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 (original) (raw)
Disability and Rehabilitation, 2022
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 ¼ 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 ¼ 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 ¼ 0.261, mental: r ¼ 0.193). Measured at baseline, CPAx scores correlated as expected with length of ICU stay (r ¼ À 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.
South African journal of physiotherapy, 2023
Background: 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. Objectives: Our study aimed to identify studies that assess the functional outcomes of patients nursed in ICUs that use the CPAx tool. Method: 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. Results: 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. Conclusion: The use of the CPAx tool has no impact on measuring the hospital length of stay or quality of life. Clinical implications: The tool is comprehensive and enhances the accuracy of patient assessment.
2017
There is limited research available on the use of outcome measures in intensive care units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a measure of morbidity related to physical function and assesses respiratory function and functional abilities of critically ill patients. The objectives of this study were to establish the effect of the use of the CPAx tool on ICU and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx scores and severity of illness or general morbidity during ICU admission; and to establish physiotherapists' perceptions and views towards the use of the CPAx tool in their daily clinical practice in ICU. The study consisted of two parts. Part one was a quasi-experimental design with a historical matched control group. Part two was a survey-based design. The study took place in a South African public sector hospital. Twenty six participants each were recruited into the experimental and control groups. Participants from the control group were matched with participants in the experimental group according to age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure assessment (SOFA) scores were calculated for participants in the experimental group on alternate weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants and historical control group were done using an independent t-test. Pearson's correlation coefficient was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was completed by the research assistants who administered the CPAx tool to participants in the experimental group in order to determine their perceptions of the tool.
Disability and Rehabilitation, 2021
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 prespecified hypotheses accepted at baseline, critical care, and hospital discharge. Interrater reliability was high (ICCs > 0.8) across all visits. Limit of agreement ranged from À2 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. ä 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.
2025
Purpose: To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil. Methods: The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists’ assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated. Results: Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99. Conclusion: A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.
The Physical Function Intensive Care Test: Implementation in Survivors of Critical Illness
Physical Therapy, 2014
Background. Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population.
The American Surgeon, 2012
The Acute Physiology and Chronic Health Evaluation II (APACHE II) score has never been validated to risk-adjust between critically ill trauma (TICU) and general surgical (SICU) intensive care unit patients, yet it is commonly used for such a purpose. To study this, we evaluated risk of death in TICU and SICU patients with pneumonia. We hypothesized that mortality for a given APACHE II would be significantly different and that using APACHE II to directly compare TICU and SICU patients would not be appropriate. We conducted a retrospective review of patients admitted to the TICU or SICU at a tertiary medical center over an 18-month period with pneumonia. Admission APACHE II scores, in-hospital mortality, demographics, and illness characteristics were recorded. One hundred eighty patients met inclusion criteria, 116 in the TICU and 64 in the SICU. Average APACHE II scores were not significantly different in the TICU versus SICU (25 vs 24; P = 0.4607), indicating similar disease severit...
Journal of Wound, Ostomy & Continence Nursing, 2020
PURPOSE: No risk assessment scale exists in the United States specifically designed for use among patients with critical illness. The aim of this project was to modify the Norton Scale for Pressure Sore Risk to improve its predictive power when used in the critical care setting. PARTICIPANTS AND SETTING: The setting for this quality improvement project was a 1157-bed academic medical center in the Southeast United States. Data were collected from 114 clinicians; 111 were critical care nurses and 3 were certified wound care nurses. METHODS: Participants assessed the pressure injury risks of a video-simulated critical care patient using the optimized Norton Scale (oNS); this instrument was modified from the Norton Scale. Data were collected on reliability, validity, usability, and preference. OUTCOMES: All 114 participants accurately predicted a patient's severe high risk for pressure injury using the oNS. Predictive validity and reliability of the oNS were excellent based on a correlation coefficient of more than 0.6 and a Cronbach α = 0.944, respectively. The intraclass correlation coefficient (ICC) was 0.933 (95% confidence interval, 0.911-0.950). From 71.2% to 84.9% of the participants agreed that the oNS represented the desired characteristics for optimal usability in the critical-care setting. Preference for the oNS was associated with perceptions that it was easier, quicker, and more critical-care-specific than the Braden Scale for Pressure Sore Risk currently used in critical care units in the project facility. IMPLICATIONS FOR PRACTICE: The oNS offered critical care nurses in our facility a quick, easy-to-use, critical care-specific risk assessment tool that focused on the unique vulnerabilities of patients with critical illness.
A systematic review of measurements of physical function in critically ill adults
2012
Existing clinical trial data suggest that interventions aimed at encouraging early activity and mobilisation in the intensive care unit may reduce duration of mechanical ventilation and ICU length of stay, while improving physical function in survivors. 1 However, the applicability of these data to the Australian and New Zealand setting is uncertain. A program of research evaluating early activity and mobility in the ICU is therefore underway in Australia and New Zealand, commencing with an observational study of current mobilisation practices in ventilated ICU patients (ClinicalTrials.gov NCT01674608). Our intention is to follow the observational study with a multicentre Phase II trial. The Australian and New Zealand Intensive Care Society Clinical Trials Group recently published a consensus statement on the use of end points for Phase II trials involving critically ill patients. 2 This statement highlights the importance of end points that measure limitations in physical function (so-called functional end points) and suggests that such end points could be used in trials investigating mobility interventions in the ICU in particular. The aim of this systematic review was to identify, describe and evaluate measurements of physical function that have been used to assess early mobilisation in critically ill adults. A secondary aim was to evaluate the available evidence for the measurement properties and risk of bias associated with the identified end points when used with ICU patients. These data may assist in the design of Phase II trials of early activity and mobility interventions and may also have relevance to evaluating the quality of survival after critical illness. This review had two parts: Search Strategy 1 identified studies of ICU rehabilitation or mobilisation that measured physical function; and Search Strategy 2 identified studies that examined the measurement properties and risk of bias associated with the physical function measures in the ICU from Search Strategy 1. A literature search of Ovid MEDLINE, Embase, CINAHL, Cochrane Library and PEDro (Physiotherapy Evidence Database) was conducted in June 2012 using the search strategy outlined in Table . Additional studies were identified through reference and citation tracking, personal communication with a content expert, and by contacting authors of eligible trials. Review papers and meta-analyses were reviewed for publications that may otherwise have been missed. Two independent reviewers extracted data relating to patient and hospital outcomes and assessed the methodological quality of included studies.
Disability and Rehabilitation, 2019
Objectives: To translate and culturally adapt the Chelsea Critical Care Physical Assessment Tool into Swedish and to test the interrater reliability of the Swedish version in critically ill patients. Design: 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.
Validation of an Instrument for Nursing Care for Critically Ill Patients with Trauma
Research and reviews: journal of nursing and health sciences, 2019
Objective: To describe the validation process of an instrument for nursing care to the patient. Method: Methodological research, of a descriptive nature. The instrument was validated by 11 content judges, and the data were judged according to the document validation index, considering 0.80 for item validation and for a concordance comparison the binomial test was performed considering p<0.05 The judges validated the instrument as the objectives, structure, content and relevance. Results: The instrument was composed of eighteen categories in 74 questions. With regard to validation, the judges were given the overall Content Validity Index of 0.97 per excellence level of agreement between the judges. Conclusion: The instrument has been validated and can be offered for service, allowing the assistance based on evidence.
Reviews in Cardiovascular Medicine, 2022
Background: Following cardiovascular surgery, patients are at high risk of requiring systemic management in the intensive care unit (ICU), resulting in hospitalization-associated disability (HAD). Predicting the risk of HAD during the postoperative course is important to prevent susceptibility to cardiovascular events. Assessment of physical function during the ICU stay may be useful as a prediction index but has not been established. Methods: This prospective observational study conducted at a high-volume cardiovascular center included 236 patients (34% female; median age, 73 years) who required an ICU stay of at least 72 hours after surgery and underwent postoperative rehabilitation. HAD was defined as a decrease in the discharge Barthel index (BI) score of at least 5 points relative to the preadmission BI score. Physical Function ICU Test-scored (PFIT-s), Functional Status Score for the ICU (FSS-ICU), and Medical Research Council (MRC)-sumscore were used to assess physical function at ICU discharge. Results: HAD occurred in 58 (24.6%) of the 236 patients following cardiovascular surgery. The cutoff points for HAD were 7.5 points for the PFIT-s (sensitivity 0.80, specificity 0.59), 24.5 points for the FSS-ICU (sensitivity 0.57, specificity 0.66), and 59.5 points for the MRC-sumscore (sensitivity 0.93, specificity 0.66). Multivariate logistic regression analysis revealed a PFIT-s of >7.5 points (odds ratio [OR], 4.84; 95% CI, 2.39-9.80; p < 0.001) and an MRC-sumscore of >59.5 points (OR, 2.43; 95% CI, 1.22-4.87; p = 0.012) as independent associated factors. Conclusions: We demonstrate that the PFIT-s and MRC-sumscore at ICU discharge may be helpful as a predictive indicator for HAD in patients having undergone major cardiovascular surgery.
The development of a pressure area scoring system for critically ill patients: a pilot study
Intensive and Critical Care Nursing, 1993
At present no suitably sensitive scoring system is available to differentiate degrees of risk of developing pressure sores in critically ill people. The object of this study is to produce a tool that has been validated to identify and weight risk factors associated with critically ill patients. In a pilot study data were collected on 50 patients and analysed, using multiple regression analysis, to produce a set of weighted coefficients (C) suitable for use as a scoring system. The feasibility of the technique is demonstrated and five highly significant factors are described: adrenaline infusions (C = 14), noradrenaline infusions (C = 15), diabetes (C = 15), restricted movement (traction, post-operative pain, intra-aortic balloon pump and haemofiltration) (C = 8) and patients too unstable to turn (C = 17). All coefficients #O with p < 0.05. Risk factors which may become significant in a larger study are identified. In order to develop the full tool a further multi-centre study is proposed.
Validity and Reliability of the Critical Care Pain Observation Tool: A Replication Study
Pain Management Nursing, 2013
Because critically ill patients are often not able to self report the presence of pain, an observer rating scale, the Critical Care Pain Observation Tool (CPOT) was developed for pain assessment of critically ill patients. This research examines the reliability and validity of the CPOT via replication of the original research study that developed the tool. Utilizing a repeated measures design, two nurse observers used the CPOT to score patient pain behaviors during rest, with repositioning and after repositioning. Results show fair to almost perfect interrater reliability and good discriminant validity of the instrument. The Critical Care Pain Observation Tool is a promising instrument for assessment of pain in critically ill patients. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 42 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Critical Care, 2015
Introduction: Intensive care unit-acquired weakness (ICU-AW) is a significant problem. There is currently widespread variability in the methods used for manual muscle testing and handgrip dynamometry (HGD) to diagnose ICU-AW. This study was conducted in two parts. The aims of this study were: to determine the inter-rater reliability and agreement of manual muscle strength testing using both isometric and through-range techniques using the Medical Research Council sum score and a new four-point scale, and to examine the validity of HGD and determine a cutoff score for the diagnosis of ICU-AW for the new four-point scale. Methods: Part one involved evaluation of muscle strength by two physical therapists in 29 patients ventilated >48 hours. Manual strength testing was performed by both physical therapists using two techniques: isometric and through range; and two scoring systems: traditional six-point Medical Research Council scale and a new collapsed four-point scale. Part two involved assessment of handgrip strength conducted on 60 patients. A cutoff score for ICU-AW was identified for the new four-point scoring system. Results: The incidence of ICU-AW was 42% (n = 25/60) in this study (based on HGD). In part one the highest reliability and agreement was observed for the isometric technique using the four-point scale (intraclass correlation coefficient = 0.90: kappa = 0.72 respectively). Differences existed between isometric and through-range scores (mean difference = 1.76 points, P = 0.005). In part two, HGD had a sensitivity of 0.88 and specificity of 0.80 for diagnosing ICU-AW. A cutoff score of 24 out of 36 points was identified for the four-point scale.
A preliminary validation of the Swedish version of the critical-care pain observation tool in adults
Acta Anaesthesiologica Scandinavica, 2011
Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT. Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm-and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per-and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT. Results: The results provide indications of good agreement between the independent raters (ICC 5 0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (r 5 0.32-0.45). Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.
2018
Background: The American Society of Anaesthesiologists-Physical Status (ASA-PS) Classification is a grading system for classifying surgical patients based on their comorbid background. Despite numerous benefits, its highly subjective nature has led to marked inconsistency when used. The purpose of this study was to assess consistency when public sector anaesthetists score trauma and non-trauma surgical patients using the Classification.Methods: A three-part questionnaire, with 18 clinical scenarios, was administered to 98 anaesthetists requiring them to grade the scenarios using the Classification and give their opinion on its usage.Results: We received 97 completed questionnaires. Eighty-eight percent of respondents routinely use the Classification. Fifty-two percent had read the Classification within the last six months. Many limitations of the use of the ASA System were identified. There was a lack of consistency in the scoring of the scenarios, with each scenario receiving at le...
Journal of Back and Musculoskeletal Rehabilitation
BACKGROUND: Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. OBJECTIVE: This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. METHODS: Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-s...