Commentary on "Psychometric Testing of the Activity Measure for Post-Acute Care (AM-PAC) in the Pediatric Acute Care Setting".

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“How can I apply this information?” The authors identify a significant clinical need in the inpatient pediatric hospital setting. Many tools have been developed and applied to the hospitalized adult population. Having a single tool to effectively measure function and functional change across adults and pediatric patients in the inpatient hospital setting will bring a value in both standardization and application to care. The Activity Measure for Post-Acute Care (AM-PAC) basic mobility and the AM-PAC daily activities Inpatient “6 clicks” short forms may very well be that functional measure needed to identify incremental change and support discharge planning. The authors use several measures in their validity testing including the handgrip dynamometry, Timed Up and Go, and 30-second walk test (30SWT). The authors were able to demonstrate both utility and validity between the AM-PAC basic mobility and the TUG and 30SWT. Their findings demonstrated this test to be reliable and valid as a measure of function for hospitalized children ages 3 to 17 years. As the results pertain to the AM-PAC daily activities, I believe the authors selected a measure of strength, handgrip dynamometry, instead of a measure of function to correlate with this tool. As such, I do not believe we are able to generalize use of the AM-PAC daily activities to children as a functional measure. As the authors note, further studies should be conducted looking to correlate this measure to other known, established functional measures in children. “What should I be mindful about when applying this information?” When deciding how to implement this information within the inpatient pediatric hospital setting, the AM-PAC basic mobility inpatient functional assessment is a good measure of mobility for hospitalized children ages 3 to 17 years. We recommend pairing this with other functional measures of mobility being used with hospitalized children to provide an overall picture of function and to assist with clinical determination and effectiveness of interventions. This measurement may be carried into the setting following discharge from the hospital to demonstrate ongoing and continued functional progress in children. I would use caution in utilizing the AM-PAC daily activities portion and look forward to future research outlining the utility to capture functional performance of hospitalized children. Jonathan Greenwood, PT, DPT, MS, CEIS, PCS, FACHE, Megan Dakhlian, PT, DPT, PCS, Boston Children's Hospital, Boston, Massachusetts