The primary purpose was to evaluate physical function testing in routine clinical hospital practice over 1 year and compare performances to Danish reference values. Secondary purpose was to evaluate the agreement between two tests of physical function.
Adult patients referred for physical function evaluation by physio- or occupational therapists in an acute care university hospital in Denmark were evaluated with the Cumulated Ambulation Score (CAS) for basic mobility, handgrip strength (HGS) as a proxy for general strength and the 30sec-Sit-To-Stand-test (30s-STS) for function and strength in lower extremities. Results were categorized as normal (mean+/-1SD), reduced (interval between normal and strongly reduced), or strongly reduced (-2SD of normal) according to Danish sex- and age-decade reference values. For the secondary purpose, agreement between performances of HGS and CAS were evaluated in a 3x3 table with comparison of the relative percentage for each of the three performance levels.
Out of 7602 patient courses (PCs), a total of 6930 (mean±SD age 75.2±13.5y, 54% women, 82.3% from own home, and 53.9% with one or more comorbidities) discharged from an acute (n=499), surgical (n=2164) or medical (n=4267) ward, were evaluated with at least one of the three tests over one year. CAS was assessed in 6276 PCs before hospitalisation (recall questionnaire). Out of these, 86% had normal CAS level. CAS was objectively assessed in 6807 PCs at the in-hospital CAS assessment. Of these, 19% and 40% had a reduced or strongly reduced level, respectively. HGS was assessed in 3445 PCs. Of these, 25% and 23% had reduced or strongly reduced HGS levels. 30s-STS performance was assessed in 5902 PCs, of these 8% and 87% had reduced or strongly reduced levels, respectively. Both HGS and CAS was assessed in 3384 PCs, with agreement between the two tests observed in 46.3% of performances; 28.8% (normal level), 5.4% (reduced), and 12.1% with strongly reduced levels. In contrast, dissimilar performances were seen for 53.7% of assessments. Of these, 9.0% and 13.6%, had a reduced or strongly reduced CAS but a normal HGS, while 10.7% and 6.3% had reduced or strongly reduced HGS and a normal CAS.
CAS and HGS was reduced or strongly reduced in about half of adult patients assessed by physio- or occupational therapists across wards. In contrast, almost 90% had strongly reduced 30s-STS performances. Additionally, agreement between HGS and CAS performance was seen in less than half of assessments.
Systematic assessment of physical function by three simple and non-time-consuming tests is considered an important part of physiotherapists DNA, and clearly identifies patients across wards in need of physical rehabilitation. Further, our findings demonstrate that CAS and HGS clearly identifies different patients with reduced physical function supporting the use of both tests in routine clinical practice.
Frailty
Hospital
