Critical Care Physical Assessment Tool Research Articles

Measuring Physical Function in the PICU: Development and Testing of a Children's Version (Age 2-18 yr) of the Chelsea Critical Care Physical Assessment Tool.

To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children in the PICU. Modified Delphi study to adapt the Chelsea Critical Care Physical Assessment (CPAx) tool for use in children 2-18 years old, with subsequent prospective testing in a single-center cohort. Single-center tertiary PICU. Delphi process in 27 panelists (including physiotherapists, occupational therapists, and pediatric intensivists from seven countries from January 2018 to March 2018). Cohort study in 54 patients admitted to PICU for greater than 24 hours over a 3-month period (April 2018 to June 2018), with median age 5.5 years (interquartile range [IQR], 3-12.75 yr), 33 of 54 male, and 38 of 54 invasively ventilated. None. Three Delphi iterations were required to reach greater than or equal to 80% consensus in all the children's CPAx (cCPAx) items. In the subsequent cohort study, six physiotherapists used the cCPAx tool and scored 54 participants, with a total 106 observations. The median cCPAx tool score was 14.50 (IQR, 3-25) out of a possible total of 50. Inter-rater reliability for 30 randomly selected participants was excellent (intraclass correlation coefficient, 0.998). Completion rate of cCPAx in the 54 patients occurred in 78 of 106 occasions (74%). The cCPAx tool content that was developed using Delphi methodology provided a feasible and clinically relevant tool for use in assessing physical morbidity in PICU patients 2-18 years old. Overall, the cCPAx scores were low, demonstrating low levels of physical function and high levels of immobility during PICU care.

Functional outcomes of patients in ICU using the Chelsea Critical Care Physical Assessment tool: An integrative review.

Outcome measures can assess the change in the health status of a patient in an intensive care unit (ICU). The Chelsea Critical Care Physical Assessment (CPAx) tool is used to assess the functional outcomes to monitor patient progression or regression in an ICU. Our study aimed to identify studies that assess the functional outcomes of patients nursed in ICUs that use the CPAx tool. An integrative review framework was used. Data were analysed in five steps to formulate a conclusion that aligned with the objective of our study. Data were extracted from peer-reviewed articles published online between 2013 and 2022. Databases that were used include Google Scholar, Directory of Open Access Journals (DOAJ) and PubMed for reviewed articles. Keywords were used in the search strategy, and screening of abstracts was done to extract studies that met the inclusion criteria. We retrieved 41 studies, of which 11 matched the inclusion criteria. Data were thematically arranged into studies measuring the validity and reliability of the CPAx tool, using the CPAx tool to measure outcomes in the ICU, the tool used at ICU and hospital discharge. The use of the CPAx tool has no impact on measuring the hospital length of stay or quality of life. The tool is comprehensive and enhances the accuracy of patient assessment.

Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability.

Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983-0.994) and at "B" 0.994 (0.990-0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996-0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland-Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.

Impact of Physiotherapy on Functional Status and Length of Stay of Patients Admitted to Intensive Care Unit

Background: Early mobilization of patients with critical illness reduces the consequences of extended periods of bed rest and improves self-care functions and quality of life. Early mobilization for mechanically ventilated patients in any ICU prevents patients from a spiral of progressive complications, leading to either nursing home placement or persistent critical illness. Early mobilization of ICU patients has been associated with improved muscle strength and functional independence, a shorter duration of delirium, mechanical ventilation, and ICU length of stay. Objective: This study was undertaken to assess the impact of physiotherapy management and early mobilization on Functional Status and Length of Stay in patients admitted to the Intensive Care Unit. Methods: An observational study was conducted at a tertiary care university teaching hospital in Mysore, South India, among patients admitted to medical and surgical intensive care units. The patients were assessed, and the patient’s baseline characteristics were recorded. The study subjects were divided into two groups, the intervention and the control groups. There were 71 patients in the intervention group and 67 patients control group. Subjects in the intervention group underwent physiotherapy management and early mobilization. Subjects in the control group did not undergo physiotherapy management and early mobilization. Physiotherapy intervention was given 2-3 times/day, and the outcome measures were the length of stay in ICU and assessment of physical morbidity using the Chelsea Critical Care Physical Assessment Tool (CPAx). Results: The results showed that subjects in the intervention group were weaned from the ventilator support (3.86±3.4 and 5.59±4.3, p = 0.005) and oxygen support (5.23±0.99 and 7.48±2.0, p = 0.000) much earlier than the subjects in the control group. The length of ICU stay was significantly less in the intervention group than in the control group (7.71±3.70 days and 11.64±4.8 days with a p-value, p = 0.000). respectively Conclusion: This study demonstrated that implementation of physiotherapy intervention and early mobilization in critically ill patients undergoing treatment in intensive care unit resulted in early weaning from ventilator support and supplemental oxygen therapy, with improvement in functional status leading to reduced length of ICU stays compared to the patients who were not given physiotherapy intervention and early mobilization.

Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey

Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.

Predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) in critically ill, mechanically ventilated adults: a prospective clinimetric study

Purpose To investigate the predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) at intensive care unit (ICU) discharge in critically ill adults for their 90-day outcomes. Materials and methods This prospective clinimetric study investigated four theory-driven, a-priori hypotheses in critically ill adults recruited within 72–144 h of mechanical ventilation. The primary hypothesis was a moderate accuracy (AUROC = 0.750) in predicting residence at home within 90 days. Secondary hypotheses included discrimination between hospital discharge destinations, correlation with subsequent health-related quality of life and length of ICU stay. Results We observed a good accuracy (AUROC = 0.778) of the CPAx at ICU discharge in predicting a return to home within 90 days. The CPAx score significantly increased between the discharge groups “undesirable” ≤ “rehabilitation” ≤ “home” (p < 0.001), but was not associated with 90-day health-related quality of life (physical: r = 0.261, mental: r = 0.193). Measured at baseline, CPAx scores correlated as expected with length of ICU stay (r = −0.443). Conclusions The CPAx at ICU discharge had a good predictive validity in projecting residence at home within 90 days and general discharge destinations. The CPAx might therefore have clinical value in prediction, though it does not seem useful to predict subsequent health-related quality of life. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) identification number: DRKS00012983, registered on September 20, 2017 IMPLICATIONS FOR REHABILITATION The CPAx is a valid and reliable measurement instrument to evaluate critically ill adults’ physical function and activity, in addition the CPAx might be useful to predict rehabilitation needs. The CPAx had a moderate to good predictive validity with three out of four a-priori hypotheses accepted. A CPAx score of ≥18 at critical care discharge has a sensitivity of 80% and a specificity of 70% in predicting a return to home within 90 days. The CPAx might consequently be valuable to identify critically ill adults’ rehabilitation needs, to advise on their potential trajectory of recovery or to screen patients for follow-up after hospital discharge.

Physical recovery of COVID-19 pneumosepsis intensive care survivors compared with non-COVID pneumosepsis intensive care survivors during post-intensive care hospitalization: The RECOVID retrospective cohort study.

BackgroundCoronavirusdisease 2019 (COVID‐19) pneumosepsis survivors are at a high risk of developing intensive care unit (ICU)–acquired weakness (ICUAW) because of high incidence of acute respiratory distress syndrome and the common need for prolonged invasive ventilation. It remains unknown whether regular postpneumosepsis physical rehabilitation strategies are suitable for this extraordinary patient category.MethodsWe retrospectively compared the physical recovery of COVID‐19 and non‐COVID pneumosepsis ICU survivors during post‐ICU hospitalization, defined as the difference in performance on the Medical Research Council Sum‐Score (MRC‐SS), Chelsea Critical Care Physical Assessment tool (CPAx), and percentage of predicted handgrip strength (POP‐HGS). An analysis of covariance model was built using age, sex, Barthel index, body mass index, admission Acute Physiology And Chronic Health Evaluation II score, adequacy of protein delivery during ICU stay, and ward length of stay as covariates.ResultsThirty‐five COVID‐19 ICU patients could be compared with 21 non‐COVID pneumosepsis ICU survivors. All patients scored ≤48 on the MRC‐SS at ICU discharge, indicating ICUAW. When controlling for covariates, COVID‐19 patients performed worse on all physical assessments upon ICU discharge, but had improved more at hospital discharge on the MRC‐SS (ɳ2 = 0.214, P =.002) and CPAx (ɳ2 = 0.153, P =.011). POP‐HGS remained lower in COVID‐19 patients throughout hospital stay.ConclusionCOVID‐19 ICU survivors are vulnerable to ICUAW, but they show better tendency towards physical rehabilitation than non‐COVID pneumosepsis ICU survivors during the post‐ICU hospitalization period regarding MRC‐SS and CPAx. COVID‐19 ICU patients might benefit from early, more intensive physical therapy.

German version of the Chelsea Critical Care Physical Assessment Tool (CPAx-GE): translation, cross-cultural adaptation, validity, and reliability

Purpose To translate and cross-culturally adapt the Chelsea Critical Care Physical Assessment tool from English to German (CPAx-GE) and to examine its validity and reliability. Materials and methods Following a forward-backward translation including an expert round table discussion, the measurement properties of the CPAx-GE were explored in critically ill, mechanically ventilated adults. We investigated construct, cross-sectional, and cross-cultural validity of the CPAx-GE with other measurement instruments at pre-specified timepoints, analysed relative reliability with intraclass correlation coefficients (ICCs) and determined absolute agreement with the Bland–Altman plots. Results Consensus for the translated CPAx-GE was reached. Validity was excellent with >80% of the pre-specified hypotheses accepted at baseline, critical care, and hospital discharge. Interrater reliability was high (ICCs > 0.8) across all visits. Limit of agreement ranged from −2 to 2 points. Error of measurement was small, floor, and ceiling effects limited. Conclusions The CPAx-GE demonstrated excellent construct, cross-sectional, and cross-cultural validity as well as high interrater reliability in critically ill adults with prolonged mechanical ventilation at baseline, critical care, and hospital discharge. Consequently, the CPAx-GE can be assumed equal to the original and recommended in the German-speaking area to assess physical function and activity of critically ill adults across the critical care and hospital stay. Trial registration: German Clinical Trials Register (DRKS) identification number: DRKS00012983 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012983), registered on 20 September 2017, first patient enrolled on 21 November 2017. Implications for rehabilitation Early rehabilitation of critically ill patients is recommended to prevent and treat the subsequent functional disability, but a suitable measurement instrument for the German-speaking area is lacking. The translated, cross-culturally adapted German CPAx demonstrated excellent validity and reliability in assessing physical function and activity in critically ill adults. Cross-sectional validity of the CPAx has been newly established and allows the use of this tool at clinically relevant time-points in the course of a critical illness. The CPAx-GE can therefore be used in clinical practice by German-speaking therapists to assess physical function and activity during early rehabilitation in the ICU and hospital.

Chinesisation, adaptation and validation of the Chelsea Critical Care Physical Assessment Tool in critically ill patients: a cross-sectional observational study

PurposeTo translate and adapt the Chelsea Critical Care Physical Assessment Tool (CPAx) into Chinese version (‘CPAx-Chi’), test the reliability and validity of CPAx-Chi, and verify the cut-off point for the...

A single center observational study of the incidence, frequency and timing of critical care physiotherapy intervention during the COVID-19 pandemic.

IntroductionThe recent COVID-19 pandemic saw many patients admitted to an intensive care setting and requiring mechanical ventilation. The NHS increased their critical care beds which included expanding the amount of staff. Physiotherapists were a key part of this and were required to complete numerous interventions within the COVID critical care setting throughout the pandemic. Our aim was to collect the incidence and frequency of physiotherapy interventions performed during the COVID-19 pandemic in a critical care setting.MethodData was collected across all critical care beds at the Royal London Hospital for an eight-week period between March- April 2020. We retrospectively collected physiotherapy interventions for example, endotracheal suctioning and functional rehabilitation for every patient in the critical care setting. The Chelsea Critical Care Physical Assessment Tool (CPAx) scores were also obtained for patients on ACCU admission and discharge.ResultsA total of 213 patients were included in the sample, 163 COVID-19 positive and 50 COVID-19 negative. Recorded sessions included secretion management (821), weaning (271), rescue therapy (82) and functional rehab (534) across the eight-week period. The mean CPAx score on admission to ACCU for the entire sample was 9/45 points. On discharge that score had improved to 25/45 points.ConclusionThis unique project has enabled us to report on the critical care physiotherapy interventions provided during the COVID 19 pandemic. This interesting data on frequency and timing of interventions may be useful to plan future relocation staffing plans and optimal allocation of care.

Recovery after acute illness after hospital discharge – a prospective cohort study

Background: Long-term outcomes after acute medical and surgical illness are largely unknown. Aim: To describe cognitive and physical function, health-related quality of life and risk of anxiety and depression after acute illness. Design: Prospective cohort study. Methods: Home visit at three and twelve months measuring: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Chelsea Critical Care Physical Assessment tool, Short Form Health Survey, Hospital Anxiety and Depression Scale and Trail Making Test. Results: Of 101 included patients, 60 were visited at three and 36 at twelve months. The RBANS value was 84 (69-96) at three months and 88 (69-101) at twelve months. Conclusions: We found a moderately reduced cognitive function three and twelve months after acute illness.

Cross-cultural adaptation and inter-rater reliability of the Swedish version of the Chelsea critical care assessment tool (CPAX-Swe) in critically ill patients

Objectives To translate and culturally adapt the Chelsea Critical Care Physical Assessment Tool into Swedish and to test the inter-rater reliability of the Swedish version in critically ill patients. Design This is an observational study. Methods Translation and cross-cultural adaptation was performed in line with international recommendations, including forward and backward translation and expert round table discussions. The inter-rater reliability of the Chelsea Critical Care Physical Assessment Tool – Swedish was then explored in 50 critically ill adult patients, pragmatically recruited, in a University Hospital clinical setting. Reliability was calculated using intraclass correlation coefficient for aggregated scores and quadratic weighted Cohen’s kappa analysis for individual items Results The expert round table discussion group agreed that the translation was a satisfactory equivalent to the original version and applicable for use within the clinical setting. Reliability of aggregated scores and individual items were very good (intraclass correlation coefficient of 0.97 and quadric weighted kappa values ranging from 0.88 to 0.98). The measurement error for aggregated scores was low, with a standard error of measurement of 1.79, smallest detectable change of 4.95, and limits of agreement of 5.20 and −4.76. The percentage agreement for individual items ranged from 64% to 88%. Conclusion The Chelsea Critical Care Physical Assessment Tool – Swedish was found applicable and appropriate for assessment of functioning in critically ill patients in an acute setting in Sweden, and it displayed high inter-rater reliability. This implies that the Swedish version can be used as assessment tool within intensive care and acute wards in Sweden. Implications for rehabilitation There is a lack of validated instruments to test the functional status of critically ill patients in Sweden. The Chelsea Critical Care Physical Assessment Tool is validated and reliable in English. The Chelsea Critical Care Physical Assessment Tool – Swedish is considered reliable for use by physiotherapist in intensive care settings in Sweden. The Swedish version is feasible for use within clinical practice due to its simplicity and strong clinical relevance.

Physical function and actigraphy in intensive care survivors-A prospective 3-month follow-up cohort study.

Impaired physical function after intensive care unit (ICU) stay is common. We aimed to study the association between activity levels in the ward after discharge from ICU and physical function at 3-month follow-up. Prospective cohort study of adult patients admitted to the ICU for more than 24hours. Patients wore an accelerometer for up to 7days at the ward. At discharge from ICU and at 3-month follow-up, patients were tested with the Chelsea Critical Care Physical Assessment Tool (CPAx). We screened 66 consecutive, eligible patients; 41 completed actigraphy and 19 patients were visited at 3months. The median CPAx increased from 31 (IQR 23-41) at discharge from ICU to 47 (IQR 44-49) at follow-up (P<0.0001). Mean daily activity for the first week was correlated with CPAx at ICU discharge (R2 =0.14, P=0.017; all 41 patients). For the 19 visited patients, we found no significant correlation for activity levels with CPAx at ICU discharge (R2 =0.12, P=0.14) nor at visit (R2 =0.2, P=0.058). We found improved physical function for most patients 3months after ICU treatment. Activity levels for 1week after ICU discharge at the ward were not associated with better physical function at 3-month follow-up.

On the Move: The Children's Chelsea Critical Care Physical Assessment Tool: An Observational Pilot Study

Introduction: The Children’s Chelsea Critical Care Physical Assessment tool (cCPAx) is a measure of physical function for use in the paediatric intensive care unit (PICU). Growing evidence supports the efficacy and safety of early mobilisation (EM) in the PICU, yet there is a paucity of validated tools to effectively evaluate physical function and mobility in critically ill children. The cCPAx was developed using an iterative Delphi consensus method involving an expert panel to examine content validity and adapt the adult Chelsea Critical Care Physical Assessment tool for paediatrics.

Feasibility for the use of the Chelsea Critical Care Physical Assessment tool in a complex Neurorehabilitation Unit

Feasibility for the use of the Chelsea Critical Care Physical Assessment tool in a complex Neurorehabilitation Unit

Diagnostic tools of intensive care unit acquired weakness: a systematic review

To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status. There were 19 literatures including 14 assessment scales and ultrasound diagnosis. The 14 assessment scales were medical research council score (MRC-Score), Barthel index (BI), 6-minute walk test (6MWT), clinical outcome variables scale (COVS), the Chelsea critical care physical assessment tool (CPAx), functional independence measure (FIM), functional status score for the intensive care unit (FSS-ICU), the ICU mobility scale (IMS), rivermead mobility index (RMI), the Perme ICU score (PERME), the physical function ICU test (PFIT), the physical function ICU test score (PFIT-s), the surgical ICU optimal mobility score (SOMS), and the Manchester mobility score (MMS). Nine scales (60%) were tested reliability and the rang of inter-rater reliability was 0.600-0.996, and the test reliability was 0.970, and the range of internal consistency reliability was 0.680-0.992. Validity of 6 scales (40%) were evaluated, and the range of structure validity was 0.57-0.94, the range of content validity was 0.830-0.988, the range of concurrent validity was 0.730-0.823. It was shown that the reliability of ICUAW assessment scale was relatively good at present, but the degree of accurate assessment of ICUAW was relatively low. The evaluation content of ICUAW can be divided into three categories: in the first, they measured the muscles strength of body just like MRC-Score; in the second, they evaluated the physical function and mobility, such as COVS, CPAx, FIM, FSS-ICU, IMS, PERME, PFIT, RMI, SOMS and MMS; in the third, they evaluated daily activity and physiology parameter just as 6MWT, BI and ultrasound. Different scales were correlated with the length of ICU stay (ICU-LOS), the hospital discharge, and the mortality. For example: COVS, CPAx, FSS-ICU, PFIT, PFIT-s and SOMS could predict the ICU-LOS and hospital discharge, RMI and SOMS can predict patient mortality. However, there was no evidence to testify the consistency between them. Now, the specialist consensus about the observation nodes of threshold and electrophysiological records were the complex action potential (CMAP) range < 0.43-0.65 mV and the sensory nerve action potential (SNAP) range < 17.6 μV. There are many diagnostic tools in ICUAW, and the reliability of each scale is relatively good. In future studies, we should collect the advantages of each scale, explore the specific indicators to evaluate ICUAW and improve the accuracy and validity of diagnostic ICUAW.

Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: An experimental study.

BackgroundCritically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU.ObjectivesTo determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans.MethodA single-centred pre–post quasi-experimental study was conducted. The population was a consecutive sample of surgical and trauma ICU patients. Participants’ functional ability was assessed with the CPAx tool on alternative days during their ICU stay, and rehabilitation goals were modified according to their CPAx score. Intensive care unit and hospital LOS data were collected and compared to data of a matched historical control group. Descriptive and inferential statistics were used.ResultsA total of 26 ICU patients were included in the intervention group (n = 26). They received CPAx-guided therapy, and outcomes were matched with ICU patients in the historical control group (n = 26). The median sequential organ failure assessment (SOFA) score was significantly higher in the control group (p = 0.005) (3.5 [IQR 2–6.3]) versus (2 [IQR 1.8–2.5]) for the intervention group. The median admission CPAx score for the intervention group was 33.5 (IQR 16.1–44), and the median ICU discharge score was 38 (IQR 28.5–43.8). No significant differences were found in ICU days (control 2.7 [IQR 1.1–5.2]; intervention 3.7 [IQR 2.3–5.4]; p = 0.27) or hospital LOS (control 13.5 [IQR 9.3–18.3]; intervention 11.4 [IQR 8.4–20.3], p = 0.42). Chelsea critical care physical assessment scores on ICU admission had a moderate negative correlation with hospital LOS (r = −0.58, p = 0.00, n = 23). Chelsea critical care physical assessment scores at ICU discharge had strong positive correlation with discharge SOFA scores (r = 0.7; p = 0.025; n = 10).ConclusionProblem-oriented patient rehabilitation informed by the CPAx tool resulted in improvement of physical function but did not reduce ICU or hospital LOS.Clinical implicationsA higher level of physical function at ICU admission, measured with CPAx, was associated with shorter hospital LOS.

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

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.

CPAx: effectiveness of an outcome measure to score physical morbidity in critical care

Purpose: To critically evaluate current research on the Chelsea Critical care physical assessment tool.

Physical Therapist-Led Ambulatory Rehabilitation for Patients Receiving CentriMag Short-Term Ventricular Assist Device Support: Retrospective Case Series.

Short-term ventricular assist device (VAD) support is used in the intensive care unit (ICU) to support individuals in end-stage heart failure prior to heart transplantation or implantation of a long-term left VAD. The literature investigating the feasibility, safety, and content of rehabilitation for this patient group is lacking. This report retrospectively describes the rehabilitation strategy, safety measures used, and nature of any adverse events and, therefore, the feasibility of this practice. Ten individuals (80% male) admitted to the ICU in critical cardiogenic shock required support via a short-term VAD. A prerehabilitation risk assessment was used to reduce the risk of cannula dislodgement. The therapeutic strategy was a stepwise progression of exercises, mobilization, and ambulation. Retrospective inspection of the case notes showed 330 rehabilitation sessions (X̅=33, SD=18.1, range=16-72) were performed and progressed to ambulation on 71 occasions (X̅=7.1, SD=7.7, range=1-27). Distance ambulated ranged from 7 to 1,200 m (X̅=157.7, SD=367.3). The Chelsea Critical Care Physical Assessment Tool (CPAx) score for 7 patients improved from a median of 0 (interquartile range=0-1) on day 1 to a median peak score of 39 (interquartile range=37-42). There were 8 episodes of minor adverse events (2.4% incidence rate), including 7 of transient low VAD flows. There were no major adverse events. Early rehabilitation and ambulation of recipients of short-term VAD support was safe and feasible. Recipients demonstrated improvements in physical function (CPAx score) while the VAD was in situ.