الفهرس 
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Abstract
Critically ill patients who require round-the-clock intensive care are kept in the ICUs. Long-term stay in the ICU can result in neuromuscular weakness, physical impairments, and mental impairments. In the first few hours after admission, mechanically ventilated patients exhibit muscular atrophy and loss of muscle mass. (Boerio. et al, 2018) A fundamental strategy for assessing and starting movement in a therapeutic intervention is range of motion exercise. Exercises come in three varieties: active, passive, and active-assistive. It has an impact on every structure involved in movement of the body, including muscles, joint surfaces, ligaments, fascia, arteries, and nerves. Musculoskeletal health is benefited by exercise as well. The exercises also maintain the circulation, vascular dynamics, and the strengthening of the synovial action to feed cartilage, which helps to avoid muscle atrophy and enhance strength in critically ill, immobilized patients. (Fazzini. et al, 2023 & Dres. et al, 2017). Aim of the Study The aim of the study was To evaluate the effect of passive muscle exercises on acquired muscle weakness among critically ill patient. seRehtoaya hcraeReR l stiritayyll iyyl laritirC who received passive muscle exercises were expected to exhibit lower musclel staaitCCl tartC compared to control group who didn’t receive exercises Research design Quasi- experimental research design Setting The study was conducted at Surgical Intensive Care Unit at Emergency Hospital of Tanta University Hospitals which affiliated to Ministry of Higher Education and Scientific Research. This unit involves five rooms and each room had 4 beds (total beds: 20). Subjects: A Purposive sample of 60 adult patients was collected from the previously mentioned setting. The sample size was calculated through Steve Thompon equation for calculating the sample size, assuming total number of patients admitted to ICU per year in 2020.Nearly 220 patients admitted per year. The sample size was calculated as the following: The adult patients were divided into two groups, 30 patients in each group as follows:- The subjects were divided into two groups: Control group: - consist of (30) patients and will receive routine care of intensive care unit. Study group: - consist of (30) patients and will receive passive muscle exercises and routine care The inclusion criteria was as follow: - New admitted patient - Adult patients aged 21-60 years old. - Hemodynamic stability. - No contraindication for elevation head of bed. The exclusion criteria was as follow: - Preexisting lnCCtytlstaaitCCleila niCCieilrelretlssm - stCteyepitayl iCet ttClaClCliiayltet lytCieiCrlotaiilCrtnllteoytnC, Guillain-Barre syndrome, myasthenia gravisl and traumatized patients, amputees, patients with leg or arms fractures or any disorders Tools of data collections: To collect the necessary data, two tools were used in this study as the following: Tool I: Critically ill Patient Assessment (12,13). This tool was developed by the researcher; it was include two parts as follow: Part (1): Patients’ Demographic characteristic it includes age, gender Part (2): Clinical data of studied patients such as current diagnosis, past medical history, previous hospital admission, body mass index, state of consciousness based on GCS, mean arterial pressure, systolic blood pressure, heart rate, oxygen saturation, respiration rate per minute, and arrhythmia. Tool II: Manual Muscle Strength Test This tool was measured by MRC-sum score which developed by Hough et al., 2011(14), it was used to assess muscle strength within the ICU six muscle groups (shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion) is evaluated on both sides. It evaluates the deltoid, biceps, and wrist extensor muscles of the upper limb, and the hip flexor, quadriceps, and anterior tibial muscles of the lower limbs. Scoring system The score is evaluated from 0 to 5 point as the following: • 0 point indicates no muscle contraction visible or palpable • 1 point indicates flicker contraction visible or palpable although no limp movement • 2 points indicate full motion range without gravity • 3 points indicate gravity full motion range • 4 points indicates movement against moderate resistance over full range of motion, • 5 points indicate normal muscle strength. • Summation of scores gives MRC-sum score, ranging from 0 to 60. • Score below 48 indicate moderate muscle weakness or significant weakness • score below 36/48 indicates severe weakness The present study showed the following results: 1. As for patients, age, the result revealed that 46.67 of the study group& 60.00 of the control group were in the age group 50-60 years old. 2. Regarding gender, about two thirds (63.33%) of the study group and 70.00% of control group were males. 3. No significant differences were observed between both groups regarding their demographic characteristics. 4. Regarding current diagnosis, it was observed that half (50%)of the study group compared to more than half (60%) of the control group had acute respiratory failure. 5. As for past medical history, it was noticed that two thirds (66.67%) of the study group compared to less than half (46.67%) of the control group had diabetes mellitus. 6. In relation to the previous hospital admission, it was noticed that 73.33% and 56.67% of the study and the control group were previously admitted to hospital respectively. 7. No statistical significant differences were found between the two groups in relation to current diagnosis, past medical history and previous hospital admission where p=0.584, 0.587 and 0.279 respectively. Regarding the body mass index (BMI) among the studied groups. It showed that less than half (43.33%) of the study group and 23.33% of the control group had overweight. 8. In relation to conscious level according Glasgow Coma Scale there were more than two third (76.76%) of the study group and (73.33) of the control group were semiconscious on admission, while nearly half (43.33%) of the patients in the study group compared to (26.67%) of the control group were conscious at the end of the second week . 9. In relation to heart rhythm ,it explored that two third (60%) of the study group and 63.33 of the control group had regular heart rhythm on admission , on the other hand the majority of the study group (90%) had regular heart rhythm compared to less than two thirds (63.33%) of the control group at the end of the second week. 10. In relation to Assessment hemodynamic parameters of the studied patients it showed that there was statistical significant differences related respiratory rate and saturation of peripheral oxygen (spo2) among the study and control group where P=<0.05 respectively. 11. No statistical significant differences were found between the two groups regarding pulse, mean arterial pressure and while p> 0.05 respectively but within normal rang. 12. Concerning manual muscle strength test it described that half of the study group compared to 16.67% of the control group had mild muscle weakness at the end of the second week. 13. Statistically significant difference was found between the control and the study group regarding score of manual muscle strength at the end of the second week where p =0.002. 14. Regarding relation between level of consciousness of the studied patients and their level of manual muscle strength it showed that there was no significant correlation between patients’ total levels of consciousness and level of manual muscle strength at the end of the 1st and 2nd week of implementation of intervention among study group with 0.016, 0.933 and 0.046, 0.811 respectively. While no significant correlation was observed between the control group with P >0.05. 15. Regarding relation between demographic characteristics of the studied patients and their total score of consciousness represented that no significant relation was observed between demographic characteristics (age, gender and body mass index) of the studied patients and their total score of consciousness where p>0.05 16. Concerning relation between demographic characteristics of the studied patients and their total score of manual muscle strength it represented that no significant association was observed between demographic characteristics (age, gender and body mass index) of the studied patients and their total score of manual muscle strength where p>0.05 Recommendations Upon completion of this study, it can be recommended that: 1. Recommendations for Nurses &patients In-service training programs should be conduct periodically and regularly for all nurses caring for critically ill patients with acquired muscle weakness. Intensive care units must have a documented policy describing the standard exercise program for muscle weakness patients. Disseminate protocol &guidelines for preventing acquired muscle weakness among ICU patients. Passive muscle exercises should be a basic routine of nursing care for critically ill patients in ICU. Assessment of acquired muscle strength should be performed daily in ICU. 2. For further studies and research: Replication of the study on larger random sample acquired from different geographical areas in Egypt to figure out the main aspect of this problem is recommendation to gather in depth knowledge about nursing care standard.