File
Whelan M.J.1, Van Aswegen H.1
1University of the Witwatersrand, Physiotherapy Department, Johannesburg, South Africa
Background: Research on the use of outcome measures in intensive care units (ICU) in South Africa is limited. The Chelsea Critical Care Physical Assessment (CPAx) tool measures morbidity related to physical function through assessment of respiratory function and functional abilities of patients with critical illness.
Purpose: To establish the effect of the use of the CPAx tool on patients' ICU and hospital length of stay (LOS); the usefulness of the CPAx tool according to patient admission diagnosis; the association between CPAx scores, severity of illness scores and morbidity scores during ICU stay; and physiotherapists' perceptions of the CPAx tool.
Methods: The study was performed in a South African public health care sector hospital. Part one was a quasi-experimental design with matched historical control group. Part two was a survey-based design. Participants in the experimental group received assessment with the CPAx tool on alternate weekdays during their ICU stay and their rehabilitation goals were modified according to CPAx scores obtained. Control participants were matched with participants in the experimental group for age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. Sequential organ failure assessment (SOFA) scores were calculated for both groups. A questionnaire was developed and was completed by physiotherapists who administered the CPAx tool to determine their perceptions of the tool.
Results: Participants in both groups (n=26 respectively) were comparable with regards to demographics, diagnoses and APACHE II scores. Mean SOFA scores were significantly higher for control group
(4.15 ±2.6) than experimental group (2.42 ±1.79) participants at ICU admission (p=0.03) and at ICU discharge (control 2.87±1.81, experimental 1.8±0.42; p=0.05). Mean initial CPAx score for the experimental group was 29.73 points (±14.81) and mean CPAx score at ICU discharge was 36.15 (±8.33). Mean CPAx scores changed by 9.45 points between ICU admission and discharge for experimental group participants who underwent surgical procedures and by 3.9 points for those who sustained traumatic orthopaedic injuries. No significant differences were found in ICU LOS (control 4.56 (±5.25) days, experimental 5.84 (±7.43) days; p=0.54) or hospital LOS (control 19.31 (±15.79) days, experimental 17.43 (±16.68) days, p=0.8) between the groups. Initial SOFA scores had a significant negative correlation with initial CPAx scores (r=-0.45; p=0.02; n=26). CPAx scores at ICU discharge had significant positive correlation with SOFA scores at discharge (r=0.8; p=0.05; n=10). Physiotherapists (n=2) reported positive perceptions of the CPAx tool.
Conclusion(s): CPAx did not influence ICU or hospital LOS in participants who underwent surgery or sustained traumatic injury. CPAx was more responsive to change when used with patients recovering from surgical procedures. Future work may include a multi-centre trial to evaluate the effect of CPAx on 24 hour LOS instead of 12 hour LOS and its effect on duration of mechanical ventilation.
Implications: Patients with low morbidity at admission to ICU present with higher levels of physical function. Physiotherapists endorsed use of the CPAx tool in daily clinical practice. Raising awareness of this tool among South African ICU physiotherapists may enhance the use of outcome measures in clinical practice.
Funding acknowledgements: SASP Research Foundation Fund
Topic: Critical care
Ethics approval: University of the Witwatersrand Human Research Ethics (Medical) Committee (M150726), South Africa.
All authors, affiliations and abstracts have been published as submitted.
