Functional Assessment Scales in a General Intensive Care Unit. A Review

Patients in the intensive care unit (ICU) are often exposed to prolonged immobilization, thus they lose their functional ability. Therefore, it is crucial to assess patients’ functional ability during their stay in and upon their discharge from the ICU. Several scales have been used so far for the assessment of functional ability, impairment and/or disability in ICU patients. These outcome measures include several assessment scales, such as the Barthel Index, the Functional Independence Measure, the Functional Status Score for the ICU, the Physical Function ICU Test Modified Rankin Scale, the Karnofsky Scale Index, the 4P questionnaire, the Glasgow Outcome Scale, and the Disability Rating Scale. The choice of the most appropriate assessment scale will depend on the specific patient population, the diagnosis and rehabilitation phase and the psychological properties of the available measurement. The aim of the present review is to describe the functional assessment scales for ICU, to examine the psychometric evidence for reliability and validity and to summarize the strengths and the weaknesses of these scales. I N t r O D U c t I O N During an intensive care unit (ICU) stay, patients are often exposed to prolonged bed rest, dysfunction of vital organs, sepsis, hypoxemia and neuromuscular drug toxicity. As a result, the cardiovascular system status may be impaired and critical illness neuromuscular syndromes may occur. Both of the these conditions may delay ventilator weaning and increase ICU and hospital stay. In particular, the prolonged immobility and inactivity may result in loss of muscle strength and endurance, and loss of balance and neuromuscular coordination, further leading to total functional impairment, and thus impaired quality of life. Research has shown that after 1 week of bed rest, muscle strength may decrease as much as 20%, with an additional 20% loss of remaining strength occurring each subsequent week. Therefore, examining the functional ability and starting early mobilization of ICU patients should increase the weaning success rate, decrease ICU and hospital stay, and improve their quality of life in the ICU and beyond. Due to the functional impairment of ICU patients during their stay in the unit, there is a need to assess functional ability upon their discharge from the unit. Furthermore, the cost of caring for the survivors of ICU after their discharge from the unit is quite high and the impact of an effective functional treatment for them would be significant economically and socially. Thus, the development and use of a functional revIew Critical Care Medicine Department, Evagelismos General Hospital of Athens, University of Athens, Athens, Greece HOSPITAL CHRONICLES 2013, 8(4): 164–170