Clinical Implications of a Moderate Positive Correlation Between the Braden Score and the AM-PAC Basic Mobility Score in the Acute Care Setting

Abstract

Introduction: The Braden scale (Braden) is a scoring system used by bedside nursing staff to document a patient's risk of developing a pressure injury. This scale is completed immediately upon hospital admission and every 12 hours throughout the hospital course. The Activity Measure for Post-Acute Care inpatient basic mobility short form “6 clicks” (AM-PAC) is a scale used by physical therapists (PT) that provides a numerical value to help determine a patient's activity limitations and translates into a potential discharge destination from the acute care setting. The AM-PAC is scored on initial physical therapy evaluation and every physical therapy session during hospital course. The relationship between the 2 has yet to be hypothesized. Methods: A total of 212 patient medical charts met the inclusion criteria for this retrospective chart review study. Criteria incorporated patients with acute care admission to a large tertiary care teaching hospital between March 1, 2019, and March 31, 2021. All patients received at least 1 physical therapy visit during the course of their admission. The Braden admission score for this study is defined as the score documented on the same day and time as the first physical therapy evaluation during admission. Admission AM-PAC score was defined as the score recorded during physical therapy evaluation not admission to hospital. Discharge AM-PAC was defined as the final physical therapy note documented during the hospital admission (may not line up with acute hospital discharge date). Admission and discharge scores for both scoring systems were calculated for comparison. Results: The Spearman correlation for the Braden and AM-PAC was positive with an R value of 0.613 (P = .000) for admission and an R value of 0.555 (P = .000) for discharge, making it a statistically significant relationship with a moderate correlation. When the Braden score increased in value, the AM-PAC score increased in value at admission and discharge of physical therapy. In addition, as the values increased, the standard deviation decreased. Trends in discharge destination were recorded; in each of these relationships the discharge and admission Braden and AM-PAC continued to change together and a correlation for the numeric value was gathered. Discussion: Overall, when calculated for comparison between patient admission and discharge, the numerical results of the Braden and AM-PAC scores had a positive moderate relationship. The result of the present study suggests that the Braden score obtained on hospital admission may assist in determining discharge needs early in hospital admission. Additionally, this relationship may allow for reallocation of hospital resources to areas of greater mobility needs, and allow for monitoring of a decline in patient function. Conclusion: The relationship between the Braden and AM-PAC scores may assist in closing the knowledge gap between bedside nursing and PT in terms of patient mobility. The use of this data is a starting point for education and further research that may lead to further clinical implications. Through the early identification of patients ready and in need of physical therapy services, hospitals may be able to better allocate resources and improve patient outcomes.