Joint contractures in the intensive care unit: association with resource utilization and ambulatory status at discharge

Abstract

Purpose. The objectives of our study were (1) to explore the link between joint contractures acquired in the ICU and the ambulatory status of patients at discharge home, to determine (2) when and how many patients received physiotherapy services in ICU and on the hospital ward, and (3) the differences in the use of hospital resources in the presence or absence of joint contractures.

Method. Data on ICU joint contractures were extracted from an existing contracture database containing information on 155 Canadian patients with a tertiary ICU stay of 14 days or more.

Results. Of 155 patients, 115 (74.2%) received a range of motion assessment in the ICU. The assessment took place a median of 7 days (IQR 0–36) after ICU admission. Significantly fewer patients with joint contractures than without joint contractures were mobilized on the hospital ward (21/38 [55.3%] vs. 27/34 [79.4%], P = 0.03). At discharge home, more patients with joint contractures had a low ambulatory status (38 [64.4%]) compared with patients without joint contractures (26 [51.0%]; P = 0.002).

Conclusion. The median delay of 7 days before musculoskeletal assessment in the ICU together with failure to assess 26% of patients may have allowed the development of contractures, which affected the patients' ambulatory status at discharge from hospital.

Keywords:

• Joint contractures
• intensive care unit
• resource utilization

Acknowledgment

The authors thank Dr. Hans Uhthoff for providing feedback throughout data analysis and for reviewing the final manuscript. We also thank Gloria Baker for editorial assistance.