Abstract
IntroductionWith growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study.MethodsSixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman’s rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated.ResultsMean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen’s d = 0.71).ConclusionsThere is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the ICU.Trial registrationClinicaltrials.gov NCT02214823. Registered 7 August 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0829-5) contains supplementary material, which is available to authorized users.
Highlights
With growing awareness of the importance of rehabilitation, new measures are being developed for use in the intensive care unit (ICU)
On awakening a large positive relationship existed between Physical Function in Intensive care Test scored (PFIT-s) and the other functional measures: FSS-ICU, ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB)
Impairment in physical function is a significant problem for survivors of critical illness [1,2,3]
Summary
With growing awareness of the importance of rehabilitation, new measures are being developed for use in the intensive care unit (ICU). The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This includes whether there is a floor or ceiling effect; the ability of the outcome measure to detect meaningful change over time (responsiveness) [8]; and whether there is a known minimal important difference (the smallest change in the outcome measure that patients and clinicians consider to be clinically relevant) [9] These clinimetric properties should be examined within the setting in which the outcome measure will be used [10]. This is important for a challenging environment such as ICU, where fluctuations in patient mental alertness, ability to follow commands, and both rapid changes in medical stability and a confined space may impact on the choice, reliability and validity of outcome measures [2,11,12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
