbscoHost、科学网和Scopus进行电子数据库检索，检索时间从建库至2023年11月。两名评审员独立对标题、摘要和全文研究应用纳入和排除标准。提取的数据包括发表年份、国家、参与者年龄、随访时间框架以及使用的身体测量工具。工具根据ICF领域进行分类。
纳入了1995年至2023年11月发表的80项研究。确定了44种不同的结局测量指标。大多数研究（68项）包括多个随访点，且在一年内完成，很少有研究（12项）随访超过一年。基于ICF，11种（25%）工具测量损伤，33种（75%）测量活动受限。肌肉力量功能是最常测量的损伤（65%），采用徒手肌力测试（37.3%）。六分钟步行试验（6MWT）是活动/参与领域最常用的工具（31.6%）。只有一种工具涉及所有五个身体活动/参与领域，而大多数工具集中在移动性领域。
多种工具用于报告ICU幸存者经历的身体缺陷，测量损伤或活动/参与受限情况。大多数研究报告生存第一年内的身体功能。所使用工具随时间的异质性和不一致性阻碍了数据综合以确定干预效果。需要确定ICU幸存者中所报告测量指标的有效性、预测价值和敏感性，只有这样才能设计干预研究来测量有效性。
本范围综述通过对危重症幸存者纵向研究中使用的身体功能测量工具进行全面系统的梳理，为现有文献以及危重症研究标准化核心结局测量指标集（COMS）的发展做出了贡献。通过根据国际功能、残疾和健康分类（ICF）框架对这些工具进行分类，该综述为该领域结局测量的现状提供了新视角。
