Adaptation and validation of the ICU Mobility Scale in Spain

Abstract

ObjectiveTo adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). MethodDescriptive metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. ResultsAfter obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r = .389; p < .001) and significant comparison between groups with and without ICU-acquired weakness (p < .001). Divergent validity: no correlation between IMS-Es and BMI [r(95%CI)=-.112((-.232)-(.011))], weight [r(95%CI)=-.098((-.219)-(.026))], Charlson [r(95%CI)=-.122((-.242)-(.001))] and Barthel [r[95%CI]=-.037((-.160)-(.087))] and no differences between sexes (p = .587) or BMI categories (p = .412). Predictive validity: moderate and significant correlations with post-ICU hospital stay [r(95%CI)=-.442((-.502)-(-.377))] and physical component of SF-12 (PCS) [r(95%CI) = .318(.063-.534)]; patients without active mobilisation in ICU increased risk of hospital mortality [OR(95%CI) = 3.769(1.428-9.947)]. Interobserver reliability: very good concordance between nurses [CCI (95%CI) = .987(.983-.990)] and nurse-physiotherapist [CCI (95%CI) = .963(.948-.974)]. Sensitivity to change: small effect on discharge from ICU (d = .273) and moderate effect at 3 months after hospital discharge (d = .709). Minimal difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. ConclusionsThe IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.