Pre-Admission Predictors of Walking Independence in Critically Ill Patients.

BACKGROUND: Recovery of walking independence in critically ill patients is required for safe discharge home. However, the pre-admission predictors affecting this outcome in this patient group are unknown. This study aimed to identify these predictors. METHODS: We included subjects who required mechanical ventilation for at least 48 h and could walk before admission. We investigated frailty, cognitive impairment, and malnutrition risk according to the pre-admission health status. Walking independence was defined as the ability to walk for at least 45 m on level ground. The primary outcome was the association between the time to event from an ICU discharge to walking independence, and pre-admission predictors were analyzed using a Fine-Gray proportional hazards regression. RESULTS: The rate of walking independence was 38.0 (100 cases/person-month; sample N = 144). In the proportional hazards regression model, adjusted for covariates, frailty (hazard ratio [HR] 0.08 [95% CI 0.01-0.67]), pre-frailty (HR 0.37 [95% CI 0.14-0.99]), cognitive impairment (HR 0.21 [95% CI 0.05-0.90]), and malnutrition risk (HR 0.20 [95% CI 0.07-0.58]) were associated with walking independence. CONCLUSIONS: Pre-admission frailty or pre-frailty, cognitive impairment, and malnutrition risk can help predict walking independence in critically ill patients who require mechanical ventilation.

Factors related to self-care behaviors among hospitalized patients with heart failure in Japan, based on the European Heart Failure Self-Care Behaviour Scale.

[Purpose] The characteristics of heart failure in hospitalized patients with poor self-care behaviors are unknown. We investigated factors associated with self-care behaviors by using the European Heart Failure Self-Care Behaviour Scale (EHFScBS) in heart failure patients based on three comprehensive concepts. [Participants and Methods] This was a cross-sectional single-center study of heart failure patients hospitalized at a tertiary-care hospital. We investigated age, gender, family living together/apart, employment, and the Specific Activity Scale (SAS). A physical therapist provided the EHFScBS one time to determine the patients' pre-hospital self-care behavior status. The 12 items of the EHFScBS were classified into the following three categories: Maintenance, Monitoring, and Management. [Results] The median age of the 39 consecutive patients was 81 years. A multiple regression analysis revealed that the factors exhibiting significant associations were the SAS score (ß=0.504) for Management and age (ß=-0.403) for the total EHFScBS score (adjusted by the number of hospitalizations for heart failure). Maintenance and Monitoring were not significantly associated with the survey items. [Conclusion] These data indicate that self-care education for hospitalized patients with heart failure leads to individualized approaches based on characteristics such as age and physical activity capacity.

Inter-rater reliability of a wright respirometer to measure vital capacity in neuromuscular disorders.

[Purpose] We examined the inter-rater reliability of the Wright respirometer between therapists who assessed the vital capacity of patients with neuromuscular disorders. [Participants and Methods] We examined 18 patients with neuromuscular disorders. We performed a test-retest method after measuring their vital capacities. Two physical therapists experienced in the use of the Wright respirometer, specifically, therapist A with six years of clinical experience and therapist B with one, each took one measurement of the vital capacity of the same patients. The measurements between the therapists were taken at intervals of 3-7 days. We made a manual to standardize the measurements between the therapists. [Results] The vital capacities were 905 ± 490 mL for therapist A and 897 ± 483 mL for therapist B. The inter-rater reliability of ICC2,1 was 0.96 (95% CI: 0.89-0.98). Bland-Altman analyses revealed neither a fixed nor proportional bias. [Conclusion] These results demonstrated good to excellent inter-rater reliability of the Wright respirometer for patients with neuromuscular disorders using a manual and instructions.