Floor and ceiling effects of functional status and peripheral muscle strength assessment scales in non-intubated critically ill patients.

Abstract

Background: Floor and ceiling effects of functional status (FS) and peripheral muscle strength (PMS) assessment scales are reported in patients under mechanical ventilation at Intensive Care Unit (ICU) (Parry, S.M. et al. Critical Care 2015; 19:127). These effects can influence sensibility and responsiveness of those scales to clinical changes of different health conditions. Objective: To evaluate the frequency of floor and ceiling effects of FS and PMS scales in non-intubated patients during ICU stay. Methods: 40 patients (26 men). Functional Independence Measure (FIM), Functional Status Score for the Intensive Care Unit (FSS-ICU), Physical Function ICU Test Score (PFIT-s), Basic Mobility Scale (ICF-BMS) and Medical Research Council score (MRC-s) were assessed at ICU admission and discharge. Floor and ceiling effects were calculated by percentage frequency of highest and lowest scores, respectively. Results: Mean age was 55.1(19.2) years old and SAPSIII was 41.7(11.0) points. The following results are all in Table 1. Conclusion: High magnitude of ceiling effect for FIM, FSS-ICU, PFIT-s and MRC-s as well as floor effect for ICF-BMS suggest that using these tools may be insufficient to detect changes in the FS and PMS of non-intubated critically ill patients during ICU stay. Table 1. Floor and ceiling effects in FS and PMS scores at ICU admission and discharge.