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Title: Functional outcomes in ICU - what should we be using? - an observational study.
Austin Authors: Parry, Selina M;Denehy, Linda;Beach, Lisa J;Berney, Susan C ;Williamson, Hannah C;Granger, Catherine L 
Affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville 3010, Melbourne, VIC, Australia
Department of Physiotherapy, Melbourne Health, Melbourne, VIC, Australia
Institute for Breathing and Sleep, Melbourne, VIC, Australia
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia, Australia
Issue Date: 29-Mar-2015
Publication information: Critical Care 2015; 19(): 127
Abstract: With growing awareness of the importance of rehabilitation new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) the predictive utility of these tests to predict discharge to home; and (4) the clinical applicability of these tests. This was a nested study within an ongoing controlled study and an observational study.Sixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman's rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated.Mean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge, whereas the IMS had a 17% floor effect on awakening. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen's d = 0.71).There is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the NCT02214823 . Registered 7 August 2014).
Gov't Doc #: 25888469
DOI: 10.1186/s13054-015-0829-5
Type: Journal Article
Appears in Collections:Journal articles

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