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AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo improve the quality of physical function assessment through routine use of the Chelsea Critical Care Physical Assessment Tool (CPAx-D) in Danish ICUs.The methodological framework was “The Model for Improvement,” including the Plan-Do-Study-Act (PDSA) cycle. The context consisted of two ICUs at Aarhus University Hospital with 38 beds. Eligible patients were aged 18 years or older and considered stable and ready for physiotherapy treatment. Evaluation methods used were questionnaires, clinical practice observations, continuous feedback, status meetings, and an audit of the medical records including patients during a three-month period in the ICUs.The quality improvement process required three PDSA cycles and two years before CPAx-D was successfully implemented into clinical practice. The following barriers were identified; the COVID-19 pandemic increased workloads and caused reorganization of care; leave of absence of the project manager caused a lack of leadership; local instructions were not sufficiently aligned with practice; and detailed manuals were missing. A facilitator for implementation was the clinicians’ perception of CPAx-D as a meaningful tool, adding value to interdisciplinary collaboration and communication, and stimulated patient motivation.By employing various interventions, routine use of CPAx-D has been successfully implemented into clinical practice at two Danish ICUs.Early rehabilitation is crucial to reduce the physical consequences of intensive care admission.Routine use of standardized assessment instruments can support goal-setting, communication, and decision-making in rehabilitation of patients in the intensive care unit.This quality improvement study outlines the barriers and facilitators identified throughout the process of implementing routine use of the Chelsea Critical Care Physical Assessment Tool.Early rehabilitation is crucial to reduce the physical consequences of intensive care admission.Routine use of standardized assessment instruments can support goal-setting, communication, and decision-making in rehabilitation of patients in the intensive care unit.This quality improvement study outlines the barriers and facilitators identified throughout the process of implementing routine use of the Chelsea Critical Care Physical Assessment Tool. [ABSTRACT FROM AUTHOR]

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Introdução: As sequelas associadas a internamentos prolongados nas Unidades de Cuidados Intensivos (UCIs) têm um impacto negativo sobre a capacidade funcional e a qualidade de vida da pessoa. É crucial a utilização de um instrumento adequado, que permita medir/avaliar as limitações e a evolução da capacidade funcional da pessoa em situação crítica durante o seu internamento. Objetivos: Traduzir e validar para a li?ngua portuguesa a Chelsea Critical Care Physical Assessment (CPAx) (Corner et al., 2013, 2014). Metodologia: Estudo de traduc?a?o, adaptação cultural e análise psicométrica do instrumento Chelsea Crítical Care Physical Assessment (CPAx) para avaliac?a?o da capacidade funcional das pessoas em situação crítica internadas em UCIs portuguesas. Resultados/Discussão: A versão portuguesa da escala CPAx, apresentou excelente concordância e confiabilidade para os domínios avaliados (? > 0,8 e ? >0,9). Conclusão: A escala revelou boas propriedades psicométricas. Pelos valores obtidos, considera-se que a CPAx se encontra validada para a população portuguesa.

Background: Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. Method: CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. Results: The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983–0.994) and at "B" 0.994 (0.990–0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996–0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland–Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. Conclusion: CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway. [ABSTRACT FROM AUTHOR]

Measurement instruments are important in clinical practice and research for assessing physical function in critically ill patients in the intensive care unit (ICU). To investigate inter-rater reliability and responsiveness of the Danish version of the CPAx (CPAx-D). Critically ill patients from three Danish ICUs were included. Patients were assessed with CPAx-D by two blinded testers during a regular physiotherapy session. Follow-up tests were performed in patients who stayed in the ICU for more than 24 hours, were not transferred to another hospital or received palliative care. Floor and ceiling effects were examined in all assessments.Results For the reliability analysis 66 patients were included. Results Showed no significant difference between raters. For the total score, intra class correlation coefficient (ICC) was 0.996 (95% CI: 0.993; 0.997), standard error of measurement was 0.72 point and minimal detectable change 2.0 points. Bland-Altman plot revealed no heteroscedacity. The responsiveness results of 24 patients showed that the effect size was 1.2 and the standardized response mean 1.1, which was in accordance with the hypothesis. No ceiling or floor effect was revealed. The CPAx-D showed excellent inter-rater reliability and responsiveness. [ABSTRACT FROM AUTHOR]

Objectives: To measure and compare the clinimetric properties of the Chelsea Critical Care Physical Assessment (CPAx) and Physical Function in Intensive Care Test-scored (PFIT-s) for assessment of physical function and activity., Design: Prospective cohort design using crossover-randomisation of the sequence in which participants were assessed with CPAx and PFIT-s., Setting: Surgical and transplant intensive care units (ICU) in an academic hospital., Participants: Adults who underwent elective open abdominal surgery. Consecutive sampling was used to enrol 69 participants., Interventions: Physical function and activity were assessed on ICU days one, three, five and at ICU discharge using the CPAx and PFIT-s in random order., Main Outcome Measures: Responsiveness to change, minimal clinically important difference (MCID), floor and ceiling effect, and convergent validity., Results: CPAx demonstrated a large responsiveness (effect size index (ESI)= 0.83) and PFIT-s moderate responsiveness (ESI=0.73) to change in scores. MCID for CPAx was 2.1 (standard error of measurement (SEM) 1.1) and for PFIT-s 0.6 (SEM=0.3). CPAx had no floor effect and a small ceiling effect (9%, n = 6) at ICU discharge compared to 2% (n = 1) floor and 48% (n = 32) ceiling effects of PFIT-s. Moderate convergent validity was found for both tools at ICU admission (n = 67, r = 0.62, p < 0.001) and discharge (n = 67, r = 0.51, p < 0.001)., Conclusion: CPAx is most responsive to changes in physical function and activity scores, has no floor and limited ceiling effects and moderate convergent validity, and is recommended for similar cohorts. CONTRIBUTION OF THE PAPER., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives: To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans. Method: A single-centred pre–post quasi-experimental study was conducted. The population was a consecutive sample of surgical and trauma ICU patients. Participants’ functional ability was assessed with the CPAx tool on alternative days during their ICU stay, and rehabilitation goals were modified according to their CPAx score. Intensive care unit and hospital LOS data were collected and compared to data of a matched historical control group. Descriptive and inferential statistics were used. Results: A total of 26 ICU patients were included in the intervention group (n = 26). They received CPAx-guided therapy, and outcomes were matched with ICU patients in the historical control group (n = 26). The median sequential organ failure assessment (SOFA) score was significantly higher in the control group (p = 0.005) (3.5 [IQR 2–6.3]) versus (2 [IQR 1.8–2.5]) for the intervention group. The median admission CPAx score for the intervention group was 33.5 (IQR 16.1–44), and the median ICU discharge score was 38 (IQR 28.5–43.8). No significant differences were found in ICU days (control 2.7 [IQR 1.1–5.2]; intervention 3.7 [IQR 2.3–5.4]; p = 0.27) or hospital LOS (control 13.5 [IQR 9.3–18.3]; intervention 11.4 [IQR 8.4–20.3], p = 0.42). Chelsea critical care physical assessment scores on ICU admission had a moderate negative correlation with hospital LOS (r = −0.58, p = 0.00, n = 23). Chelsea critical care physical assessment scores at ICU discharge had strong positive correlation with discharge SOFA scores (r = 0.7; p = 0.025; n = 10). Conclusion: Problem-oriented patient rehabilitation informed by the CPAx tool resulted in improvement of physical function but did not reduce ICU or hospital LOS. Clinical implications: A higher level of physical function at ICU admission, measured with CPAx, was associated with shorter hospital LOS.