L5: Acute Outcome Measures

ACIF stands for ________

Acute Care Index of Function

AM-PAC stands for ________

Activity Measure for Post-Acute Care

FSS-ICU stands for ________

Functional Status Score in ICU

PFIT-S stands for ________

Physical Function in the ICU Test

FIST stands for ________

Function in Sitting Test

FTSS stands for ________

5x Sit to Stand Test

The Acute Care Index of Function is for what population(s)?

Developed in the Neurologic population and has been validated in LE Orthopedic Patients

What does the Acute Care Index of Function examine?

• Mental Status

• Bed Mobility

• Transfers

• Mobility (gait, stairs, AD, WC)

  • Unable, Dependent, or Independent

What do the scores of the Acute Care Index of Function been shown to assist with?

Scores have been shown to assist with appropriate discharge placement recommendations 

T/F: The Transfers and Mobility sections are weighted more in the score calculation of the Acute Care Index of Function

True

Considering the Acute Care Index of Function, what is a "good" score?

• Higher Score = Better

• Graded as a percentage (%)

Considering the Acute Care Index of Function, what is the scoring range of a patient with a wheelchair and without a wheelchair (in the mobility part of the test)

• Without a W/C: 0 - 70
  

• With a W/C: 0 - 100
  

What is being measured in the Activity Measure for Post-Acute Care (AM-PAC)?

• 6 basic mobility items are measured based on observation

• Assessing Bed Mobility: How much difficulty does the patient currently have...

  • Turning over in bed

  • Sitting down on and standing up from a chair with arms

  • Moving from lying on back in sitting on the side of bed

• Assessing Transfers/Gait: How much help from another person does the patient currently need...

  • Moving to and from a bed to a chair

  • Need to walk in hospital room

  • Climbing 3-5 steps with a railing

What is the raw scoring range of the Activity Measure for Post-Acute Care (AM-PAC)? What do these scores mean?

• Raw Scores: 6-24 

  • 6 = Lowest Functioning

  • 24 = Highest Functioning

• Raw scores can be converted into a standardized AM-PACTM score using a conversion table (which is used for determining % of impairments)

What is the Functional Status Score for ICU (FSS-ICU)?

• Based on FIM Scoring System, but modified to tasks that are appropriate for ICU

• Individual Scores of 0-7 for:

  • Rolling

  • Supine ⇄ Sit

  • Sitting Edge of Bed (EOB)

  • Sit ⇄ Stand

  • Ambulation

What is the maximum score of the Function Status Score for ICU (FSS-ICU)?

• Maximum Score of 35

• Higher = Better / More Independent

Discuss the 0-7 Scoring of the Functional Status Score for ICU (FSS-ICU)?

• 7 - Independent 

• 6 - Modified Independent

• 5 - Supervised

• 4 - SBA / Contact Guarge Assist / Min Assist

• 3 - Moderate Assist

• 2 - Maximum Assist

• 1 - Total Dependent

What does the Physical Function ICU Test-Score (PFIT-S) assess?

Assesses endurance, strength, CV capacity, and function in the ICU patient

What is the scoring system for the Physical Function ICU Test-Scored (PFIT-S)?

• Score = 0 - 12

  • 12 is indicative of higher function

  • 0 is lower function

• Score on a 0-3 Scale for the following four categories:

  • Shoulder Flexion Strength

  • Knee Extension Strength

  • Mobility Assist

  • Marching in Place

What does the Function in Sitting Test (FIST) examine?

• Examines deficits in sitting

  • Static and Dynamic

• Has 14 tasks including anticipatory and reactive balance items, scooting, and reaching

What population is the Function in Sitting Test (FIST) validated in?

Validated in Patients with CVA

What is the scoring key for the Function in Sitting Test (FIST)?

• Uses a specific scoring key (0-4) for each of the 14 tasks

• Total Score = 56

• A higher score (e.g., 56) is better

Discuss the set-up for the 5x Sit to Stand Test (FTSS).

• Patient sits in a straight-back chair that is 16 inches high

• Arms folded across the chest

• Instructions:

  • "Stand up and sit down as quickly as possible 5x, keeping your arms folded across your chest"

• Measurement:

  • Start timing when movement is initiated and stop timing when the participant stands for the 5th time

A 60-69 y/o patient has a higher fall risk when their FTSS score is greater than _______ seconds

11.4

A 70-79 y/o patient has a higher fall risk when their FTSS score is greater than ________ seconds

12.6

A 80-89 y/o patient has a higher fall risk when their FTSS score is greater than ________ seconds

14.8

How are the 6 MWT and the 2 MWT scored?

They are scored based on the amount of distance they can travel within that time frame (either 6 or 2 minutes); greater distance = better the patient is

How is the TUG Test scored? What is an abnormal score?

• Timed Up and Go Test, measure the time it takes for the patient to get up from a chair, walk 10 feet, turn, walk 10 feet back to chair, and then sit back down

• We want a lower time (as this is indicative of greater independence / functionality)

• An abnormal score > 13 seconds

What equipment is needed for the Acute Care Index of Function (ACIF)?

• Stairs

• Wheelchair

What is the purpose of the BERG Balance Scale? How is the score interpretted?

• Determines if patients are considered a fall risk

• A score of a 41 - 56 is needed to be considered a low fall risk

What equipment is needed for the BERG Balance Scale?

• Step

• Chair

• Ruler / Yardstick

• Timer

What equipment is needed for the 6 MWT and the 2 MWT?

• Timer

• Measuring Tape

What equipment is needed for the TUG Test?

• Chair (with arm rests)

• Measuring Tape

• Timer

The 5x Sit to Stand Test (FTSS) predicts the risk of ________

Falls

What equipment is needed for the Function in Sitting Test (FIST)?

• Timer

• Tape Measure

• Object

• Stool

What is the Tinetti Performance Oriented Mobility Assessment?

• Asseses the risk of falling

• Patient performs / is measured on

  • Sit ⇄ stand (with an armless chair)

  • Immediate standing balance with eyes closed

  • Standing with slight push / perturbation

  • Turning 360 degrees

  • Gait speed

  • Step height

  • Step symmetry

  • Step continuity

  • Stance during gait

  • Trunk Motion

• Scores <  19 indicate high fall risk 

• Scores 25-28 indicate low fall risk
  

What equipment is needed for the Tinetti Performance Oriented Mobility Assessment?

• Armless Chair

• Timer