124 CHAPTER 7 reported scores for different domains (i.e. mobility, self-care, anxiety) separately and a visual analogue scale (VAS) for overall perceived health, as well with no statistically significant difference. 7.3.5 Effects of protein provision on physical functioning Six studies reported physical functioning outcomes for the effect of protein provision,51,53,54,57,58,63 using a variety of measurement instruments (Figure 3 and Appendix 2; table S2). Physical functioning outcomes regarding participation restriction were reported using PCS-SF36, Barthel ADL Index, and Katz ADL.51,53,57,58 The PCS-SF36 describes a broad range of domains, e.g. physical function, bodily pain, and general health from the patient’s perspective. The effect of higher protein was small (MD ≤8.4, SMD ≤0.07) and not statistically different. Wandrag et al51 reported scores of zero throughout the study for both outcomes. Nakamura et al57 reported a moderate statistically significant effect on the Barthel ADL Index score (MD 35.9, CI [10.7; 61.1]; SMD 0.76, CI [0.21-1.30]) in favour of the intervention group at hospital discharge. As to activity limitations, outcomes included were aimed at muscle strength and exercise tolerance. Two studies reported scores for the FFS-ICU (mobility) and PFIT (exercise and tolerance functions), with no statistically significant effects.54,57 A total of three studies demonstrated HGS and MRC-ss outcomes at ICU-discharge or ICU day seven.54,58,63 The results of one study were not reported, since no patient passed MRC-ss during the study.51 Overall, studies showed small to moderate not Figure 2. Forest plot of the effects of protein provision on quality of life (standardised mean difference). SMD > 0 favours intervention. Abbreviations: 95%-CI: 95%-confidence interval. EQ-5D: EuroQol 5 Dimension. EQ-5D-5L: 5-level EuroQol 5 Dimension (score range= 1-5; lower is better). SMD: standardised mean difference. Total: number of participants. VAS: Visual Analogue Scale (rank of overall health. Score range=0-100; higher is better). Notes: Nakamura (2021): unclear how total EQ-5D score was derived. Chapple(2020): missing, n=23/25 (intervention/comparator). Study Nakamura 2021 EQ-5D (6 months) Chapple 2020 EQ-5D-5L mobility (day 90) Chapple 2020 EQ-5D-5L self-care (day 90) Chapple 2020 EQ-5D-5L usual activities (day 90) Chapple 2020 EQ-5D-5L pain/discomfort (day 90) Chapple 2020 EQ-5D-5L anxiety/depression (day 90) Chapple 2020 EQ-5D-5L VAS (day 90) Total 373 25 58 58 58 58 58 58 Mean SD 16.0 2.2 2.0 2.5 1.8 1.8 60.0 12.6 1.3 1.2 1.3 0.9 0.9 32.0 Intervention Total 379 31 58 58 58 58 58 58 Mean SD 11.7 2.0 1.7 2.1 1.9 1.8 53.0 9.3 1.3 1.3 1.3 0.9 0.9 32.0 Comparator -0.5 0 0.5 Standardised Mean Di erence The effects of protein provision on quality of life (SMD>0 favours intervention) SMD 0.39 0.15 0.24 0.31 -0.11 0.00 0.22 95%-CI [-0.14; 0.92] [-0.21; 0.52] [-0.13; 0.60] [-0.06; 0.67] [-0.47; 0.25] [-0.36; 0.36] [-0.15; 0.58]
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