Interobserver agreement of Medical Research Council sum score assessed by the intensive care unit physiotherapist: a survey.

Abstract

The MRC sum score is a non-invasive volitional test used to assess muscle weakness acquired in intensive care. A very low score is correlated with mortality. Several studies have shown good inter-operator reproducibility, even if large disparities appear throughout the literature. In this context, we wanted to know, thanks to a survey of intensive care unit physiotherapists, the common points and the disparities in practice for this test. Between April and September 2019, we interviewed 69 physiotherapists using an online questionnaire. The results show significant variations in the evaluation of neurological status, in the performance of the test itself with notably differences in cotation, and finally in the extrapolations. These disparities absolutely match those of literature. The MRC sum score therefore makes it possible to highlight ICU neuromyopathy, even if standardization seems essential, in view of the regular use today of this test as a judgment criterion in lot of studies. Further studies should compare this MRC sum score with a 4-point MRC, the latter having shown better reproducibility. Muscular therapist evaluation in ICU is also possible by ultrasound at the acute stage, by MRC sum score as soon as the patient is neurologically able of performing the test, and by hand-grip test as soon as the patient exceeds a score of 48/60, in order to be more relevant in evolution and in the choice of early rehabilitation techniques to apply.