Mobilization practices for patients with burn injury in critical care.

PURPOSE: Patients with burn usually undergo prolonged hospitalization due partially to the treatment of wounds and scars. Although the benefits of early mobilization are well-known in critical care patients, there are a lack of studies reporting mobilization practices and functional status for patients with burn. MATERIALS: Clinical and physiotherapy data were daily collected, including ICU mobility scale (IMS) and reported barriers to mobilization therapy during a one-year period. At hospital discharge, the 6-min walking test (6MWT), Medical Research Council scale (MRCS) and handgrip strength test were applied to evaluate the patients' functionality. RESULTS: Of the 74 patients admitted, 66% were placed on mechanical ventilation (MV). Mobilization therapy was administered in 67.2% of physiotherapy sessions, with passive mobilization being the most prevalent (53.2%) followed by active in-bed exercises (13.6%). Reported barriers for mobilization included hemodynamic instability followed by limited time for assistance. At hospital discharge, the 6MWD was 270(136) meters. A positive correlation was found between handgrip evaluation and 6MWD and a negative correlation with hospital length of stay. CONCLUSIONS: Mobilization therapy of patients with burns in the ICU was characterized by a low mobility level during MV with a low functional status at hospital discharge.

Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil / Perme Intensive Care Unit Mobility Score e ICU Mobility Scale: tradução e adaptação cultural para a língua portuguesa falada no Brasil

ABSTRACT Objective: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement ( > 0.90) and reliability ( > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.

RESUMO Objetivo: Realizar a tradução e a validação cultural para a língua portuguesa falada no Brasil e determinar a concordância e a confiabilidade dos instrumentos Perme Intensive Care Unit Mobility Score (designado Perme Escore) e ICU Mobility Scale (designada Escala de Mobilidade em UTI, EMU). Métodos: Os processos de tradução e adaptação cultural seguiram as seguintes etapas: preparação, tradução, reconciliação, síntese, tradução reversa, revisão, aprovação e pré-teste. Após esses processos, as versões em português dos dois instrumentos foram utilizadas por dois pesquisadores na avaliação de pacientes críticos em UTI. O índice kappa ponderado e a disposição gráfica de Bland-Altman foram utilizados para verificar a concordância entre os instrumentos. O coeficiente alfa de Cronbach foi utilizado para verificar a confiabilidade entre as respostas dos avaliadores dentro de cada domínio dos instrumentos. A correlação entre os instrumentos foi verificada pelo teste de correlação de Spearman. Resultados: A amostra foi composta por 103 pacientes, sendo a maioria homens (n = 56; 54%), com média de idade = 52 ± 18 anos. O principal motivo de internação nas UTIs foi insuficiência respiratória (em 44%). Os dois instrumentos apresentaram excelente concordância interobservador (> 0,90) e confiabilidade ( > 0,90) em todos os domínios. Constatou-se um baixo viés interobservador na EMU e no Perme Escore (−0,048 ± 0,350 e −0,06 ± 0,73, respectivamente). Os IC95% para os mesmos instrumentos variaram, respectivamente, de −0,73 a 0,64 e de −1,50 a 1,36, respectivamente. Além disso, verificou-se alta correlação positiva entre os dois instrumentos (r = 0,941; p < 0,001). Conclusões: As versões dos dois instrumentos apresentaram alta concordância e confiabilidade interobservador.

Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil.

OBJECTIVE:: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. METHODS:: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. RESULTS:: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement ( > 0.90) and reliability ( > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (-0.048 ± 0.350 and -0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from -0.73 to 0.64 and -1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). CONCLUSIONS:: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability. OBJETIVO:: Realizar a tradução e a validação cultural para a língua portuguesa falada no Brasil e determinar a concordância e a confiabilidade dos instrumentos Perme Intensive Care Unit Mobility Score (designado Perme Escore) e ICU Mobility Scale (designada Escala de Mobilidade em UTI, EMU). MÉTODOS:: Os processos de tradução e adaptação cultural seguiram as seguintes etapas: preparação, tradução, reconciliação, síntese, tradução reversa, revisão, aprovação e pré-teste. Após esses processos, as versões em português dos dois instrumentos foram utilizadas por dois pesquisadores na avaliação de pacientes críticos em UTI. O índice kappa ponderado e a disposição gráfica de Bland-Altman foram utilizados para verificar a concordância entre os instrumentos. O coeficiente alfa de Cronbach foi utilizado para verificar a confiabilidade entre as respostas dos avaliadores dentro de cada domínio dos instrumentos. A correlação entre os instrumentos foi verificada pelo teste de correlação de Spearman. RESULTADOS:: A amostra foi composta por 103 pacientes, sendo a maioria homens (n = 56; 54%), com média de idade = 52 ± 18 anos. O principal motivo de internação nas UTIs foi insuficiência respiratória (em 44%). Os dois instrumentos apresentaram excelente concordância interobservador (> 0,90) e confiabilidade ( > 0,90) em todos os domínios. Constatou-se um baixo viés interobservador na EMU e no Perme Escore (-0,048 ± 0,350 e -0,06 ± 0,73, respectivamente). Os IC95% para os mesmos instrumentos variaram, respectivamente, de -0,73 a 0,64 e de -1,50 a 1,36, respectivamente. Além disso, verificou-se alta correlação positiva entre os dois instrumentos (r = 0,941; p < 0,001). CONCLUSÕES:: As versões dos dois instrumentos apresentaram alta concordância e confiabilidade interobservador.