Shoulder Impairment Following Critical Illness: A Prospective Cohort Study

Objectives: Identify the prevalence of shoulder impairment in ICU survivors within 6 months of discharge from ICU. Evaluate the impact of shoulder impairment on upper limb functional status in patients treated on an ICU. Identify risk factors for the development of shoulder impairment. Design: Prospective cohort study. Setting: A tertiary care medical-surgical-trauma ICU at a U.K. hospital over 18 months, with a further 6-month follow-up after hospital discharge. Subjects: Adult patients with an ICU length of stay of greater than 72 hours with no preexisting or new neurologic or traumatic upper limb injury. Interventions: None. Measurements and Main Results: Patients underwent targeted shoulder assessments (pain, range of movement, Constant-Murley Score, QuickDASH score) at hospital discharge, 3 and 6 months after hospital discharge. Assessments were undertaken on 96 patients, with 62 patients attending follow-up at 3 months and 61 patients at 6 months. Multivariate regression analysis was used to investigate risk factors for shoulder impairment. ICU-related shoulder impairment was present in 67% of patients at 6 months following discharge from hospital. Upper limb dysfunction occurred in 46%, with 16% having severe dysfunction (equivalent to shoulder dislocation). We were unable to identify specific risk factors for shoulder impairment. Conclusions: Shoulder impairment is a highly prevalent potential source of disability in ICU survivors. This persists at 6 months after discharge with a significant impact on upper limb function. More research is needed into potential mechanisms underlying shoulder impairment and potential targeted interventions to reduce the prevalence. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Drs. McKechnie and Igo contributed equally to this work. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Mr. Gustafson's institution received funding from the Intensive Care Foundation (United Kingdom). Dr. Watkinson's institution received funding from Drayson Health, National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom, and Innovate UK, and he disclosed that he has developed an electronic observations application for which Drayson Health has purchased a sole license. The company has a research agreement with the University of Oxford and may in the future pay him personal fees. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: owen.gustafson@ouh.nhs.uk Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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