Introduction
Physical functioning in the context of the International Classification of Functioning (ICF) framework
Importance of measuring physical functioning in the ICU
Major considerations in choosing an instrument
Purpose of assessment
Measurement properties
Instrument name (range for score) | Evidence of reliability? | Evidence of validity? | Evidence of predictive validity? | Evidence of responsiveness? | Evidence for MID? | Evaluation of floor and ceiling effects?#
|
---|---|---|---|---|---|---|
ACIF (0–1) | Yes | Construct validity: Yes | Yes: for discharge to home | No | No | Low floor and ceiling in ICU |
CPAx (0–50) | Yes | Content validity: Yes Construct validity: Yes | Yes: for discharge to home | Yesa
| Yesa
| High floor at ICU admission; Low floor and ceiling at ICU and hospital dischargea
|
CcFROM (0–63) | Yes | Face/content validity: Yes | No | No | No | Low floor and ceiling in ICU |
DEMMI (0–100) | Yes | Convergent validity: Yes Divergent validity: Yes | No | No | No | Low floor and ceiling in ICU |
FSS-ICU (0–35) | Yes | Construct validity: Yes Discriminant validity: Yes Known groups validity: Yes | Yes: for discharge to home and post-ICU hospital LOSb
| Yes | Yes | Low floor and ceiling at awakening and ICU discharge, high ceiling at hospital discharge |
IMS (0–10) | Yes | Construct validity: Yes Divergent validity: Yes | Yes: for discharge to home and 90-day survivalb
| Yes | No | High floor at ICU admission; Low floor and ceiling at ICU awakening and ICU discharge |
MMS (0–7) | Yes | Construct validity: Yes | Yes: for post-ICU hospital LOS | No | No | High floor during ICU stay |
Perme (0–32) | Yes | Construct validity: Yes | No | No | No | High floor during ICU stay |
PFIT-s (0–10) | Yes | Construct validity: Yes Divergent validity: Yes | Yes: for discharge to home, post-ICU hospital LOS; Not predictive of 28-day and 12-month mortalityc
| Yes | Yes | High floor at ICU admission; Low floor and ceiling at awakening and ICU discharge |
SOMS (0–4) | Yes | Construct validity: Yes Divergent validity: Yes | Yes: for ICU and hospital LOS, and in-hospital mortalityd
| No | No | Low floor and ceiling at ICU admission |
SPPB (0–12) | No | Construct validity: Yes Divergent validity: Yes | Not predictive of discharge to homeb
| Yes | Yes | High floor at awakening and ICU discharge |
Patient capacity
Outcome measure | Type of assessment#
| Patient population with original development | Equipment required* | Scoring information (minimum to maximum score) | Time required to physically undertake testing | Training Rresources |
---|---|---|---|---|---|---|
ACIF [32] | Comprehensive | Acute neurological (including neurosurgery) [23] | Access to 5 stairs; walking marker (distance) | 20 items, 4 subcategories (0–1.00) | 12 min | No specified training package or video currently available, instructions and recording sheet available [23] |
Comprehensive | General and trauma ICU [31] | Handgrip dynamometera
| 10 items, each scored 0–5 (0 –50) | 2–10 min | Online 40–60 min free training (requires registration) at http://cpax.ocbmedia.com
| |
CcFROM [37] | Comprehensive | General, neurosurgery and trauma ICU [33] | Stopwatch | 9 items, each scored 0–7 (0–63) | 10–30 min | Instructions and recording sheet available [33], no training package or video currently available |
DEMMI [38] | Comprehensive | General hospitalized geriatric medical patients [24] | Chair with 45 cm seat height with arm rests; stopwatch; pen (DEMMI item 13); walking marker (distance) | 15 items, 5 subcategories, each scored 0–2 (0–100) | 10–30 min | Instructions and recording sheet available in supplementary [24] (no details specific to the ICU setting) |
Comprehensive | Medical ICU [37] | Walking marker (distance) | 5 items, each scored 0–7 (0–35) | 10–30 min | Detailed free instructions (registration required) at www.improvelto.com/, free training package including video available from primary author1
| |
Simple | General ICU (medical, surgical, trauma) [28] | None | 1 item, score based on highest classification level (11 options) (0–10) | <1 min | Instructions available [28] | |
MMS [46] | Simple | General ICU (medical, surgical, trauma) [39] | None | 1 item, score based on highest classification level (7 options) (0–7) | <1 min | Instructions and recording sheet available [39]—further detailed instructions available from primary author2, no training package or video currently available |
Comprehensive | General ICU (medical, surgical) [43] | Stopwatch; Borg RPE sheet (optional) | 4 items, individual items scored 0–3 (0–10) | 10–15 min | Free training package, including video, available from primary author3
| |
Comprehensive | None | 15 items, individual items scored 0–3 (0–32) | 15–60 min | No training package or video currently available. The scoring criteria and detailed instructions are available in the manuscript [46] | ||
Simple | Surgical ICU [49] | None | 1 item, score based on highest classification level (5 options) (0–4) | <1 min | No training package or video currently available, scoring criteria available in manuscript [49] | |
SPPB [26] | Comprehensive | Geriatric, non-hospitalized | Stopwatch; tape-measure (for 4-m course) | 3 items, each item scored 0–4 (0–12) | 5–10 min | Free training via: https://www.irp.nia.nih.gov/branches/leps/sppb/index.htm and https://www.youtube.com/watch?v=XgiuciJXPm4 (no details specific for ICU) |
Clinical utility
Recommendations for clinical practice
Areas for future investigation
FSS-ICU | PFIT-s | IMS | CPAx | ACIF#
| ccFROM | DEMMI | SOMS | SPPB | MMS | Perme#
| |
---|---|---|---|---|---|---|---|---|---|---|---|
Body functions | |||||||||||
B4. Functions of cardiovascular and respiratory systems | |||||||||||
Respiratory functions, other specified [b4408] | X | ||||||||||
Additional respiratory functions [b450] | X | ||||||||||
General physical endurance [b4550] | X | X | |||||||||
B7. Neuromuscular and movement-related functions | |||||||||||
Mobility of joint functions [b710] | X | ||||||||||
Power of isolated muscles and muscle groups [b7300] | X | X | X | X | X | ||||||
Power of muscle of one limb [b7301] | |||||||||||
Activities and participation | |||||||||||
D4. Mobility | |||||||||||
Lying down [d4100] | X | X | X | X | X | X | X | X | X | ||
Sitting [d4103] | X | X | X | X | X | X | X | X | X | X | |
Standing [d4104] | X | X | X | ||||||||
Maintaining a lying position [d4150] | X | X | |||||||||
Maintaining a sitting position [d4153] | X | X | X | X | X | X | X | X | |||
Maintaining a standing position [d4154] | X | X | X | X | X | X | X | X | |||
Transferring one-self while sitting [d4200] | X | X | X | X | X | X | |||||
Fine hand use (picking up) [d4400] | X | ||||||||||
Jumping [d4553] | X | ||||||||||
Walking short distances [d4500] | X | X | X | X | X | X | X | X | X | ||
Walking, other specified [d4508] | X1
| X2
| X3
| ||||||||
Climbing [d4551] | X | ||||||||||
Moving around using equipment [d465] | X |