setting specific

acute - AMPAC

Activity Measure Post Acute Care

6 clicks

multidimensional measures that use 6 questions to assess functional outcomes of patients in post-acute care settings

the AMPAC measures what?

difficulty, assistance, and limitations in ADLs

- the 6-clicks short form can be used quickly provide health care professionals with data to assist in predicting acute care discharge destinations

cut-off score for the AM-PAC

18

- <18 = dec functional ability so inc fall risk

- >18 inc functional ability so dec fall risk

sensitivity identifies

people with the disease

- i'm sensitive so I capture everything

if a test is sensitive and someone scores negative, what does this mean?

they most likely don't have the disease

specificity identifies

people without the disease

- I only care for some

- goes right for what I need

if a test is specific and someone scores positive, what does this mean?

you are pretty sure they have the disease

SPIN

a test with high specificity has few false positives

- SPecific test + Positive result = rule IN disease

- ex: cancer screen (if + cancer is likely present)

SNOUT

a test with high sensitivity has few false negatives

- Sensitive + Negative = rule OUT disease

- ex: covid test

a highly sensitive test is best used for what?

screening

a highly specific test is best used for what?

confirming/diagnosing

the MDC for the AM-PAC depends on what variables?

- population

- type of mobility/activity

what is the SEM for the AM-PAC

approx 3

MDC for AM-PAC

4-8pts

cutoff scores vary based on what?

- what the outcome is for the cutoff score

- can change your sensitivity and specificity

cutoff score for basic mobility on the AM-PAC

43.7

cutoff score for daily activity on the AM-PAC

38.9

AM-PAC cutoff scores

- sensitive for risk of falls

- specific for D/C home

John Hopkins ICU scale

8 point ordinal scale used to quantify patient's observed mobility

- range from bed level, sitting at the edge of bed, out of the bed to a chair, to standing and amb activities

John Hopkins ICU scale is used to provide what?

a simple language tool used to standardize the description of achieved patient mobility across inter-professional providers

how AMP-AC scores relate to JH-HLM scores and activity

- 1 (lay in bed)

- AMPAC 6-7 = 2 (bed activities/ dependent transfer)

- AMPAC 8-9 = 3 (sit at edge of bed)

- AMPAC 10-15 = 4 (move to chair/commode)

- AMPAC 16-17 = 5 (stand 1 or more minutes)

- AMPAC 18-21 = 6 (walk 10 steps or more)

- AMPAC 22-23 = 7 (walk 25 feet or more)

- AMPAC 24 = 8 (walk 250 feet or more)

JH-HLM mobility scale scores 6-8 may use what?

- canes

- crutches

- walkers

- sit to stand lift device with ambulation option

JH-HLM mobility scale scores 4-5 may use what?

stand pivot devices

JH-HLM scoring

based on the observed performance of the specific mobility activity

- based on cumulative performance during a session

- patient must perform the activity for score to count

what is not taken into consideration when scoring the JH-HLM?

level of assistance required, number of people assisting and/or use of AD

- except for score 2

JH-HLM reliability

- excellent test-restest reliability when used by PTs and nurses (0.94 for PTs, and 0.95 for nurses)

- excellent interrater reliability (ICC = 0.99)

MDC for JH-HLM

0.6

SEM for JH-HLM

0.2

if a patient's AM-PAC score is 24, what is their JH-HLM score and level of mobility?

score of 8; walk 250ft or more

if a patient's AM-PAC score is 19, what is their JH-HLM score and level of mobility?

score of 6; walk 10 steps or more

if a patient's AM-PAC score is 13, what is their JH-HLM score and level of mobility?

score of 4; move to chair/commode

if a patient's AM-PAC score is 6, what is their JH-HLM score and level of mobility?

score of 2; bed activities and dependent transfers

the JH-HLM has good validity to what?

AM-PAC

AM-PAC helps to give what?

cutoff scores

FIM

basic indicator of severity of disability

- measures type and amount of assistance required for a person with a disability to perform basic life activities effectively

- widely used to measure outcomes of rehab

WeeFIM

pediatric version of the FIM

- similar to adult FIM but differs in scoring process

- takes into account the child's developmental stages

FIM scoring

scored on a scale of 1-7 at admission to rehab, D/C from rehab, and one follow-up visit (likely in OP)

- motor sub scale

- cognitive sub scale

FIM - motor

- self care (eating, grooming, bathing, dressing UE/LE, toileting)

- sphincter control (bowel/bladder management)

- transfer (bed/chair/wheelchair, toilet, tub/shower)

- locomotion (walk/wheelchair, stairs)

FIM - cognitive

- comprehension

- expression

- social interaction

- problem solving

- memory

age for WeeFIM and FIM

- WeeFIM = 3-8yrs

- WeeFIM or FIM = 8-18

WeeFIM and FIM can compare functional outcome across certain diagnoses such as

- traumatic brain injury (TBI)

- geriatrics

- multiple sclerosis (MS)

- orthopedic conditions (including LBP)

- spinal cord injury (SCI)

- stroke

**different cutoff scores based on diagnosis

how long does the FIM take to complete?

30-45 mins

reliability of the FIM

- motor test-retest (ICC = .90)

- cognitive test-retest (ICC = .80)

predictivity for FIM

admission score for neurologic and stroke diagnosis was predictive of discharge

- **test is used to predict d/c

FIM validity

correlation between the FIM and other tests such as

- walking index for SCI (WISCI)

- berg balance scale

- LFIM and WISCI (highest r=.88-.92)

- LFIM and berg balance (high r=.86-.89)

- LFIM and 50ft walk test

FIM responsiveness

internal consistency .93 admission; .95 discharge

outpatient scales

ex: knee scale questionnaire

- looks for pt's biggest issue to direct your tests and measures and treatment

how long does it take to complete a knee scale questionnaire in an OP setting?

10 mins

good vs excellent test-retest reliability

- good test-retest reliability (ICC >0.70)

- excellent test-retest reliability (ICC >.80)

MDC specific to diagnosis for a knee outcome measure questionnaire

- pain = 6.1

- symptoms = 8.5

- ADL = 8.0

- sport/rec. = 5.8

- QoL = 7.2

SEM specific to diagnosis for knee outcome measure questionnaire

- pain = 2.2

- symptoms = 3.1

- ADL = 2.9

- sport/rec. = 2.1

- QoL = 2.6

an outcome measure such as a knee questionnaire directs what?

your POC

the AM-PAC directs what?

the John Hopkins mobility scale

- JH-HLM gives info on how to direct other staff

- give a goal on how you want the patient to move

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