Comparison of two outcome measures to detect changes in physical function for patients after open abdominal surgery
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Date
2020
Authors
Fourie, Marelee
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Abstract
Background: There is limited evidence regarding responsive physiotherapy-related outcome measures to assess patients’ physical function recovery after open abdominal surgery in intensive care unit (ICU) settings. The Physical Function in Intensive Care Test-scored (PFIT-s) assesses physical function (strength, endurance, exercise capacity). The Chelsea Critical Care Physical Assessment (CPAx) assesses respiratory function and physical function. Objectives: To measure and compare the responsiveness to changes in physical function scores; minimal clinically important difference (MCID) in physical function scores; floor and ceiling effects of scores; and, the level of convergent validity for CPAx and PFIT-s scores for patients after open abdominal surgery. Design: A prospective observational longitudinal cohort study. Methods: Participants were recruited from the Wits Donald Gordon Medical Centre surgical-and transplant ICUs. Participants’ physical function was assessed on days one, three and five postoperatively and ICU discharge using the CPAx and PFIT-s (in random order) from August 2019-November 2019. Descriptive and inferential statistics were used for data analysis. Results: Sixty-nine participants (mean age 54 (±15.5)) underwent open abdominal surgery. Majority were female (n=43, 62.3%). Effect size index (ESI) for CPAx=0.910 indicating large responsiveness to change. The ESI for PFIT-s=0.712 indicating moderate responsiveness to change. The MCID for CPAx=4.4 and PFIT-s=0.8. The CPAx tool had a limited floor and ceiling effect on ICU admission (floor effect: 0.00%, ceiling effect: 0.00%) and discharge (floor effect: 0.01%, ceiling effect: 7.25%). The PFIT-s had a significant ceiling effect (46.38%) on ICU discharge. CPAX and PFIT-s ICU admission scores and ICU discharge scores showed moderate convergent validity (r=0.60 n=69 p=0.00, and r=0.51 n=68 p=0.00 respectively). Conclusion: Both the CPAx and PFIT-s are valid for assessing physical function in postoperative patients. The CPAx is more responsive to detect an improvement in physical function in this cohort recovering from open abdominal surgery. It has a clinically significant MCID with limited floor and ceiling effects
Description
A dissertation report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Physiotherapy, 2020