Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach.

BACKGROUND: There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients. METHODS: Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient. RESULTS: The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832). CONCLUSIONS: This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.

Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.

BACKGROUND: Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. OBJECTIVE: To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. METHODS: 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. RESULTS: During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; p<0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage. CONCLUSION: Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.

Observational practice of incentive spirometry in stroke patients.

BACKGROUND: Stroke may lead to several health problems, but positive effects can be promoted by learning to perform physical therapy techniques correctly. OBJECTIVE: To compare two different types of observational practice (video instructions and demonstration by a physical therapist) during the use of incentive spirometry (IS). METHOD: A total of 20 patients with diagnosis of stroke and 20 healthy individuals (56±9.7 years) were allocated into two groups: one with observational practice with video instructions for the use of IS and the other with observational practice with demonstration by a physical therapist. Ten attempts for the correct use of IS were carried out and the number of errors and the magnitude of response were evaluated. The statistic used to compare the results was the three-way ANOVA test. RESULTS: The stroke subjects showed less precision when compared to the healthy individuals (mean difference 1.80±0.38) 95%CI [1.02-2.52], p<0.0001. When the type of practice was analyzed, the stroke subjects showed more errors with the video instructions (mean difference 1.5±0.5, 95%CI [0.43-2.56] (p=0.08)) and therapist demonstration (mean difference 2.40±0.52, 95%CI [1.29-3.50] (p=0.00)) when compared to the healthy individuals. CONCLUSION: The stroke subjects had a worse performance in learning the use of volume-oriented incentive spirometry when compared to healthy individuals; however, there was no difference between the types of observational practice, suggesting that both may be used to encourage the use of learning IS in patients with stroke.