There are two groups for whom studies of interobserver agreement of MRC sum scores have been described: patients with Guillain-Barré syndrome and ICU survivors after hospital discharge. However, little is known about the feasibility or test characteristics of manual muscle testing (MMT) or about ICUAW as a dichotomous diagnosis on the basis of the MRC sum score for the general population of patients with critical illness. Systematic strength assessment and the definition of ICUAW according to the MRC sum score is becoming more common in research and has been recommended for both research and clinical practice. Observational studies have reported that ICUAW is common, with an incidence of 25%, and is associated with poor outcomes, including mortality, prolonged mechanical ventilation and the need for additional institutional care after hospital discharge. This condition is diagnosed on the basis of the average Medical Research Council (MRC) strength score combined for 12 specified muscle groups (the MRC sum score) being less than 48, indicating that average strength is limited to movement against gravity and partial resistance. This severe weakness has been termed "intensive care unit-acquired paresis" or ICU-acquired weakness (ICUAW). Many of these patients have severe weakness which is detectable on the basis of a clinical strength evaluation. Patients with acute respiratory failure, shock and other manifestations of critical illness or injury are at risk of developing neuromuscular dysfunction as a result of entities such as critical illness polyneuropathy, critical illness myopathy and disuse atrophy.
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