Musculoskeletal problems in intensive care unit patients post discharge

Introduction: The aim of this study was to examine the incidence of\ud musculoskeletal problems (i.e. pain, weakness, decreased joint range\ud of movement) in critical care patients post discharge. Post intensive\ud care syndrome (PICS) is now a widely used term to describe the collection\ud of problems patients develop due to their stay in intensive\ud care. ICU survivors have been found to have a high risk of developing\ud not only psychological problems but physical problems\ud such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic\ud pain [1, 2].\ud Methods: Discharged patients from ICU attended a 5 week multidisciplinary\ud rehabilitation programme as part of a quality improvement\ud initiative within Glasgow Royal Infirmary ICU. Participants completed\ud a one-one musculoskeletal assessment with an ICU physiotherapist.\ud Ethics approval was waived as the programme was part\ud of a quality improvement initiative.\ud Results: Data was collected from 47 of the 48 patients who attended\ud the programme (median age was 52 (IQR, 44-57), 67% of the patients\ud were men, median ICU length of stay (LOS) was 15 days (IQR 9-25)\ud and median APACHE II was 23 (IQR 18-27). 66% of participants\ud (n = 47) reported a new incidence of pain since discharge from ICU,\ud 28% reporting lower limb (LL) pain and 25% reporting shoulder pain.\ud Bilateral symptoms were reported in 84% of those who complained\ud of lower limb pain in contrast to 25% of those with shoulder pain. In\ud relation to muscle weakness, 74% of participants presented with LL\ud weakness compared with 51% in the upper limb (UL). UL joint range\ud of movement was reduced in 40% of participants and a 19% reduction\ud for the LL. 23% of all participants reported numbness in UL/LL\ud or both.\ud Conclusions: Musculoskeletal problems especially shoulder pain and\ud bilateral LL pain and weakness remain a significant problem for survivors\ud of critical illness. This may have implications regarding falls risks,\ud exercise capacity and reduce the likelihood of patients returning\ud to work. Shoulder pain was found to be one of the most common\ud complaints of pain supporting other research [1] with contributing\ud factors such as the position of ventilator tubing, dialysis lines or\ud central lines hypothesised. Collecting this data has helped raise\ud awareness of these problems and may strengthen the case for more\ud equipment for active mobilisation in ICU and herald a need for increased\ud understanding in downstream wards on ICUAW.