Predictors of Activities of Daily Living in Intensive Care Unit Survivors: A Propensity Score Matching Analysis

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  • Matsumoto Tsuyoshi
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Yoshikawa Ryo
    Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  • Harada Risa
    Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  • Fujii Yasumitsu
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Adachi Akimasa
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Onishi Hirokazu
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Imamura Ai
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Takamiya Daiki
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  • Makiura Daisuke
    Department of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
  • Komaki Kodai
    Department of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
  • Ogawa Masato
    Department of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
  • Sakai Yoshitada
    Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

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<p>Objectives: Increased long-term impairment is common among intensive care unit (ICU) survivors. However, predictors of activities of daily living (ADL) in ICU survivors are poorly understood. We aimed to focus on the trajectory of physical function and explore the clinical variables that affect ADL at hospital discharge.</p><p>Methods: We enrolled 411 patients admitted to the ICU from April 2018 to October 2020. Physical function was evaluated at ICU admission, ICU discharge, and hospital discharge. We assessed physical function (grip strength, arm and calf circumference, quadriceps thickness, and Barthel index). Patients were assigned to the high or low ADL group based on their Barthel index at discharge. Propensity score matching analysis was performed to minimize selection biases and differences in clinical characteristics.</p><p>Results: After matching propensity scores, 114 of the 411 patients (aged 65±15 years) were evaluated. The high ADL group showed better physical function at ICU discharge and hospital discharge than the low ADL group. An overall decreasing trend in muscle mass was observed over time; the rates of decline were lower in the high ADL group than in the low ADL group. The cutoff values for relative changes in calf circumference and quadriceps thickness to predict high ADL were −7.89% (sensitivity: 77.8%, specificity: 55.6%) and −28.1% (sensitivity: 81.0%, specificity: 58.8%), respectively.</p><p>Conclusions: The relative decreases in calf circumference and quadriceps thickness during hospitalization were lower in patients who maintained their ADL. Assessment of the trajectory of physical function can predict ADL status at hospital discharge among ICU survivors.</p>

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