This study was performed to investigate the prognostic value of assessing symptom burden using the Edmonton Symptom Assessment System (ESAS) in older patients with Heart Failure (HF). This prospective cohort study was performed in consecutive patients ≥ 60 years old hospitalized with HF at a university hospital between September 2020 and June 2023. ESAS was used to assess nine common symptoms at hospital discharge (total score: 0-90) with higher scores indicating greater severity. The primary outcome was the combined event of HF readmission and all-cause mortality within 6 months. The median ESAS sum score in the study population consisting of 306 patients (median age, 79 years; 54.9% male) was 13 points. The commonly reported moderate-to-severe symptoms were impaired well-being (34.9%), anxiety (27.5%), drowsiness (25.8%), tiredness (24.9%), and depression (22.2%). In multivariate analyses, ESAS sum score was significantly associated with the combined event (adjusted hazard ratio for each 5-point increase, 1.10 (95% confidence interval: 1.04-1.17; p < 0.001). Inclusion of ESAS sum score in the risk model significantly increased both continuous net reclassification improvement (p = 0.028) and integrated discrimination improvement (p = 0.002) for the primary outcome. Comprehensive assessment of symptom burden with ESAS provided additional prognostic information to conventional risk factors in older patients with HF.

Prehabilitation is known to improve outcomes of gastrointestinal surgery; however, the issue of low adherence during the waiting period for surgery remains unresolved. This study evaluated the effectiveness and feasibility of a newly developed mobile health application, “Preha,” designed to support home-based prehabilitation. A single-group pilot study involving patients scheduled for major hepatobiliary-pancreatic (HBP) surgery for malignancy between March 2023 and September 2024 was conducted. The patients downloaded the Preha application, and there was no direct intervention from the medical staff during the preoperative period. The application recorded step counts, moderate-intensity exercise times, and squat counts. Adherence was defined as meeting at least one of the following: ≥ 5,000 steps/day, ≥ 10 min/day of ≥ 3 METS activities, or ≥ 30 squats/day, for more than three days per week. Among 30 eligible patients, 21 (median age, 67 years) were included in the analysis. During prehabilitation, 52 https://jrct.niph.go.jp/ ; registration number: jRCTs042220106.

Background & aims: Data regarding the association between cachexia and clinical outcomes in hepatopancreatobiliary (HPB) malignancies are limited. This retrospective study sought to investigate the prognostic significance of preoperative cachexia in patients undergoing major HPB surgery for malignancies. Methods: Data from patients, who underwent major open surgery for HPB malignancies between March 2014 and December 2018, were retrospectively reviewed. Cachexia was evaluated a few days before surgery, and defined according to modified Asian Working Group for Cachexia criteria: low body mass index (<21 kg/m(2)) and decreased handgrip strength (<28 kg [males] and <18 kg [females]) or elevated C-reactive protein level (>0.5 mg/dL). The primary endpoint was postoperative overall survival (OS); secondary endpoints included disease-free survival (DFS) and postoperative complications. Results: Of 332 patients (228 male; mean age, 68.8 +/- 10.3 years), 93 (28 %) had preoperative cachexia. There were 154 (46 %) deaths and 181 (55 %) combined events (death or recurrence) during a five-year follow-up (mean, 3.3 +/- 1.7 years), with no significant differences in major postoperative complications between the 2 groups (P = 0.329). After adjusting for covariates, cachexia (n = 93) exhibited significant associations with shorter OS (adjusted hazard ratio [HR] 1.65 [95 % confidence interval (CI) 1.18-2.30]; P = 0.004) and DFS (adjusted HR 1.39 [95 % CI 1.01-1.91; P = 0.043) compared with non-cachexia (n = 239). Cachexia significantly shortened OS only in a subset with pathological stage <= II disease (adjusted HR 2.45 [95 % CI 1.27-4.74]; P = 0.008) but not otherwise (P for interaction, 0.040). Conclusions: Preoperative cachexia did not affect short-term surgical complications but significantly deteriorated postoperative prognosis in patients who underwent surgery for HPB malignancies.

BackgroundEmerging evidence has supported the idea that goal-directed prehabilitation is a promising approach to boost functional capacity in preoperative patients. However, its usefulness has not been tested in the hepatobiliary and pancreatic fields. The objective of this trial was to investigate the efficacy of goal-directed prehabilitation for improving functional capacity in patients who were planned to undergo major hepatobiliary and pancreatic operations.MethodsThis assessor-blinded, parallel-arm, randomized clinical trial recruited patients who were scheduled for major hepatobiliary and pancreatic surgeries for malignancy. Patients were randomly allocated into the step goal-directed prehabilitation group as the test group and into the conventional prehabilitation group as the control group. Patients in the goal-directed prehabilitation group participated in a walking prehabilitation program with an intergrading goal of the step count. Patients in the conventional prehabilitation group received standard physical and nutritional prehabilitation. The primary outcome was change in the 6-minute walking distance, which ranged from the time before starting prehabilitation (baseline) to the time after completing prehabilitation (immediately before surgery).ResultsAmong 180 randomized patients, 144 patients were included in the primary analysis (73 patients in the conventional prehabilitation group and 71 patients in the goal-directed prehabilitation group). The mean change in the 6-minute walking distance was 27 meters in the conventional prehabilitation group and 31 meters in the goal-directed prehabilitation group (P = .633).ConclusionIn patients undergoing major hepatobiliary and pancreatic surgeries for malignancies, a goal-directed prehabilitation program did not result in a significantly greater increase in functional capacity than did conventional prehabilitation. Registration number: UMIN000038791 (https://www.umin.ac.jp/).

We investigated the effects of acute-phase intensive electrical muscle stimulation (EMS) on physical function in COVID-19 patients with respiratory failure requiring invasive mechanical ventilation (IMV) in the intensive care unit (ICU). Consecutive COVID-19 patients requiring IMV admitted to a university hospital ICU between January and April 2022 (EMS therapy group) or between March and September 2021 (age-matched historical control group) were included in this retrospective observational case–control study. EMS was applied to both upper and lower limb muscles for up to 2 weeks in the EMS therapy group. The study population consisted of 16 patients undergoing EMS therapy and 16 age-matched historical controls (median age, 71 years; 81.2% male). The mean period until initiation of EMS therapy after ICU admission was 3.2 ± 1.4 days. The EMS therapy group completed a mean of 6.2 ± 3.7 EMS sessions, and no adverse events occurred. There were no significant differences between the two groups in Medical Research Council sum score (51 vs. 53 points, respectively; P = 0.439) or ICU mobility scale at ICU discharge. Addition of upper and lower limb muscle EMS therapy to an early rehabilitation program did not result in improved physical function at ICU discharge in severe COVID-19 patients.

This prospective observational cohort study was performed to investigate the physical function and mental health trajectories of novel coronavirus disease 2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after discharge from the intensive care unit (ICU). The study population consisted of 64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum score < 48 points, and prolonged IMV was significantly associated with lower MRC sum score and handgrip strength. Symptoms were similar between groups at ICU discharge, and the symptoms most commonly reported as moderate-to-severe were impaired well-being (52%), anxiety (43%), tiredness (41%), and depression (35%). Although muscle strength and mobility status were significantly improved after ICU discharge, Edmonton Symptom Assessment System score did not improve significantly in the prolonged IMV group. EuroQol five-dimension five-level summary index was significantly lower in the prolonged than short IMV group at 6 months after ICU discharge. We found substantial negative physical function and mental health consequences in the majority of surviving COVID-19 patients requiring IMV, with prolonged period of IMV showing greater negative effects not only immediately but also at 6 months after discharge from the ICU.

BACKGROUND:Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair-climbing to 12-m height was used to investigate whether preoperative chest 3D-computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function.METHODS:Seventy-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enroled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair-climbing time, spirometry and diffusing capacity of the lung for carbon monoxide (DLCO ) at baseline and 6-month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO2 t) was evaluated based on the stair-climbing time.RESULTS:Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO2 t. Mean loss of VO2 t was -6.2%, -1.4%, -1.6% and -0.1% in the large volume/LAV (+), large volume/LAV (-), small volume/LAV (+) and small volume/LAV (-) groups, respectively. The large volume/LAV (-) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DLCO .CONCLUSIONS:Analysis of chest 3D-CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy.

Considering advances in current post-recurrence treatment, we examined the prognostic significance of the number of risk factors for loss-of-exercise capacity (LEC) after lung cancer surgery, which were identified by our previous prospective observational study. Risk factors for LEC were defined as a short baseline 6-min walk distance (<400 m), older age (≥75 years), and low predicted postoperative diffusing capacity for carbon monoxide (<60%). Patients were classified as Risk 0/I/II/III according to the number of risk factors. The survival data were retrospectively analyzed. Between 2014 and 2017, 564 patients (n = 307, 193, 57, 7; Risk 0/I/II/III) who underwent lung cancer surgery were included in the study. The number of risk factors was associated with smoking status, predicted postoperative forced expiratory volume in 1 s, histology, pathological stage, and adjuvant therapy. In a multivariate Cox regression analysis, compared to Risk 0, Risk I/II/III showed significant associations with overall survival (hazard ratios: 1.92, 3.35, 9.21; 95% confidence interval: 1.27–2.92, 2.01–5.58, 3.64–23.35; Risk I/II/III, respectively). In 141 patients with recurrence, molecular targeted therapies (MTTs) or immune checkpoint inhibitors (ICIs) were included in 58%, 47%, 32%, and 0% (Risk 0/I/II/III) during the course of treatment. In patients with MTT/ICI treatment, the estimated 1-year and 3-year post-recurrence survival rates were 88% and 58%, respectively. Risk classification for LEC was associated with survival after lung cancer surgery, as well as post-recurrence treatment. The concept of physical performance-preserving surgery may contribute to improving the outcomes of current lung cancer treatment.

BACKGROUND:Early mobilization after liver transplant (LT) plays an important role in postoperative recovery and complication prevention; however, patients undergoing LT cannot achieve early mobilization because of mechanical ventilation and poor preoperative physical performance. We investigated the effect of neuromuscular electrical stimulation (NMES) on lower limb muscle strength after living donor liver transplant (LDLT).METHODS:Adult patients who underwent LDLT between December 2016 and January 2019 at a university hospital were recruited. A consecutive series of patients who underwent LDLT without NMES therapy before the clinical trial (April 2014-May 2016) were enrolled as the non-NMES (control) group. Patients in the NMES group received NMES on the quadriceps muscles starting 1 day post LDLT for 4 weeks. The study was conducted in accordance with the Declaration of Helsinki, and all patients provided informed consent.RESULTS:Twenty-four patients in the NMES group and 16 patients in the non-NMES group were analyzed. There was no significant difference between groups regarding changes in any outcome.CONCLUSIONS:The application of NMES in patients with LDLT did not yield greater improvement of muscle strength, functional capacity, activities of daily living, or length of hospital stay 4 weeks postoperatively compared with the control group. However, developing a novel NMES device and confirming whether additional NMES is effective for other body areas may yield different results.

AbstractBackgroundDespite the associations of both preoperative sarcopenia and physical performance with post‐operative mortality in non‐small‐cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC.MethodsThis retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex‐specific tertile) and non‐sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross‐sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post‐operative overall survival (OS) and disease‐free survival (DFS).ResultsThe 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non‐sarcopenia/long‐distance group (58%), sarcopenia/long‐distance group (26%), non‐sarcopenia/short‐distance group (9%), and sarcopenia/short‐distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow‐up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short‐distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79–6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non‐sarcopenia/long‐distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre‐existing risk model increased the area under the curve on time‐dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery.ConclusionsThe presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post‐operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

Background Workplace risk factors, such as repetitive tasks, can cause work-related musculoskeletal disorders. In a rat model, decreased grip strength and median nerve injury develop following repetitive reaching and grasping tasks, involving negligible force. Objective We investigated whether median nerve injury is involved in the early onset of decreased grip strength due to such tasks METHODS: Sprague-Dawley rats were divided into: non-task-performing (0-week) and task-performing (1-, 2-, and 3-week) groups. After an initial training period, the task-performing groups continued to perform the task for 2 h/day, 3 days/week, for 1-3 weeks. Grip strength and relative muscle weight of the flexor digitorum superficialis (FDS) muscle were measured. Median nerve injury was evaluated by histopathology and immunohistochemistry. Results Grip strength of the reach limb (forelimb used in tasks) was significantly lower in the 3-week group compared with the other groups and was significantly lower than that of the non-reach limb in all groups. There were no significant differences in the relative FDS muscle weights of either limb among groups. No evidence of median nerve demyelination was observed and no cells expressed activating transcription factor-3, a specific marker of peripheral nerve injury, in the anterior horn of the spinal cord. Conclusion Median nerve injury does not contribute to the decreased grip strength caused by 3 weeks of repetitive reaching and grasping tasks, involving negligible force, in rats.

Nitric oxide (NO) is an important part of the host defense mechanism; however, it displays both pro- and anti-inflammatory properties depending on its location and concentration. Importantly, excessive or inappropriate NO production can cause tissue damage. Systemic and local administration of NO synthase (NOS) inhibitors ameliorates and may exacerbate the inflammatory response, respectively. Here, we used a carrageenan-induced pleurisy model of acute inflammation in rats to confirm the location-dependent effects of NO and investigate the underlying mechanisms. As expected, localized suppression of NO production exacerbated inflammation, as evidenced by increased pleural exudate volumes and leukocyte counts and enhanced activity of enzymes related to oxidative stress. In contrast, local NO supplementation reduced leukocyte infiltration, vascular permeability, and the activity of oxidative stress-related enzymes. Interestingly, inhibition of heme oxygenase-1 (HO-1) reversed the anti-inflammatory effects of localized NO production, while the addition of hemin (HO-1 substrate) or carbon monoxide (CO; HO-1 metabolite) decreased leukocyte migration and exudation. Together, these findings confirm a protective role for NO at the inflammatory site, which appears to be mediated via NOS induction of the HO-1/CO pathway. Thus, NO supplementation may be a potential new treatment for oxidative stress-associated inflammatory diseases.

The current study was designed to investigate the association between the average preoperative physical activity and postoperative outcomes in patients undergoing surgeries for hepato-pancreato-biliary (HPB) malignancy. Patients who were scheduled to undergo open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were included. The average steps per day were recorded by a pedometer and calculated for each patient during the preoperative waiting period. Physical activity levels were classified according to the average number of daily steps as poor (< 5000 steps/day) and good (≥ 5000 steps/day). Of the 105 eligible patients, 78 met the inclusion criteria. The median number of steps per day was 6174. There were 48 patients (62%) with good physical activity and 30 patients (38%) with poor physical activity. Patients with poor physical activity revealed a significantly higher rate of major complications with Clavien grade ≥ 3 (63% vs. 35%, p = 0.016), a higher rate of infectious complications (53% vs. 23%, p = 0.006), and a longer postoperative hospital stay (median, 30 vs. 21 days, p < 0.001) compared with those with good physical activity. After a multivariate analysis, poor physical activity was identified as an independent risk factor for the development of major complications (odds ratio, 2.842, p = 0.042) and infectious complications (odds ratio, 3.844, p = 0.007). The current study demonstrated that preoperative physical activity levels are associated with the incidence of major postoperative complications following HPB surgery for malignancy.

BACKGROUND: Workplace risk factors, such as repetitive tasks, can cause workrelated musculoskeletal disorders. In a rat model, decreased grip strength and median nerve injury develop following repetitive reaching and grasping tasks, involving negligible force. OBJECTIVE: We investigated whether median nerve injury is involved in the early onset of decreased grip strength due to such tasks METHODS: Sprague-Dawley rats were divided into: non-task-performing (0-week) and task-performing (1-, 2-, and 3-week) groups. After an initial training period, the task-performing groups continued to perform the task for 2 h/day, 3 days/week, for 1–3 weeks. Grip strength and relative muscle weight of the flexor digitorum superficialis (FDS) muscle were measured. Median nerve injury was evaluated by histopathology and immunohistochemistry. RESULTS: Grip strength of the reach limb (forelimb used in tasks) was significantly lower in the 3-week group compared with the other groups and was significantly lower than that of the non-reach limb in all groups. There were no significant differences in the relative FDS muscle weights of either limb among groups. No evidence of median nerve demyelination was observed and no cells expressed activating transcription factor-3, a specific marker of peripheral nerve injury, in the anterior horn of the spinal cord. CONCLUSION: Median nerve injury does not contribute to the decreased grip

Surgery for esophageal cancer is associated with high morbidity and mortality. Reduced pulmonary functions and exercise capacity are known as risk factors for complications after esophagectomy. The 6-minute walk distance (6MWD) measured by the 6-minute walk test (6MWT) is a simple field test that can be used to evaluate the functional exercise capacity of patients who undergo thoracic surgery. The aim of this study was to evaluate the association of the preoperative 6MWD with postoperative complications in patients with esophageal cancer. Records of a total of 111 patients who underwent thoracic surgery followed by postoperative rehabilitation from January 2013 to December 2015 were retrospectively reviewed. Data of patients who experienced Clavien-Dindo grade II or severer (grade >= II) complications were compared with those who experienced grade <= I complications. The 6MWD was significantly correlated with age, serum albumin concentration, hemoglobin concentration, and hand grip strength. A total of 42 patients experienced grade >= II. The 6MWD of patients with grade >= II complications was significantly shorter than that of those with grade <= I complications. In receiver operating characteristic analysis, 6MWD <= 454 m was a threshold for predicting grade >= II complications with 71.0% sensitivity and 54.8% specificity. The incidence of grade >= II complications led to delayed ambulation and longer stays in hospital. In the multiple regression analysis, the preoperative risk factors for incidence of grade >= II complications included lower levels of preoperative 6MWD and % of the predicted value of forced expiratory volume in 1 second. Our results indicate that the 6MWT is useful to assess preoperative physical status in patients with esophageal cancer.

Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt). Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO2t: 43.06 − 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed. Median (interquartile range) baseline SCt was 31.5 (28.2–36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50–18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94–43.93, p = 0.005) were significantly associated with loss-of-exercise capacity. Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.

The effects of exercise on mechanical hyperalgesia, joint contracture, and muscle injury resulting from immobilization are not completely understood. This study aimed to investigate the effects of cyclic stretching on these parameters in a rat model of chronic post-cast pain (CPCP). Seventeen 8-week-old Wistar rats were randomly assigned to (1) control group, (2) immobilization (CPCP) group, or (3) immobilization and stretching exercise (CPCP+STR) group. In the CPCP and CPCP+STR groups, both hindlimbs of each rat were immobilized in full plantar flexion with a plaster cast for a 4-week period. In the CPCP+STR group, cyclic stretching exercise was performed 6 days/week for 2 weeks, beginning immediately after cast removal prior to reloading. Although mechanical hyperalgesia in the plantar skin and calf muscle, ankle joint contracture, and gastrocnemius muscle injury were observed in both immobilized groups, these changes were significantly less severe in the CPCP+STR group than in the CPCP group. These results clearly demonstrate the beneficial effect of cyclic stretching exercises on widespread mechanical hyperalgesia, joint contracture, and muscle injury in a rat model of CPCP.

BackgroundThe impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.MethodsPatients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.ResultsThe prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30days; p=0.045).ConclusionThe introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.

To clarify the relationship between mobility disability at the time of discharge from the ICU and clinical factors evaluated at ICU admission in septic patients.DESIGN:A single-center, retrospective, observational study.SETTING:Ten-bed, the emergency and medical ICU.PATIENTS:We analyzed the data of septic patients who were admitted to our ICU between September 2012 and September 2016 and received early rehabilitation.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The patients were categorized into two groups based on their scores on the ICU mobility scale at the time of discharge from the ICU: the mobility disability group (ICU mobility scale score < 9) and the no mobility disability group (ICU mobility scale score ≥ 9). Of the 110 eligible patients, 63 met the inclusion criteria; of these, 46 patients (73%) were classified into the mobility disability group, and 17 patients (27%) were classified into the no mobility disability group. The age (median, 72 vs 64 yr; p = 0.024), prevalence of patients with clinical frailty scale scores of greater than or equal to 5 (54% vs 12%; p = 0.003), Sequential Organ Failure Assessment score (median, 9.0 vs 6.0; p = 0.006) and rate of vasopressin use (26% vs 0%; p = 0.026) were significantly higher in the mobility disability group as compared with the no mobility disability group. Among the candidate variables for which values recorded before/at the time of ICU admission were available, the clinical frailty scale score was identified as the only independent, statistically significant predictor of mobility disability at ICU discharge (odds ratio, 7.77; 95% CI, 1.37-44.21; p = 0.021). The positive predictive value and negative predictive value of clinical frailty scale scores greater than or equal to 5 for mobility disability at ICU discharge were 92.6% and 41.7%, respectively.CONCLUSIONS:The clinical frailty scale score was associated with increased mobility disability at ICU discharge in septic patients receiving early rehabilitation.