Thrush A1
1Cleveland Clinic Abu Dhabi, Rehabilitation and Physical Therapy, Abu Dhabi, United Arab Emirates
Background: Measuring the functional status of patients admitted to hospital is of great significance. Physical therapists work to ensure that patients do not decline in function during bouts of illness, and that they return to highest level of function. Two outcome measures becoming increasingly more common in acute care are the AMPAC 6 Clicks (6CL) and the Functional Status Score - ICU (FSS-ICU). A comparison of their utility, and more robust psychometrics, are needed for both measures - particularly within our novel setting as a tertiary hospital in the Middle East.
Purpose: Our purpose was to measure the functional progress of all admitted patients referred to physical therapy in our hospital. We aimed to evaluate each measure with regard to floor and ceiling effects, average change in score from admission to discharge, whether the change score is clinically significant, and responsiveness to change in specific hospital populations.
Methods: Initial and ongoing staff training for the use of each measure was carried out. We then collected data at admission, regularly during hospitalization, and as close to discharge as possible, using both outcome measures. The measures have been implemented since August 2017.
Results: Data is presented from all patients admitted to hospital in the last six months (n = 1,554). The FSS-ICU has a lower floor effect compared with the 6CL at time of PT evaluation (5.8% vs 13.2%, respectively), and at time of final PT assessment (2.4% vs 8.4%, respectively). Ceiling effects both at time of PT evaluation and time of final PT assessment were similar (4.5% vs 4.4%, and 23.3% vs 24.2%). The FSS-ICU shows better responsiveness to patient change, reflected in the percent of patients whose scores improved from first to last assessment (78.4% vs 66.5%), as well as in the percentage of patients whose scores did not change from first to last assessment (11.4% vs 25.3%). The average change from first to last score for the FSS-ICU was 6.7 points, well above the reported minimal clinically importance difference. The average change from first to last score for the 6CL was 3.3 points, which is below the reported minimally detectable change value of 4.7 (no clinically important difference has been established). Among patient groups which have lower levels of functional abilities, the psychometric superiority of the FSS-ICU is even stronger.
Conclusion(s): Measuring patient function in hospital with measures suitable for both intensive care and ward populations is critically important as our profession seeks to demonstrate its value. This data offers robust information regarding the responsiveness, utility, and floor and ceiling effects of two outcome measures increasingly utilized in hospital settings. Furthermore, our hospital in the Middle Eastern represents a novel environment in which we can further explore the universality of these measures.
Implications: The 6CL and the FSS-ICU are able to provide data on functional status trends among admitted patients. Both measures have a role in measuring functional outcomes. The FSS-ICU has several significant advantages and may be considered more useful for physical therapists to implement along the continuum from intensive care to ward management.
Keywords: outcome measures, acute care, functional status
Funding acknowledgements: None.
Purpose: Our purpose was to measure the functional progress of all admitted patients referred to physical therapy in our hospital. We aimed to evaluate each measure with regard to floor and ceiling effects, average change in score from admission to discharge, whether the change score is clinically significant, and responsiveness to change in specific hospital populations.
Methods: Initial and ongoing staff training for the use of each measure was carried out. We then collected data at admission, regularly during hospitalization, and as close to discharge as possible, using both outcome measures. The measures have been implemented since August 2017.
Results: Data is presented from all patients admitted to hospital in the last six months (n = 1,554). The FSS-ICU has a lower floor effect compared with the 6CL at time of PT evaluation (5.8% vs 13.2%, respectively), and at time of final PT assessment (2.4% vs 8.4%, respectively). Ceiling effects both at time of PT evaluation and time of final PT assessment were similar (4.5% vs 4.4%, and 23.3% vs 24.2%). The FSS-ICU shows better responsiveness to patient change, reflected in the percent of patients whose scores improved from first to last assessment (78.4% vs 66.5%), as well as in the percentage of patients whose scores did not change from first to last assessment (11.4% vs 25.3%). The average change from first to last score for the FSS-ICU was 6.7 points, well above the reported minimal clinically importance difference. The average change from first to last score for the 6CL was 3.3 points, which is below the reported minimally detectable change value of 4.7 (no clinically important difference has been established). Among patient groups which have lower levels of functional abilities, the psychometric superiority of the FSS-ICU is even stronger.
Conclusion(s): Measuring patient function in hospital with measures suitable for both intensive care and ward populations is critically important as our profession seeks to demonstrate its value. This data offers robust information regarding the responsiveness, utility, and floor and ceiling effects of two outcome measures increasingly utilized in hospital settings. Furthermore, our hospital in the Middle Eastern represents a novel environment in which we can further explore the universality of these measures.
Implications: The 6CL and the FSS-ICU are able to provide data on functional status trends among admitted patients. Both measures have a role in measuring functional outcomes. The FSS-ICU has several significant advantages and may be considered more useful for physical therapists to implement along the continuum from intensive care to ward management.
Keywords: outcome measures, acute care, functional status
Funding acknowledgements: None.
Topic: Outcome measurement; Critical care
Ethics approval required: No
Institution: Cleveland Clinic Abu Dhabi
Ethics committee: Cleveland Clinic Abu Dhabi Research Ethics Committee
Reason not required: HAAD Exemption Category: D- Use of existing data, documents, records, specimens and the information is recorded or extracted without any identified or codes linking to subjects. The committee has given favourable ethical opinion for the above project based on the application form, protocol and supporting documentation that comply with the conditions and principles established by the International Conference on Harmonisation – Good Clinical Practice ( ICH GCP).
All authors, affiliations and abstracts have been published as submitted.
