Acute care outcome measures

Why is it important for PT to provide intervention in the acute care setting?

• Prevent decline via early mobility 

• Improve pt out comes and decrease hospital stays  

• Help with safe discharge planning

Acute Care Core Outcome Measures recommendations

• Activity Measure for Post-Acute Care Inpatient Basic Mobility Short form (AM-PAC-6 Clicks) OR

• DeMorton Mobility Index (DEMMI)

• Four-Meter Gait Speed

• Intensive Care Unit Mobility Scale (IMS) OR

• John Hopkins Highest Level of Mobility

Acute Care Core Supplemental Outcome Measures Reccomendations

• Chelsea Critical Care Physical Assessment Test (CPAX) OR

• Functional Status Score for ICU (FSS ICU) OR

• Physical Function in the ICU Test Score OR

• Perme ICU Mobility Score

• 6- Minute Walk Test

• 30 Second Chair Stand Test

• Short Physical Performance Battery

• Timed Up and Go Test

  • these are extra tests, not replacements

Activity Measure for Post-Acute Care “6 clicks” (AM-PAC)

• measures basic mobility and daily activity

• 6-item outcome measure

• 4-point ordinal scale, total 24 points

Basic mobility cut-off for AM-PAC “6 clicks’’ outcome measure

42.9

Daily Activity cut-off for AM-PAC “6 clicks’’ outcome measure

39.4

Basic mobility categories in AM-PAC “6 clicks” outcome measure

• turning over in bed

• supine to sit

• bed to chair

• sit to stand

• walk around the room

• 3-5 steps with rail

scoring for AM-PAC “6 clicks” outcome measure

1 - unable (total assist)

2 - a lot (mod/max assist)

3 - a little (min assist/supervision)

4 - none (independent)

What does the DEMortons Mobility Index (DEMMI) assess?

Mobility and functional independence across multiple tasks in hospitalized patients

• mobility and function in older adults across clinical settings

  • assessing how well can they do these tasks vs just observing if they can do them

How many tasks are in the DEMMI?

15

• bed mobility

• chair activities

• static balance

• walking

• dynamic balance activities

How are DEMMI items scored?

0 = unable, 1 = partial, 2 = independent

What is the maximum DEMMI raw score?

19

What is the DEMMI converted score maximum?

100

What outcomes are associated with higher DEMMI scores?

Shorter hospital stay and discharge home

• hospital discharge in < 1 week

• pt is indicated to have greater independence and better mobility

gait speed (4 meter walk test)

• sixth vital sign

• predictive of various outcomes

• this measure evaluates and monitors functional capacity and general health status

• AD is permitted

• self-selected or habitual speed measured in meters per second

• ideal for people with hip and knee OA, RA, joint replacements

ICU Mobility Scale

• designed to quickly document the highest level of functional mobility for ICU patients

• consists of 11 items (0-10) on categorical scale

• a score is given on the highest level of mobility once per day

John Hopkins Highest Level of Mobility

• one of the ICU specific outcome measures

• assesses general patient mobility over a fixed period of observation

  • observing what patient did that day

• 1 item with 8 point ordinal response categories

• strong correlation with AM-PAC “6 clicks”

Chelsea Critical Care Physical Assessment Tool (CPAx)

• an ICU specific outcome measure

• a tool used in the ICU to measure functional recovery from critical illness

  • looks at whole function not just mobility

• 10 components, graded on 6-point scale (0-5 levels), total out of 50

  • respiratory function

  • cough

  • bed mobility

  • supine to sit

  • dynamic sitting

  • sit to stand

  • standing balance

  • transfer to chair

  • stepping

  • grip strength

A CPAx score of ≥18/50 at discharge has a sensitivity of 80% and specificity of 70% in predicting…

a return to home within 90 days

What does the FSS-ICU measure?

Functional mobility tasks in ICU patients (bed mobility → ambulation)

• higher the score = greater functional independence

What tasks are included in FSS-ICU?

Rolling, supine → sit, sitting EOB, sit → stand transfer, ambulation

What is the scoring range for each FSS-ICU task?

1–7 (1 = total assist, 7 = complete independence)

What is the total score range for FSS-ICU?

0–35

FSS-ICU is derived from which outcome measure?

Functional Independence Measure (FIM)

What FSS-ICU score is associated with discharge home?

≥ 27 within 24 hours prior to DC

If ≤2 tasks are not performed (not due to weakness but due to pt declining or pt’s equipment prevents performance), how is FSS-ICU scored?

Use the average of completed tasks

If >2 tasks are not performed (not due to weakness but due to pt declining or pt’s equipment prevents performance), what happens?

Total FSS-ICU score cannot be calculated

What does PFIT-s measure?

Strength, endurance, and functional performance in ICU patients

• outcome measure for critically ill patients in ICU who are at risk for developing functional mobility impairment, limited endurance, and/or muscle weakness

• Can be used to guide exercise prescription in the ICU setting and measure functional recovery

What are the 4 components of PFIT-s?

Sit-to-stand, marching in place cadence, shoulder flexor strength, knee extensor strength

How is sit-to-stand scored in PFIT-s?

0 = unable, 1 = assist x2, 2 = assist x1, 3 = no assist

How is cadence scored in PFIT-s?

0 = unable, 1 = >0 to 49, 2 = 50 to <80, 3 = 80+ steps/min

What does the Perme ICU Mobility Score measure?

Overall mobility status in ICU patients, including barriers, strength, and functional mobility

• measure mobility status of patients with decreased functional mobility frequently present during a critical illness

What is the total score range for the Perme ICU Mobility Score?

0–32

What does a higher Perme score indicate?

Fewer mobility barriers and decreased need for assistance

What makes the Perme ICU Mobility Score different from other ICU outcome measures?

It accounts for mobility barriers (ventilation, lines/tubes, pain, infusions)

What are the categories of the Perme ICU Mobility Score?

Mental status, mobility barriers, functional strength, bed mobility, transfers, gait, endurance

• begins with assessing ability to follow commands (mental status)

What is the highest-level mobility task assessed in Perme?

Distance walked in 2 minutes (endurance)

In the Perme score, how is strength assessed?

Ability to lift arms about 45 degrees with elbows straight and lift legs about 20 degrees with knee straight against gravity

What is included in the bed mobility section of Perme?

Supine → sit, and static sitting balance at edge of bed

What is included in the transfers section of Perme?

Sit to stand, static standing balance, and bed ↔ chair

Confusion Assessment Method for ICU (CAM-ICU)

• tool used in the ICU setting to monitor for the presence or absence of delirium

CAM-ICU delirium assessment diagnostic features

• Acute change or fluctuating course of mental status

• Inattention

• Altered levels of consciousness—assessed using the Richmond Agitation Sedation Scale (RASS)

• Disorganized thinking

What does RASS measure?

Level of agitation/sedation

What does a positive RASS score indicate?

Agitation

• +4 combative state

What does a negative RASS score indicate?

Sedation

At what RASS level do you STOP and not assess delirium?

-4 or -5

• deep sedation and unarousable

When can CAM-ICU be performed?

RASS ≥ -3

how is inattention tested on the CAM-ICU delirium assessment?

Squeeze hand when hearing letter “A”

How many errors = inattention positive?

≥2 errors

• move on to altered levels of consciousness portion of assessment (which is the RASS)

What does the 6MWT measure?

Exercise tolerance and endurance

What is the modified version of the 6MWT?

2-minute walk test

• used s/p cardiac surgery, s/p amputation, COPD

What populations commonly use the 6MWT?

Cardiac, pulmonary, knee OA

How long should the patient rest on chair before the 6MW test?

10 minutes

What vitals should be monitored during 6MWT?

HR, SpO₂, RR, RPE

• Every 2 minutes during and 2 minutes after

Which outcome measure uses the RPE scale?

6MWT

What is the MCID for the 6MWT?

54–70 meters

• If patient improves within that range → meaningful improvement

• If outside that range → may NOT reflect real functional change

• revalent for COPD, CHF, frail elderly populations

What does the 30-second chair stand test measure?

Strength and endurance

What population is the 30-second chair stand test commonly used for?

primarily adults >60 years old and hip OA

What is the Minimal detectable change (MDC) for the 30-second chair stand test in OA patients?

2.96 repetitions (~3 reps)

What does the 5xSTS test measure?

Strength, power, and functional mobility

What populations is 5xSTS used for?

Pulmonary, MS, arthritis, fractures, PD, stroke

• more neuro pop

What is the cutoff time for 5xSTS in Parkinson’s disease?

16 seconds

• >16 = impaired function

What does the short physical performance battery (SPPB) assess?

Lower extremity function in community-dwelling adults ages 65 and older

short physical performance battery (SPPB) is a strong predictor of ….

Disability, institutionalization, and mortality

What populations has short physical performance battery (SPPB) been validated in?

Cardiopulmonary, MS, dementia, frail individuals

What 3 components make up the Short Physical Performance Battery?

Balance, gait speed (4MWT), 5xSTS

What score indicates severe limitation in the short physical performance battery?

0–3

What score indicates moderate limitation in the short physical performance battery?

4-6

What score indicates mild limitation in the short physical performance battery?

7-9

What score indicates minimal limitation in the short physical performance battery?

10-12

TUG

• uses a timed score to assess gait and balance in elderly population

  • assess fall risk

• population: geriatric pop with various diagnosis

• time: 1-3 min to complete

• equipment: armchair, stopwatch, AD

• interrater reliability: ICC = 0.99

• validity: none reported

Less than 20 seconds on TUG =

pt is independent with functional mobility  

More than or equal to 13.5 seconds on TUG =   

increased fall risk for community ambulation

Patients who have undergone hip fracture surgery and discharged from acute care setting has a TUG score of…

More than or equal to 24 seconds

these patients are more likely to fall in the next 6 months compared to a patient with scores < 24 seconds

berg balance scale

• Assess level of function and balance in various population 

• population: good for the elderly patients who have sustained acute CVA and/or are in a rehab setting

• scoring for each task ranges from 0-4

  • 0 = unable to complete certain task (poor balance)

  • 4 = completely carries out task (good balance)

•   higher scores = greater independence and better ability to balance

• lower scores = greater fall risk

• has 14 item

What is the difference between the BBS and the short form BBS? 

• BBS = 14 items 

  • Scored 0-4 

• Sf-BBS = 7 items  

  • Scored 0,2,4 

short form BBS

• assess patients who have had a CVA; recently studied with hip and knee replacement and older adults

• includes 7 items and scoring levels are 0,2,4

what are the items on the short form BBS

1. Reaching with outstretched arm  

2. Standing Eyes Closed 

3. Standing one foot in front 

4. Turn and reach (turning to look behind)  

5. Pick something from ground 

6. Stand on one leg  

7. Sit to stand  

DGI

• assess fall risk in older adults

• Total points: 24  

• < 19 = fall risk for community ambulation  

What components are different at DGI vs FGA?

• Stairs  

• Eyes closed  

FIST

• Purpose: 

  • Assess sitting balance  

  • good one for SCI patients

  • 14 items on a 0 to 4 scale, max of 56

COVID Core OM

Cognition	Saint Louis University Mental Examination (SLUMS)
Health-Related Quality of Life	Promis Global-10
Muscle Strength and Power	Medical Research Council Sum Score
Functional Mobility	Short Physical Performance Battery
Endurance	2-min Step Test