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Introduction Hip fractures are common, with over 300,000 occurring each year in the United States (1) and 75,000 in the United Kingdom (2) and a rising incidence globally. They reduce [...], Objective. Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. Methods. Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. Results. Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness overtime (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. Conclusion. Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. Impact. This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes. Keywords: Hip Fractures, Mobility, Outcome Assessment (Health Care)

Introduction Traumatic injury is a significant global public health problem, responsible for 9% of the world's total deaths annually and 6% of years lived with temporary or permanent disability. (1) [...], Objective. The longer-term impact of injury is increasingly recognized, but the early phases of recovery are less well understood. The best tools to measure early recovery of mobility and physical function following traumatic injury are unclear. The purpose of this study was to assess the clinical utility, validity, reliability, and responsiveness of 4 mobility and physical function measures in patients following traumatic injury. Methods. In this cohort, measurement-focused study (n =100), the modified Iowa Level of Assistance Score, Acute Care Index of Function, Activity Measure for Post-Acute Care "6 Clicks" short forms, and Functional Independence Measure were completed during first and last physical therapy sessions. Clinical utility and floor and ceiling effects were documented. Known-groups validity (early vs late in admission and by discharge destination), predictive validity (using 6-month postinjury outcomes data), and responsiveness were established. Interrater reliability was assessed in 30 patients with stable mobility and function. Results. Participants had a median age of 52 years (interquartile range = 33-68 years), and 68% were male. The modified Iowa Level of Assistance Score, Acute Care Index of Function, and "6 Clicks" short forms were quick to administer (an extra median time of 30 seconds-1 minute), but the Functional Independence Measure took much longer (extra median time of 5 minutes). At the last physical therapy session, ceiling effects were present for all measures except the Functional Independence Measure (18%-33% of participants). All had strong known-groups validity (early vs late in admission and by discharge destination). All were responsive (effect sizes >1.0) and had excellent interrater reliability (intraclass correlation coefficients =0.79-0.94). Conclusion. All 4 measures were reliable, valid, and responsive; however, their clinical utility varied, and ceiling effects were common at physical therapy discharge. Impact. This study is an important step toward evidence-based measurement in acute trauma physical therapy care. It provides critical information to guide assessment of mobility and physical function in acute trauma physical therapy, which may facilitate benchmarking across different hospitals and trauma centers and further progress the science and practice of physical therapy following traumatic injury. Keywords: Acute care, Mobility, Outcome Assessment (Health Care), Physical Therapists, Wounds and Injuries

Outcome measures are integral to assessing the effectiveness of treatments, with the aim of improving patient and hospital outcomes. (1) Physical therapists are continually striving for excellence in patient care, [...], Background. Functional outcome measurement tools exist for individual diagnoses (eg, stroke), but no prospectively validated mobility measure is available for physical therapists' use across the breadth of acute hospital inpatients. The modified Iowa Level of Assistance Scale (mILOA), a scale measuring assistance required to achieve functional tasks, has demonstrated functional change in inpatients with orthopedic conditions and trauma, although its psychometric properties are unknown. Objective. The aim of this study was to assess interrater reliability, known-groups validity, and responsiveness of the mILOA in acute hospital inpatients. Design. This was a cohort, measurement-focused study. Methods. Patients at a large teaching hospital in Melbourne, Australia, were recruited. One hundred fifty-two inpatients who were functionally stable across 5 clinical groups had an mILOA score calculated during 2 independent physical therapy sessions to assess interrater reliability. Known-groups validity ('ready for discharge'/'not ready for discharge') and responsiveness also were assessed. Results. The mean age of participants in the reliability phase of the study was 62.5 years (SD=17.7). The interrater reliability was excellent (intraclass correlation coefficient [2,1] =.975; 95% confidence interval =.965,.982), with a mean difference between scores of -.270 and limits of agreement of ± 5.64. The mILOA score displayed a mean difference between 2 known groups of 15.3 points. Responsiveness was demonstrated with a minimal detectable change of 5.8 points. Limitations. Participants were included in the study if able to give consent for themselves, thereby limiting generalizability. Construct validity was not assessed due to the lack of a gold standard. Conclusions. The mILOA has excellent interrater reliability and good known-groups validity and responsiveness to functional change across acute hospital inpatients with a variety of diagnoses. It may provide opportunities for physical therapists to collect a functional outcome measure to demonstrate the effectiveness of inpatient therapy and allow for benchmarking across institutions.

A Simple Discharge Planning Tool Following Hospital Admission for an Isolated Lower Limb Fracture Early determination of which patients require inpatient rehabilitation and who may go directly home following an [...], Background. Early, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures. Objective. The aims of this study were: (1) to prospectively validatate the TRaPT, (2) to assess whether its performance could be improved by adding additional demographic data, and (3) to simplify it for use as a bedside tool. Design. This was a cohort, measurement-focused study. Methods. Patients with isolated lower limb fractures (N=114) who were admitted to a major trauma center in Melbourne, Australia, were included. The participants' TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight-bearing status, and home supports, was assessed using measures of discrimination and calibration. A simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into 8 categories. Simplified TRaPT performance measures, including specificity, sensitivity, and positive and negative predictive values, were evaluated. Results. Prospective validation of the TRaPT showed excellent discrimination (C-statistic=0.90 [95% confidence interval=0.82, 0.97]), a sensitivity of 80%, and specificity of 94%. All participants able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%. Limitations. Generalizability may be limited given the compensation system that exists in Australia, but the methods used will assist in designing a similar tool in any population. Conclusions. The TRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool.