title: Evaluating the musculoskeletal health state of intensive care unit survivors
Creators: name: Gustafson, Owen
Publisher: name: Oxford Brookes University
publisherIdentifier: https://ror.org/04v2twj65
publisherIdentifierScheme: ROR
Year: 2024

description: Survivors of critical illness frequently experience long-term physical impairment, decreased health-related quality of life and low rates of return to employment. There has been limited investigation of the underlying problems impacting physical function of patients post-Intensive Care Unit (ICU) admission. Musculoskeletal (MSK) conditions may be complex in presentation, with ICU survivors potentially at greater risk of their development. The MSK health state of ICU survivors and the relationship to physical function and wider participation remains largely unknown. The objectives of this research are to: 1. Determine the current evidence reporting MSK outcomes following discharge from hospital after critical illness. 2. Determine the MSK health state of ICU survivors six months following admission to ICU and assess its relationship with health-related quality of life, employment, anxiety and depression, and symptoms of post-traumatic stress disorder. 3. Identify prognostic factors for MSK health state following critical illness. 4. Characterise the specific MSK complications experienced by ICU survivors using a standardised comprehensive MSK assessment. 5. Evaluate patient mobility and upper limb function, and the extent of the relationship to muscle structure and function in those patients with poor MSK health. The extent to which MSK complications have been reported following critical illness was determined using a scoping review methodology. Thirty-two studies were identified, which used multiple different outcome measures to report a variety of MSK health problems. There was very limited investigation in the studies of the association between MSK health problems and physical function. The results of the scoping review were used to inform the design of a multicentre prospective observational study evaluating the MSK health state of ICU survivors (the MSK-ICU study). Adults admitted to ICU for more than 48 hours without MSK trauma or neurological insult were recruited from four UK hospitals. Of the 334 participants recruited, 254 participants were followed-up six months after their ICU admission. One-hundred-and-fifty of the 254 (59%) participants had an MSK health problem and only 60/254 (24%) had received physiotherapy after hospital discharge. Functional comorbidity index, Clinical Frailty Scale, days in ICU and prone positioning were independently associated with worse MSK health. Musculoskeletal health state correlated with quality of life, anxiety, and depression. Participants with an MSK problem had more falls and were less physically active after discharge from hospital than those without a problem. Sixty-one of the 150 participants (41%) with an MSK problem underwent an MSK assessment. All participants experienced pain as part of their MSK problem, with a median (IQR) Visual Analogue Scale score of 70 (41.5-80). The most commonly reported location for an MSK problem was the shoulder (n= 30, 49.2%), with multisite problems reported by more than half (n= 33, 54.1%). One quarter of participants (n= 15, 24.6%) had high levels of fear-avoidance beliefs related to physical activity. Eleven of the 44 participants (25%) with the worst MSK health state underwent a comprehensive in-person functional assessment. The relationship between outcomes at the three domains of the International Classification of Functioning, Disability and Health framework (ICF) and MSK health were assessed. Biceps brachii size and knee extension strength were correlated with MSK health state. At the participation domain, the number of moderate-vigorous physical activity minutes undertaken was correlated with the MSK-HQ score. This novel research identifies and evaluates a source of physical impairment following critical illness and is an important step towards improving post-ICU recovery. These findings from the MSK-ICU study provide important information that could be used to inform future complex intervention development to improve the long term MSK health state and physical function of ICU survivors.