Elsevier Logo

Careplan

Muscle Strength, Adult

Dec.17.2019

Muscle Strength Impairment (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing muscle weakness that limits performance of daily activities or ability to maintain functional positions.

Key Information

  • Strengthening programs should be individualized. Medical condition, age, activity level and patient goals will influence the planning and implementation of a strengthening program.
  • Muscle-strength testing and interventions may be contraindicated with conditions, such as joint instability or inflammation, unhealed fractures, osteoporosis or postoperative restrictions.
  • Isometric strengthening exercises may be contraindicated for a patient with hypertension or cardiac disease.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Improved Muscle Strength

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Muscle Strength Impairment

Signs/Symptoms/Presentation

  • active movement limitation
  • balance limitation
  • gait impairment
  • limitations in daily activity performance
  • low muscle tone
  • mobility impairment
  • muscle atrophy

Problem Intervention

Optimize Muscle Strength

  • Assess muscle strength using a standardized procedure (e.g., manual muscle testing, dynamometry) or functional screen to determine individual limitations or risk for impairment.
  • Consider any contraindications or precautions to individualize treatment plan, such as fracture, recent nerve or tendon repair, poor nutrition, medications that impact cognitive or functional status; address contraindications and refer for further evaluation, if needed.
  • Assess for changes or abnormalities in muscles or movement patterns, such as atrophy, abnormal reflexes, muscle tone impairment, substitution patterns or weakness in myotome patterns.
  • Design and implement interventions to address strength impairments with type, time, frequency, intensity and resistance that are individualized to the patient (e.g., progressive resistive or isometric exercises).
  • Ensure proper body alignment and exercise technique. Modify as needed, such as seated exercise or reducing range of motion.
  • Monitor and address signs and symptoms of intolerance, such as unexpected pain or shortness of breath.
  • Utilize appropriate modalities, devices or techniques to facilitate muscle strength (e.g., biofeedback, electrical stimulation, robotics).
  • Encourage early mobilization and performance of daily activities, if able, while providing level of assistance needed for safety.
  • Recommend and train in use of adaptive or assistive devices or environmental modification to compensate for strength impairment, while facilitating independence and safety (e.g., rolling walker, tub bench, enlarged lightweight eating utensils).
  • If poor oral intake is suspected, perform a nutrition assessment that includes a nutrition-focused physical exam to identify malnutrition risk.

Associated Documentation

  • Adaptive Equipment Use
  • Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

  • description

  • signs/symptoms

Self Management

  • activity

  • assistive/adaptive devices

  • home safety

  • prevent skin breakdown

  • provider follow-up

  • rehabilitation therapy

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

Population-Specific Considerations

Geriatric

  • Resistance training can benefit the older adult and assist in prevention and treatment of frailty and sarcopenia. Health benefits may include maintenance of bone density and improved strength, cognition, function and quality of life.

References

  • (2016). Braddom, R. L.; Chan, L.; Harrast, M. A.; Kowalske, K. J.; Matthews, D. J.; Ragnarsson, K. T.; Stolp, K. A (Eds.), Physical medicine and rehabilitation. Philadelphia: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • (2020). Paz, J. C.; West, M. P.; Panasci, K.; Greenwood, K. C (Eds.), Acute care handbook for physical therapists. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Burke, D.; Gorman, E.; Stokes, D.; Lennon, O. An evaluation of neuromuscular electrical stimulation in critical care using the ICF framework: A systematic review and meta-analysis. The Clinical Respiratory Journal. 2016;10(4), 407-420. doi:10.1111/crj.12234 [Metasynthesis,Meta-analysis,Systematic Review]
  • de Labra, C.; Guimaraes-Pinheiro, C.; Maseda, A.; Lorenzo, T.; Millán-Calenti, J. C. Effects of physical exercise interventions in frail older adults: A systematic review of randomized controlled trials. BMC Geriatrics. 2015;15(1), 154. doi:10.1186/s12877-015-0155-4 Source[Systematic Review]
  • Doiron, K. A.; Hoffmann, T. C.; Beller, E. M. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database of Systematic Reviews. 2018;(3) doi:10.1002/14651858.CD010754.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • eaudart, C.; Rolland, Y.; Cruz-Jentoft, A. J.; Bauer, J. M.; Sieber, C.; Cooper, C.; Al-Daghri, N.; de Carvalho, I. A.; Bautmans, I.; Bernabei, R.; Bruyère, O.; et al. Assessment of muscle function and physical performance in daily clinical practice. Calcified Tissue International. 2019;105(1), 1-14. doi:10.1007/s00223-019-00545-w [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Fiogbé , E.; Carnavale, B. F.; de Medeiros Takahashi, A. C. Exercise training in older adults, what effects on muscle force control? A systematic review of randomized clinical trials. Archives of gerontology and Geriatrics. 2019;83, 138-150. doi:10.1016/j.archger.2019.04.005 Source[Systematic Review]
  • Hart, P. D.; Buck, D. J. The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis. Health Promotion Perspectives. 2019;9(1), 1. doi:10.15171/hpp.2019.01 Source[Meta-analysis,Systematic Review]
  • Hislop, H. J.; Avers, D.; Brown, M. (2014). Daniels and Worthingham's muscle testing: Techniques of manual examination and performance testing. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Jones, S.; Man, W. D. C.; Gao, W.; Higginson, I. J.; Wilcock, A.; Maddocks, M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database of Systematic Reviews. 2016;(10) doi:10.1002/14651858.CD009419.pub3 [Metasynthesis,Meta-analysis,Systematic Review]
  • Knowles, O. E.; Drinkwater, E. J.; Urwin, C. S.; Lamon, S.; Aisbett, B. Inadequate sleep and muscle strength: Implications for resistance training. Journal of Science and Medicine in Sport. 2018;21(9), 959-968. doi:10.1016/j.jsams.2018.01.012 [Metasynthesis,Meta-analysis,Systematic Review]
  • Koester, K.; Troeller, H.; Panter, S.; Winter, E.; Patel, J. J. Overview of intensive care unit-related physical and functional impairments and rehabilitation-related devices. Nutrition in Clinical Practice. 2018;33(2), 177-184. doi:10.1002/ncp.10077 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Lee, S. Y.; Tung, H. H.; Liu, C. Y.; Chen, L. K. Physical activity and sarcopenia in the geriatric population: A systematic review. Journal of the American Medical Directors Association. 2018;19(5), 378-383. doi:10.1016/j.jamda.2018.02.003 Source[Systematic Review]
  • Li, Z.; Peng, X.; Zhu, B.; Zhang, Y.; Xi, X. Active mobilization for mechanically ventilated patients: A systematic review. Archives of Physical Medicine and Rehabilitation. 2013;94(3), 551-561. [Metasynthesis,Meta-analysis,Systematic Review]
  • Liao, C. D.; Chen, H. C.; Huang, S. W.; Liou, T. H. The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: A systematic review and meta-regression analysis of randomized trials. Nutrients. 2019;11(8), 1713. doi:10.3390/nu11081713 Source[Meta-analysis,Systematic Review]
  • Liu, C. J.; Latham, N. K. Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews. 2009;(3) doi:10.1002/14651858.CD002759.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • Lopes, J. S. S.; Machado, A. F.; Micheletti, J. K.; de Almeida, A. C.; Cavina A. P.; Pastre, C. M. Effects of training with elastic resistance versus conventional resistance on muscular strength: A systematic review and meta-analysis. SAGE Open Medicine. 2019;7 doi:10.1177/2050312119831116 [Metasynthesis,Meta-analysis,Systematic Review]
  • Lopez, P.; Pinto, R. S.; Radaelli, R.; Rech, A.; Grazioli, R.; Izquierdo, M.; Cadore, E. L. Benefits of resistance training in physically frail elderly: A systematic review. Aging Clinical and Experimental Research. 2018;30(8), 889-899. doi:10.1007/s40520-017-0863-z Source[Systematic Review]
  • Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Quittan, M. Aspects of physical medicine and rehabilitation in the treatment of deconditioned patients in the acute care setting: The role of skeletal muscle. Wiener Medizinische Wochenschrift. 2016;166(1-2), 28-38. doi:10.1007/s10354-015-0418-x [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Raymond, M. J.; Bramley-Tzerefos, R. E.; Jeffs, K. J.; Winter, A.; Holland, A. E. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Archives of Physical Medicine and Rehabilitation. 2013;94(8), 1458-1472. doi:10.1016/j.apmr.2013.02.022 Source[Systematic Review]
  • Sexton, B. P.; Taylor, N. F. To sit or not to sit? A systematic review and meta-analysis of seated exercise for older adults. Australasian Journal on Ageing. 2019;38(1), 15-27. doi:10.1111/ajag.12603 [Meta-analysis,Systematic Review]
  • Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Trethewey, S. P.; Brown, N.; Gao, F.; Turner, A. M. Interventions for the management and prevention of sarcopenia in the critically ill: A systematic review. Journal of Critical Care. 2019; doi:10.1016/j.jcrc.2019.01.008 [Metasynthesis,Meta-analysis,Systematic Review]
  • Trethewey, S. P.; Brown, N.; Gao, F.; Turner, A. M. Interventions for the management and prevention of sarcopenia in the critically ill: A systematic review. Journal of Critical Care. 2019;50, 287-295. doi:10.1016/j.jcrc.2019.01.008 Source[Systematic Review]
  • Umphred, D. A.; Lazaro, R. T.; Roller, M. L.; Burton, G. U. (2013). Umphred's neurological rehabilitation. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Veronese, N.; Stubbs, B.; Punzi, L.; Soysal, P.; Incalzi, R. A.; Saller, A.; Maggi, S. Effect of nutritional supplementations on physical performance and muscle strength parameters in older people: A systematic review and meta-analysis. Ageing Research Reviews. 2019;51, 48-54. doi:10.1016/j.arr.2019.02.005 Source[Meta-analysis,Systematic Review]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.