Inter-rater Reliability and Responsiveness of Key Physical Functional Outcome Measures in ICU Survivors
CCCF ePoster library. Costigan F. Nov 9, 2018; 233400; 95
Dr. F. Aileen Costigan
Dr. F. Aileen Costigan
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Introduction/Background.  With more patients surviving ICU due to advances in critical care, an increased number are also at risk for physical function impairments that can last for up to 8 years after ICU discharge.  Effective interventions to maintain or improve physical function post-ICU are urgently needed.  In parallel, psychometrically rigorous measures to assess the effectiveness of these interventions are required. There is no consensus on the optimal instrument(s) to assess physical function in ICU survivors. Simple one-item measures of physical tasks typically incorporated into therapy sessions may be the most attractive candidates given their ease of use and limited need for training of assessors. It is imperative that we ensure that potential measures are adequately tested to document reliability and responsiveness.


Objectives. To train front-line clinicians to administer and to prospectively analyze the inter-rater reliability of 3 physical function measures in ICU survivors: Physical Function ICU Test-scored (PFIT-s), the 30 second sit-to-stand (30STS), and the two-minute walk test (2MWT).


Methods.  We conducted a two-centre, prospective observational study with adult medical-surgical ICU patients in Hamilton, Ontario. Inclusion criteria: Patients with an ICU length of stay of 3 days or greater, who were mechanically ventilated for at least 24 hours, and who were able to ambulate independently with or without a gait aid prior to hospital admission. Outcome measures were the 4-item PFIT-s (10 points), the 30STS (# of stands), and the 2MWT (distance in m). For each patient, 2 blinded assessments were collected weekly within 24 hours of each other from ICU discharge to hospital discharge.  We engaged multiple raters at each site; clinical schedules determined the rater for each assessment. We calculated inter-rater reliability using the intra-class correlation coefficient (ICC) for the total score for each measure using a 2-way random effects model.  We also calculated the standard error of the measurement (SEM), and the minimal detectable change at 90% confidence (MDC90). For continuous variables, we calculated the mean and standard deviation (SD) or median and interquartile range (IQR) if not normally distributed.


Results.  Each of 20 therapists across 2 sites participated in a 1.5 hour long training session. We enrolled 42 patients, and 40 had at least 1 measure collected. Our consent rate was 89%. Enrolled patients had a mean (SD) age of 62 (17) years, 53% were female, 73% medical admissions, and had a median (IQR) APACHE II score of 20 (14). Median (IQR) ICU and hospital length of stay were 7 (8) and 21 (33) days respectively.  For the PFIT-s, 36 patients had 66 paired scores; ICC was 0.78 (0.66, 0.86), SEM was 1.04, and MDC90 was 2.42. For the 30STS, 35 patients had 67 paired scores; ICC was 0.85 (0.75, 0.91), SEM was 1.89, and MDC90 was 4.42.  For the 2MWT, 35 patients had 58 paired scores; ICC was 0.79 (0.62, 0.88), SEM was 20.72, and MDC90 was 48.35.  


Conclusions. The PFIT-s, the 30STS, and the 2MWT, measured weekly across the hospital stay in ICU survivors, show good inter-rater reliability and require little additional assessor training as they consist of tasks that fit naturally into clinical practice. This study is an important step in addressing the need for a reliable, valid and practical core set of outcome measurements to monitor the continuum of patient recovery following an ICU stay. 


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