D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d Di s c ove ry w ith H um anis m in Me dicine
Vol. 8 Issue 1 Jan 2019
Physical Activity and Weakness Score (PAWS) and Assessment of Muscle Weakness in Hospitalized Patients Experienced clinicians commonly observe that patients admitted to the hospital develop muscle weakness, and such patients are more prone to falls and injury. Muscle weakness also limits exercise ability, leads to frequent readmission to the hospital, and predisposes patients to other adverse clinical outcomes. Simplified assessment tools are needed to identify and track muscle weakness. For that reason, Drs. Rajiv Dhand and Jeffrey Hecht, along with third-year resident Asha Pathak and statistician Eric Heidel, developed a questionnaire in 2015 to assess major content areas related to muscle weakness. The Physical Activity and Weakness Score, or PAWS, is a self-reported questionnaire to screen and track patients’ level of weakness before, during, and after inpatient hospitalizations. Questions assess patients’ perception of their fitness in five areas: physical activity, shortness of breath, functional capacity, muscle strength, and fatigability. Each question has a total score value of 1-5 with a total questionnaire score ranging from 5-25. A score of 15-25 indicates the highest amount of possible weakness, 6-14 indicates some weakness, and a score of 5 indicates no weakness. In patients who were admitted to the hospital for more than 3 days and had no known reasons to have reduced muscle strength, PAWS was able to detect muscle weakness in approximately 40% of patients. This study included objective assessments of muscle strength and assessments of endurance. In 2018, clinical trials coordinator Jennifer Ferris and pulmonary fellows Drs. Bimaje Akpa and Swati Baveja noticed a close agreement between PAWS results and objective assessments of muscle strength and endurance. PAWS is able to use patients’ perception of their own fitness to capture a realistic picture of their muscle strength and physical ability. Dr. Hecht notes that the PAWS is faster and easier to administer
Jennifer Ferris and Dr. Bimaje Akpa measure a patient’s hand grip as one test to assess muscle strength.
than the FIM (Functional Independence Measure), which is widely used in rehabilitation medicine. Since participation in rehabilitation after hospitalization is extremely important for good long-term results, PAWS may be able to help guide treatment and predict health outcomes even in patients who are in rehabilitation facilities after discharge from the hospital. “While the PAWS won’t replace the other tests, these data remind us that we should listen to patients,” observed Dr. Hecht. “Often they can reliably tell us how they are doing.”
Points of View
functions and operations of Institutional Review Boards (IRBs), rules for obtaining informed consent from human subjects, and protections for vulnerable research subjects such as children, pregnant women, and prisoners. In 2017, these regulations were revised to meet the changing and growing demands of human research. After several delays, the date of implementation of these regulations (called the “Revised Common Rule”) has been set for January 21, 2019. The Revised Common Rule seeks to further enhance the protections for research participants, facilitate research that carries minimal risk, and reduce regulatory burdens for low-risk studies. It also addresses evolving research areas (such as collection of biospecimens for research) and further harmonizes research policies across several federal departments and agencies. After the Revised Common Rule goes into effect, all new studies submitted to the IRB must meet the new requirements. According to the policy of the UT Health Science Center, studies approved by the IRB before January 21, 2019 will continue continued on page 2
The Belmont Report by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research* declared human research should be governed by the ethical principles of respect for persons, beneficence, and justice. Based on this report, the first regulations protecting human subjects in research studies were issued in 1981. In 1991, these Rajiv Dhand, MD, Chair regulations were adopted by several federal departments and agencies and came to be called the “Common Rule.” These guidelines incorporated standards for obtaining informed consent, performing systematic assessments of risks and benefits, and appropriately selecting subjects for research. The Common Rule formed the regulatory framework for assuring compliance by research institutions. It provided guidance for the 1