Psychometric Properties of Physical Function Measures Used in the Intensive Care Unit: A Systematic Review

Abstract

Background: A comprehensive physical function outcome measure provides information that assists and guides the therapist in developing a plan of care and in decision making for disposition. Since physical therapists are held accountable for using evidence-based practice, the use of measures appropriate to their settings is paramount in providing those skilled recommendations. Objective: The purpose of this systematic review was to appraise and synthesize psychometric properties of outcome measures used in the intensive care unit that assess physical function and to identify gaps in those psychometric properties and their overall assessment of function. Methods: Eight electronic databases were systematically searched. Studies were considered eligible if (1) the setting was adult intensive care unit (ICU), (2) the measure was a physical functional measure, (3) psychometric properties were reported, (4) written in English, and (5) published in a peer-reviewed journal. The initial search was conducted by a single reviewer and then 2 reviewers independently reviewed the articles to score them according to the COnsensus-based Standards for the selection of health Measurements INstruments. Results: Review of the 34 articles revealed 14 physical function measures that had psychometric testing completed in the ICU setting. The Chelsea Critical Care Physical Assessment tool, Perme mobility score, De-Morton Mobility Index, Functional Status Score for the ICU, and Acute Care Index of Function are the most comprehensive. However, none of these measures examine all aspects of physical function. COnsensus-based Standards for the selection of health Measurements INstruments scores for these measures were classified in the range of poor to fair with few obtaining a score of good or excellent. Limitations: The limitations are sole inclusion of English articles and the exclusion of abstracts, conference presentations, thesis, or dissertation papers. Conclusion: This study identified 14 physical function measures currently in use, with psychometric testing available within the ICU setting. More testing is needed on many of these measures to further validate their use. The current lack of a clearly comprehensive outcome measure tool limits the validity and reliability of assessment and guidance for appropriate recommendations.