PDF herunterladen
J Pediatr Intensive Care 2015; 04(04): 218-224
DOI: 10.1055/s-0035-1563544
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Feasibility and Reliability of Muscle Strength Testing in Critically Ill Children

Kaitlyn Siu
1   Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Samah Al-Harbi
2   Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Heather Clark
2   Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Lehana Thabane
3   Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
,
Ji Cheng
3   Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
,
Mark Tarnopolsky
4   Division of Neuromuscular and Neurometabolic Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Brandon Meaney
1   Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Karen Choong
2   Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
› Institutsangaben
Weitere Informationen

Publikationsverlauf

08. Dezember 2014

11. Januar 2015

Publikationsdatum:
28. August 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Diagnosing pediatric intensive care unit–acquired weakness (PICU-AW) is challenging. The Medical Research Council (MRC) score is a widely used screening method for muscle weakness in critically ill adults; however, its utility in critically ill children has not been established. Our objective was to determine the feasibility and interobserver reliability of muscle strength testing using MRC score in critically ill children. A prospective observational substudy of critically ill children aged 1 to 17 years and limited to bed rest during the first 48 hours of PICU admission was evaluated with weekly MRC exams independently performed by two clinical raters. MRC exams were attempted on all 33 participants, but could be completed in only 21 (64%), 9 of who (43%) received at least one exam while in the PICU, and in the remaining 12 (57%), MRC exams could only be completed after PICU discharge. Of the 95 attempted MRC exams, 55 (57%) could not be conducted or completed, most commonly due to patient sedation, and inability to comply due to cognitive ability, pain, or noncooperation. The inter-rater reliability for MRC sum score was excellent (intraclass correlation coefficient: 0.87). However, the inter-rater reliability was only moderate when used to determine PICU-AW (Cohen kappa: 0.48). MRC testing in the PICU was not feasible as an early screening tool for muscle weakness in the majority of critically ill children in this study. Further research is needed to find an appropriate screening tool that is both feasible and predicts clinically relevant outcomes in children, such as function and recovery following critical illness.

Keywords

pediatrics - critical illness - muscle strength testing - muscle weakness - neuromuscular disorder - reliability
 

  • References

  • 1 Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007; 131 (5) 1541-1549
    CrossrefPubMedSuche in Google Scholar
  • 2 Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA 2008; 300 (14) 1685-1690
    CrossrefPubMedSuche in Google Scholar
  • 3 De Jonghe B, Sharshar T, Lefaucheur JP , et al; Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288 (22) 2859-2867
    CrossrefPubMedSuche in Google Scholar
  • 4 Ali NA, O'Brien Jr JM, Hoffmann SP , et al; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 2008; 178 (3) 261-268
    CrossrefPubMedSuche in Google Scholar
  • 5 Herridge MS, Tansey CM, Matté A , et al; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364 (14) 1293-1304
    CrossrefPubMedSuche in Google Scholar
  • 6 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304 (16) 1787-1794
    CrossrefPubMedSuche in Google Scholar
  • 7 Sharshar T, Bastuji-Garin S, Stevens RD , et al; Groupe de Réflexion et d'Etude des Neuromyopathies En Réanimation. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med 2009; 37 (12) 3047-3053
    CrossrefPubMedSuche in Google Scholar
  • 8 van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Poor functional recovery after a critical illness: a longitudinal study. J Rehabil Med 2009; 41 (13) 1041-1048
    CrossrefPubMedSuche in Google Scholar
  • 9 Banwell BL, Mildner RJ, Hassall AC, Becker LE, Vajsar J, Shemie SD. Muscle weakness in critically ill children. Neurology 2003; 61 (12) 1779-1782
    CrossrefPubMedSuche in Google Scholar
  • 10 Choong K, Al-Harbi S, Siu K , et al; Canadian Critical Care Trials Group. Functional recovery following critical illness in children: the “wee-cover” pilot study. Pediatr Crit Care Med 2015; 16 (4) 310-318
    CrossrefPubMedSuche in Google Scholar
  • 11 Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty's Stationery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain 2010; 133 (10) 2838-2844
    CrossrefPubMedSuche in Google Scholar
  • 12 Kleyweg RP, van der Meché FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve 1991; 14 (11) 1103-1109
    CrossrefPubMedSuche in Google Scholar
  • 13 Florence JM, Pandya S, King WM , et al. Intrarater reliability of manual muscle test (Medical Research Council scale) grades in Duchenne's muscular dystrophy. Phys Ther 1992; 72 (2) 115-122 , discussion 122–126
    PubMedSuche in Google Scholar
  • 14 Waak K, Zaremba S, Eikermann M. Muscle strength measurement in the intensive care unit: not everything that can be counted counts. J Crit Care 2013; 28 (1) 96-98
    CrossrefPubMedSuche in Google Scholar
  • 15 Vanpee G, Hermans G, Segers J, Gosselink R. Assessment of limb muscle strength in critically ill patients: a systematic review. Crit Care Med 2014; 42 (3) 701-711
    CrossrefPubMedSuche in Google Scholar
  • 16 Jain M, Smith M, Cintas H , et al. Intra-rater and inter-rater reliability of the 10-point Manual Muscle Test (MMT) of strength in children with juvenile idiopathic inflammatory myopathies (JIIM). Phys Occup Ther Pediatr 2006; 26 (3) 5-17
    CrossrefPubMedSuche in Google Scholar
  • 17 Escolar DM, Henricson EK, Mayhew J , et al. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve 2001; 24 (6) 787-793
    CrossrefPubMedSuche in Google Scholar
  • 18 Hough CL, Lieu BK, Caldwell ES. Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement. Crit Care 2011; 15 (1) R43
    CrossrefPubMedSuche in Google Scholar
  • 19 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1) 159-174
    CrossrefPubMedSuche in Google Scholar
  • 20 Gosselink R, Clerckx B, Robbeets C, Vanhullebusch T, Vanpee G, Segers J. Physiotherapy in the intensive care unit. Neth J Crit Care 2011; 15 (2) 66-75
    PubMedSuche in Google Scholar
  • 21 Lee CM, Fan E. ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients?. BMC Med 2012; 10: 115
    CrossrefPubMedSuche in Google Scholar
  • 22 Hermans G, Clerckx B, Vanhullebusch T , et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve 2012; 45 (1) 18-25
    CrossrefPubMedSuche in Google Scholar
  • 23 Baldwin CE, Paratz JD, Bersten AD. Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care 2013; 28 (1) 77-86
    CrossrefPubMedSuche in Google Scholar
  • 24 Lee JJ, Waak K, Grosse-Sundrup M , et al. Global muscle strength but not grip strength predicts mortality and length of stay in a general population in a surgical intensive care unit. Phys Ther 2012; 92 (12) 1546-1555
    CrossrefPubMedSuche in Google Scholar
  • 25 Leijten FS, De Weerd AW, Poortvliet DC, De Ridder VA, Ulrich C, Harink-De Weerd JE. Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator. Intensive Care Med 1996; 22 (9) 856-861
    CrossrefPubMedSuche in Google Scholar
  • 26 De Jonghe B, Cook D, Sharshar T, Lefaucheur JP, Carlet J, Outin H. Acquired neuromuscular disorders in critically ill patients: a systematic review. Groupe de Reflexion et d'Etude sur les Neuromyopathies En Reanimation. Intensive Care Med 1998; 24 (12) 1242-1250
    CrossrefPubMedSuche in Google Scholar
  • 27 Latronico N, Fenzi F, Recupero D , et al. Critical illness myopathy and neuropathy. Lancet 1996; 347 (9015) 1579-1582
    CrossrefPubMedSuche in Google Scholar
  • 28 Bittner EA, Martyn JA, George E, Frontera WR, Eikermann M. Measurement of muscle strength in the intensive care unit. Crit Care Med 2009; 37 (10, Suppl): S321-S330
    CrossrefPubMedSuche in Google Scholar