A. Thrush1, E. Steenbergen1
1Cleveland Clinic Abu Dhabi, Physical Therapy, Abu Dhabi, United Arab Emirates
Background: Outcomes measures in acute care serve important purposes such as measuring progress, setting goals, predicting discharge setting, and justifying rehabilitation needs. Despite this, physiotherapists underutilized outcome measures in acute care.
Purpose: This investigation seeks to determine psychometric properties of the Activity Measure for Post-Acute Care “6-clicks” and the Functional Status Score for the ICU (FSS-ICU) in a population of hospitalized adults in a tertiary hospital in the United Arab Emirates.
Methods: All admitted patients referred to physiotherapy were assessed with each instrument. No exclusion criteria were applied as the intent was to evaluate each instrument as a global outcome measure across all patients referred to physiotherapy. Data from medical records was extracted retrospectively from March 2018 to February 2020. Scores from admission and discharge were used to determine the measurement properties of interest. Median admission and discharge scores are reported. Responsiveness is reported by providing mean change, effect size, and p-value using a mixed effect regression model. Floor and ceiling effects are reported as percent of patients scoring minimum and maximum scores. Minimal clinically important difference (MCID) is estimated via distribution-based methods by calculating 0.2 and 0.5 standard deviations (SD). These metrics will also be reported for subpopulations of patients with stroke, medical, and cardiovascular diagnoses. Finally, inter-rater reliability for the FSS-ICU is evaluated following a survey completed by inpatient physiotherapists.
Results: Data from 6,823 (6-clicks) and 6,831 (FSS-ICU) patients was extracted. The number of patients with ≥2 scores on each instrument were 4,065 for the 6-clicks and 3,287 for the FSS-ICU. Average age was 60 years; median length of stay was 9 days. Mean admission and discharge scores for the 6-clicks were 16 (10-18) and 19 (14-34), and for FSS-ICU were 19 (13-25) and 27 (18-33). The mean change, effect size, and p-value for the 6-clicks and FSS-ICU were: +3.0 pts and +6.09 pts; 0.61 and 0.69, and <0.001 and <0.001, respectively. 6-clicks had both a significant floor and ceiling effect on discharge (10.4% and 20.1%). The FSS-ICU had a significant ceiling effect on discharge (20.4%). Values for 0.2 and 0.5 SD for 6-clicks were 0.989 and 2.473. Values for 0.2 and 0.5 SD for FSS-ICU were 1.773 and 4.433. Interrater reliability of FSS-ICU based on each item is 0.9, and based on total score is 0.978. Total score alpha is .94.
Conclusion(s): Both measures are responsive to the functional changes observed among hospitalized patients. The 6-clicks shows significant floor and ceiling effects. MCID for the 6-clicks has not been previously reported and in this investigation is estimated to be 1-2.5 points. The FSS-ICU MCID is estimated to be 1.7-4.5 points, in agreement with a previous publication. Data generated for the stroke, medical, and cardiovascular subpopulations provide further insights into the utility of each instrument. This is the first report of these instruments in the Middle East.
Implications: The 6-clicks and FSS-ICU are useful in clinical practice in an inpatient setting. The application of the MCID for each instrument may help physiotherapists evaluate patient progress. The FSS-ICU demonstrates several advantages over the 6-clicks.
Funding, acknowledgements: There are no funding acknowledgements to disclose.
Keywords: outcome measure, acute care, psychometrics
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Cleveland Clinic Abu Dhabi
Committee: Research Ethics Committee
Ethics number: A-2020-066
All authors, affiliations and abstracts have been published as submitted.
