Inter‐rater reliability of activity measure for post‐acute care ‘ 6‐Clicks’ inpatient mobility short form in the intensive care unit

2020 ◽  
Vol 25 (4) ◽  
Author(s):  
Stephanie Hiser ◽  
Amy Toonstra ◽  
Lisa A. Friedman ◽  
Elizabeth Colantuoni ◽  
Dale M. Needham
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Short Form ◽  
Rater Reliability ◽  
Activity Measure ◽  
Post Acute Care

Use of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form and National Institutes of Health Stroke Scale to Predict Hospital Discharge Disposition After Stroke

2020 ◽  
Vol 100 (9) ◽  
pp. 1423-1433
Author(s):  
Stephanie Covert ◽  
Joshua K Johnson ◽  
Mary Stilphen ◽  
Sandra Passek ◽  
Nicolas R Thompson ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Short Form ◽  
Predictive Ability ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Activity Measure ◽  
Mobility Score ◽  
Post Acute Care

Abstract Objective Therapists in the hospital are charged with making timely discharge recommendations to improve access to rehabilitation after stroke. The objective of this study was to identify the predictive ability of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form (6 Clicks mobility) score and the National Institutes of Health Stroke Scale (NIHSS) score for actual hospital discharge disposition after stroke. Methods In this retrospective cohort study, data were collected from an academic hospital in the United States for 1543 patients with acute stroke and a 6 Clicks mobility score. Discharge to home, a skilled nursing facility (SNF), or an inpatient rehabilitation facility (IRF) was the primary outcome. Associations among these outcomes and 6 Clicks mobility and NIHSS scores, alone or together, were tested using multinomial logistic regression, and the predictive ability of these scores was calculated using concordance statistics. Results A higher 6 Clicks mobility score alone was associated with a decreased odds of actual discharge to an IRF or an SNF. The 6 Clicks mobility score alone was a strong predictor of discharge to home versus an IRF or an SNF. However, predicting discharge to an IRF versus an SNF was stronger when the 6 Clicks mobility score was considered in combination with the NIHSS score, age, sex, and race. Conclusion The 6 Clicks mobility score alone can guide discharge decision making after stroke, particularly for discharge to home versus an SNF or an IRF. Determining discharge to an SNF versus an IRF could be improved by also considering the NIHSS score, age, sex, and race. Future studies should seek to identify which additional characteristics improve predictability for these separate discharge destinations. Impact The use of outcome measures can improve therapist confidence in making discharge recommendations for people with stroke, can enhance hospital throughput, and can expedite access to rehabilitation, ultimately affecting functional outcomes.

Physiotherapists’ and Physiotherapy Assistants’ Perspectives on Using Three Physical Function Measures in the Intensive Care Unit: A Mixed-Methods Study

2021 ◽  
pp. e20200096
Author(s):  
Stephanie Hiser ◽  
Earl Mantheiy ◽  
Amy Toonstra ◽  
Lisa Aronson Friedman ◽  
Pam Ramsay ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Focus Group ◽  
Physical Function ◽  
Short Form ◽  
Ease Of Use ◽  
Mixed Methods Study ◽  
Professional Communication ◽  
Activity Measure ◽  
Responsiveness To Change

Purpose: We sought to understand physiotherapists’ and physiotherapist assistants’ perspectives on using three physical function measures in the intensive care unit (ICU) setting: the Activity Measure for Post-Acute Care Inpatient Mobility Short Form, the Johns Hopkins Highest Level of Mobility scale, and the Functional Status Score for the Intensive Care Unit. Method: A six-item questionnaire was developed and administered to physiotherapists and physiotherapist assistants working in adult ICUs at one U.S. teaching hospital. A single semi-structured focus group was conducted with seven physiotherapists, recruited using purposive sampling to include participants with a range of clinical experience. Results: Of 22 potential participants, 18 physiotherapists and 2 physiotherapist assistants completed the questionnaire. Seven physiotherapists participated in the focus group. The questionnaire found favourable perspectives on the use of the three physical function measures in clinical practice, and the focus group identified five themes related to clinicians’ experience with using them: (1) ease of scoring, (2) usefulness in inter-professional communication, (3) general ease of use, (4) responsiveness to change in physical function, and (5) generalizability across patients. Conclusions: The most frequently discussed themes in this study were ease of scoring and usefulness in inter-professional communication, highlighting their importance in designing and selecting physical function measures for clinical use in the ICU setting.

scholarly journals Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Debjit Saha ◽  
Carlos Moreno ◽  
Marc Csete ◽  
Elizabeth Kury Perez ◽  
Luigi Cubeddu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Care Facility ◽  
Limited Resources ◽  
Apache Ii Score ◽  
Do Not Resuscitate ◽  
Acute Care Facility ◽  
Intensive Intervention ◽  
Post Acute Care

Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p<0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead;p=0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility.Conclusions.Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.

Short-form activity measure for post-acute care

2004 ◽  
Vol 85 (4) ◽  
pp. 649-660 ◽  
Author(s):  
Stephen M Haley ◽  
Patricia L Andres ◽  
Wendy J Coster ◽  
Mark Kosinski ◽  
Pengsheng Ni ◽  
...  
Keyword(s):  
Acute Care ◽  
Short Form ◽  
Activity Measure ◽  
Post Acute Care

Are the Naranjo Criteria Reliable and Valid for Determination of Adverse Drug Reactions in the Intensive Care Unit?

2005 ◽  
Vol 39 (11) ◽  
pp. 1823-1827 ◽  
Author(s):  
Sandra L Kane-Gill ◽  
Levent Kirisci ◽  
Dev S Pathak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Drug Reactions ◽  
Reliability And Validity ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Drug Reactions ◽  
Rater Reliability ◽  
Cronbach Alpha

BACKGROUND The Naranjo criteria are frequently used for determination of causality for suspected adverse drug reactions (ADRs); however, the psychometric properties have not been studied in the critically ill. OBJECTIVE To evaluate the reliability and validity of the Naranjo criteria for ADR determination in the intensive care unit (ICU). METHODS All patients admitted to a surgical ICU during a 3-month period were enrolled. Four raters independently reviewed 142 suspected ADRs using the Naranjo criteria (review 1). Raters evaluated the 142 suspected ADRs 3–4 weeks later, again using the Naranjo criteria (review 2). Inter-rater reliability was tested using the kappa statistic. The weighted kappa statistic was calculated between reviews 1 and 2 for the intra-rater reliability of each rater. Cronbach alpha was computed to assess the inter-item consistency correlation. The Naranjo criteria were compared with expert opinion for criterion validity for each rater and reported as a Spearman rank (rs) coefficient. RESULTS The kappa statistic ranged from 0.14 to 0.33, reflecting poor inter-rater agreement. The weighted kappa within raters was 0.5402–0.9371. The Cronbach alpha ranged from 0.443 to 0.660, which is considered moderate to good. The rs coefficient range was 0.385–0.545; all rs coefficients were statistically significant (p < 0.05). CONCLUSIONS Inter-rater reliability is marginal; however, within-rater evaluation appears to be consistent. The inter-item correlation is expected to be higher since all questions pertain to ADRs. Overall, the Naranjo criteria need modification for use in the ICU to improve reliability, validity, and clinical usefulness.

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