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Published on: July 24, 2013
The Association between Frailty and Short-Term Outcomes in an Intensive Care Unit Rehabilitation Trial: An
A Takaoka1, D Heels-Ansdell, D J Cook
1Michelle E. Kho, PhD, PT, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Physiotherapy Department, St. Joseph's Healthcare Hamilton, Institute of Applied Health Sciences, 1400 Main St. W. Hamilton, ON L8S 1C7, Email: khome@mcmaster.ca, Telephone: (905) 525-9140 x28221, Fax Number: (905) 524-0069.
This study found no link between pre-hospital frailty and outcomes like physical function or mortality in critically ill patients receiving early ICU rehabilitation. Larger studies are needed to confirm these findings for early rehabilitation in critical care.
Area of Science:
- Critical care medicine
- Geriatric medicine
- Rehabilitation science
Background:
- Early physical therapy in the ICU may mitigate functional decline in critically ill patients.
- The impact of frailty on outcomes for patients undergoing early ICU rehabilitation remains unclear.
Purpose of the Study:
- To investigate the association between pre-hospital frailty and outcomes in critically ill patients receiving early in-ICU rehabilitation.
- To analyze the relationship between frailty, physical function, muscle strength, and hospital mortality.
Main Methods:
- Secondary analysis of the CYCLE pilot randomized clinical trial (RCT) involving 66 previously ambulatory critically ill adults across 7 Canadian ICUs.
- Regression analyses assessed the association of Clinical Frailty Scale (CFS) scores with Physical Function in ICU Test-scored (PFIT-s) and muscle strength at hospital discharge.
- Adjustments were made for illness severity (APACHE II) and the intervention (early in-bed cycling plus physiotherapy vs. physiotherapy alone); sensitivity analyses were performed.
Main Results:
- Frailty was not significantly associated with physical function (PFIT-s: MD [95% CI]=0.20, [-2.08, 2.74]) or muscle strength (MD [95% CI]=1.96, [-12.6, 16.6]) at hospital discharge.
- No significant association was found between frailty and hospital mortality (OR [95% CI]=0.91, [0.28 to 2.93]).
- Sensitivity analyses confirmed these findings.
Conclusions:
- Pre-hospital frailty did not demonstrate an association with physical function, strength, or hospital mortality in this cohort of critically ill patients undergoing early rehabilitation.
- Larger sample sizes are required to definitively ascertain the relationship between frailty and outcomes at hospital discharge in this population.
