Joint contracture following prolonged stay in the intensive care unit.
BACKGROUND
Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer.


METHODS
We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005.


RESULTS
At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29-38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14-0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture.


CONCLUSIONS
Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home.
Clavet
Heidi
H
Bone and Joint Laboratory, University of Ottawa, Ottawa, Ont.
Hébert
Paul C
PC
Fergusson
Dean
D
Doucette
Steve
S
Trudel
Guy
G
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D015331:Cohort Studies; D016001:Confidence Intervals; D003286:Contracture / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D003422:Critical Care / Q000379:methods; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006616:Hip Contracture / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D015994:Incidence; D007362:Intensive Care Units; D007719:Knee Joint / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012785:Shoulder Joint / Q000503:physiopathology; D013997:Time Factors