Journal of Rehabilitation Medicine 51-11 | Page 61

J Rehabil Med 2019; 51: 875–878
LETTER TO THE EDITOR
SELECTING THE BEST MEASURE FOR HOSPITAL-ACQUIRED DECONDITIONING
We note with interest the recent systematic review by
Gordon et al. (1) regarding assessment instruments
to evaluate hospital-acquired deconditioning (HAD).
Precipitated by immobility and inactivity during hos-
pitalization, HAD is associated with poor outcomes,
such as decreased quality of life and reduced survival
(2). Early, accurate, and routine assessment of patients’
functioning could facilitate timely identification and
treatment of patients at risk for HAD. In this light, the
systematic review by Gordon et al. is welcome and
needed to guide this area of clinical practice.
Their methodology for identification of publications
about measurement instruments was theoretically dri-
ven and clear. They then used the International Center
for Allied Health Evidence (iCAHE) Ready Reckoner
(3) to evaluate the psychometric properties and clinical
utility of the 7 assessment instruments identified through
their search. Given this excellent methodology, we were
surprised to note that publications that establish the psy-
chometric properties and clinical utility of some of the
assessment instruments were not included. After closely
examining and repeating some of their search, inclusion
and exclusion criteria, it appears that the exclusion cri-
terion “did not describe the assessment instrument” may
have eliminated several key papers. Possibly as a con-
sequence of this criterion, but not explicitly stated, only
one published manuscript for each of the instruments was
included. While an understandable exclusion to focus on
foundational publications, authors will regularly describe
an instrument and report some psychometric testing in an
initial publication and then reference that detailed instru-
ment description in subsequent papers that report other
psychometric attributes without repeating the description.
We consider that this led to iCAHE Ready Reckoner
scores being artificially low for some instruments.
For example, the article included for the Activity
Measure for Post-Acute Care (AM-PAC) was only
about its validity and so it was scored as zero (0) in all
the reliability categories (i.e. inter-tester, intra-tester,
test-retest, and internal consistency). This may have
been due to published studies on AM-PAC reliability
that do not contain a detailed description of the instru-
ment being excluded (4). In addition, cut-off scores and
normative values for AM-PAC were scored as zero (0),
possibly due to these values being in yet other exclu-
ded publications (5). Omissions such as these led the
authors to conclude that 5 of the included instruments
had not been tested for reliability. The purpose of our
effort here is to provide readers with the references
that include all published psychometric attributes
of the included instruments and update the iCAHE
Ready Reckoner with these modifications (Table I).
Table I. International Center for Allied Health Evidence (iCAHE) Ready Reckoner Checklist
TUG (7, 8) PPT NSIC (9, 10)
Validity
Face
Content
Construct
Comparison
Sensitivity
Factors
Reliability
1
1
1 1
1
1
1
1 1
1
1 a
1
1
1
SPPB (11, 12) MNA (13–17) DEMMI (18) AM-PAC ”6-clicks” (4, 5, 19–23)
1 a
1 1
1
1 1
0
1 1
1
1
1
1 1
1 1
1
0 1 1 1 a 1
1 a
1 1 0 1 a 1 a 1
Intra-tester 1 0 1 0 1
Test-retest 1 0 0 1 a 0 1 1 0 1
14
1
1
< 10 1
7
1
1
10 1 0 1
1
1
1
18
95
17
89 1
1
1
1
14
74
14
74
Norms
Cut-off scores
Appropriate to Australia
No cost
No registration/limitations
Total (proposed new score)
%Total (new score)
Total (according to Gordon et al.)
%Total (according to Gordon et al.)
1
10
1
1
5–7
1
1 a
1
1
1
15
79
13
68
1 a
1
1 a Inter-tester
Internal consistency
Clinical utility
< 20 items
Number of items
Manual scoring
< 15 min admin time
Estimated time, min
1
1
1
1 a
1 a 1 1 1 1 1 a
1
5
1
1
15 1
18
1
1
15 1
15
1
1
5–9 1
6
1
1
1 1
1
1
1
1
17
89
15
79
1 a
1
1
1
16
84
12
63
0
0
1
1
1
16
84
15
79
1 a
5
1 a
1 a
1
1
1
18
95
11
58
a
Denotes items that were modified in this version.
TUG: Timed Up and Go Test; PPT: Physical Performance Test; NSIC: Nutrition Screening Initiative Checklist; SPPB: Short Physical Performance Battery; MNA: Mini
Nutritional Assessment; DEMMI: de Morton Mobility Index; AM-PAC 6 Clicks: Activity Measure for Post-Acute Care (AM-PAC ’6 Clicks’).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2020 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2617