Background: Grip strength has been identified as an important indicator of health status and predictor of clinical outcomes. The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Less expensive dynamometers are available but have not been validated within a hospital setting.Objectives: To validate the Camry Digital Handgrip Dynamometer (Model EH101) against the validated JAMAR® Dynamometer (Model J00105) in a hospital population.Methods: A cross-sectional observational study with a randomised single-blind cross-over component was conducted on consenting adult patients admitted to general hospital wards. The best of three measurements taken using the dominant hand was used for analysis.Results: Fifty-one participants (median [interquartile range] age 42 [30–58] years; n = 27 [52.9%] female) were included. The mean difference between the Jamar® and Camry measurements was 1.9 kg ± 3.6 kg (t-value 0.9; p = 0.4). There was a strong positive correlation between the Jamar® and the Camry devices (R = 0.94; r² = 0.88; p 0.0001). Excellent agreement was found between Jamar® and Camry measurements (interclass correlational coefficient 0.97, 95% CI 0.94–0.99, p 0.0001). Hand dominance significantly affected the agreement between devices (p = 0.002).Conclusions: The Camry Digital Handgrip Dynamometer is a valid tool for assessing grip strength in hospitalised adult patients.Clinical implications: The Camry Digital Handgrip Dynamometer could be used as an inexpensive tool to measure grip strength.

Growing evidence shows that a significant number of patients with COVID-19 experience persistent symptoms, also known as long COVID-19. We sought to identify persistent symptoms of COVID-19 in frontline workers at Right to Care South Africa, who are past the acute phase of illness, using a cross-sectional survey. We analysed data from 207 eligible COVID-19 positive frontline workers who participated in a two-month post-COVID-19 online self-administered survey. The survey response rate was 30%; of the 62 respondents with a median age of 33.5 years (IQR= 30–44 years), 47 (76%) were females. The majority (n = 55; 88.7%) self-isolated and 7 (11.3%) were admitted to hospital at the time of diagnosis. The most common comorbid condition reported was hypertension, particularly among workers aged 45–55 years. The most reported persistent symptoms were characterised by fatigue, anxiety, difficulty sleeping, chest pain, muscle pain, and brain fog. Long COVID-19 is a serious phenomenon, of which much is still unknown, including its causes, how common it is especially in non-hospitalised healthcare workers, and how to treat it. Given the rise in COVID-19 cases, the prevalence of long COVID-19 is likely to be substantial; thus, the need for rehabilitation programs targeted at each persistent COVID-19 symptom is critical.

Background. Growing evidence is describing the long-term morbidity experienced by critical illness survivors, a major contributing factor being impaired physical function. Consensus is yet to be reached on which physical function measures should be included in this population. This review aimed to describe physical functioning measurement instruments used in longitudinal studies of critical illness survivors, based on the International Classification of Function (ICF). Methods. An electronic database search of EbscoHost, Web of Science and Scopus was conducted from inception to November 2023. Two reviewers independently applied the inclusion and exclusion criteria to titles, abstracts and full text-studies. Extracted data included year of publication; country; participant age; follow-up timeframes and physical measurement instruments used. Instruments were classified according to ICF domains. Results. Eighty studies published between 1995 and November 2023 were included. Forty-four different outcome measures were identified. Most studies (68) included multiple followed-up points and were completed within a year, and few studies (12) follow-up beyond a year. Based on the ICF, 11 (25%) instruments measured impairments and 33 (75%) activity limitations. Muscle power functions were the most frequently measured impairment (65%), utilising manual muscle testing (37.3%). The six-minute walk test (6MWT) was the most frequently used instrument in the activity/participation domain (31.6%). Only one instrument addressed all five the physical activity/participation domains, while the majority focused on mobility domain. Conclusions. Multiple tools are used to report on physical deficits experienced by ICU survivors, either measuring impairments or activity/ participation limitations. Most studies report on physical function within the first year of survival. The heterogeneity and inconsistency over time of instruments used prevents synthesis of data to determine intervention efficacy. The validity, predictive value and sensitivity of the reported measures within ICU survivors needs to be established, only then can intervention studies be designed to measure effectiveness.

IMPORTANCE AND OBJECTIVES: The aim of this study was to explore peripheral and respiratory muscle structure and strength from unit admission to hospital discharge among ICU patients in a resource-constrained setting. DESIGN: Prospective, observational study. SETTING: Tertiary academic hospital. PARTICIPANTS: Newly intubated critically ill adults admitted to the medical and surgical ICUs and expected to be mechanically ventilated for more than 48 hours were included in the study. MAIN OUTCOMES AND MEASURES: Ultrasonography of the right hemi-diaphragm and quadriceps muscles were taken at admission for 3 consecutive days. Respiratory and peripheral muscle strength were evaluated using the Medical Research Council-Sum Score, dynamometry and maximal inspiratory pressure (MIP) at awakening, ICU discharge and hospital discharge. RESULTS: Forty-five participants were included, with a median (interquartile range) age of 34.5 (24.3–47.4) years and 73% were male. Most of the change in diaphragm thickness was observed on day 3, with 5 (22%) participants showing a decrease of more than 10% from baseline. Minimal changes in rectus femoris cross-sectional area were noted during the first 3 days. Eleven participants (44%) presented with ICU-acquired weakness at awakening, which decreased to 7 (29%) participants at ICU discharge and 5 (24%) participants at hospital discharge. The mean ± sd percentage of predicted quadriceps force was 22.2 ± 5.1 N at hospital discharge. The mean ± sd percentage of predicted MIP scores was 29.6% ± 10.5% at ICU discharge and 29.1% ± 8.6% at hospital discharge. CONCLUSIONS AND RELEVANCE: Patients discharged from the ICU in a resource-constrained setting presented with peripheral and respiratory muscle weakness, with minimal change in muscle structure shown by ultrasonography, despite short ICU stays, low Acute Physiology and Chronic Health Evaluation II scores, and a relatively young age. Future research should explore whether these findings indicate a distinct phenotype of critical illness in such environments.

Purpose: Trauma is known as a leading cause of mortality and injury related disability globally. In South Africa (SA) the socioeconomic burden of trauma is magnified as the working age is most affected. The aim of this study was to describe the proportion of major trauma survivors who returned to work (RTW) during a 6-month period post hospital discharge and to identify the factors associated with the RTW outcome. Methods: This was a prospective observational cohort study involving major trauma survivors from a private level 1 trauma centre intensive care unit in SA between January and September 2022. RTW status was assessed using the Employment Questionnaire. Univariate and multivariable Cox proportional hazards regression was used in analysis. Results: Sixty-four of the 86 participants (74.4%) RTW at six months post hospital discharge. RTW had a median time of 16 weeks. After adjusting and backwards analysis, Chelsea Critical Care Physical assessment tool scores (adjusted hazard ratio (AHR), 1.06, 95% CI 1.01–1.10, p = 0.007), and not having applied/received any form of grants (AHR 2.26, 95% CI 1.35–3.77, p = 0.002) were the only factors that were associated with the RTW outcome. Conclusion: The cumulative probability of no RTW was 25.6% among participants after 24 weeks. Higher physical function at ICU discharge and not seeking any form of compensation was associated with a higher probability of RTW. This study has highlighted the complexities of RTW and the socioeconomic burden following major trauma. There is therefore a need for further studies on RTW following major trauma in SA.