Journal of Rehabilitation Medicine 51-11 | Page 62
Letters to the Editor
Table II. Summary of recommended measures by domains
Recommended
instrument
instruments (Gordon et al.) Updated
recommendation
18
11 – – –
1
1
1
1
5
4
4
1
1
5
4
4
3
2
0 TUG
TUG
TUG
MNA
SPPB
TUG
PPT
TUG
TUG
NSIC
-- TUG & AM-PAC
TUG & AM-PAC
TUG
MNA
SPPB
TUG & AM-PAC
AM-PAC
TUG
TUG
MNA
--
Instruments
TUG
Total iCAHE score
Proposed new score
18
Gordon
17
Domains assessed
Muscle strength
1
Aerobic capacity/fitness/respiratory function 1
Vasomotor stability and/or balance
1
Anthropometrics
Skin integrity
Mobility
1
Activities of daily living
Walking distance
1
Gait speed
1
Appetite
Incontinence
Total
PPT NSIC SPPB MNA DEMMI AM-PAC ”6 clicks”
14
14 15
13 17
15 16
12 16
15 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
In line with the original review, we did not include
studies if their objective was to describe psychometric
properties for specific conditions or diseases or if the
psychometric testing occurred within an experimental
study. Also, we searched databases up to September
2019, which lead to the inclusion of articles that were
not published at the time of the search by Gordon et al.
Gordon et al. initially concluded that only 2 as-
sessment instruments scored well in reliability (i.e.
Time Up and Go (TUG) and the De Morton Mobility
Index (DEMMI)). We found that, in addition to those
instruments, the AM-PAC also has high reliability. In
terms of norms and cut-offs we found that the Nutri-
tion Screening Initiative Checklist (NSIC), the Mini
Nutritional Assessment (MNA) and the AM-PAC
also reported these parameters. After these additions,
the total iCAHE Ready Reckoner scores changed for
all measures except the Physical Performance Test
(PPT), which lead to 5 measures having scores above
16 (>80% of the items).
After making these changes to the iCAHE Ready
Reckoner scores, there are situations in which we come
to different conclusions and recommendations about
measuring HAD (Table II). For example, if clinicians
were interested in finding the best tool to measure
mobility and activities of daily living, they would con-
sider the PPT, the MNA or the AM-PAC. Based on the
results presented by Gordon et al., it would be intuitive
for clinicians to select the PPT, since it has a higher
score (i.e. better psychometric properties and clinical
utility). However, if clinicians use our score, then the
best option would be the AM-PAC, as it has 18/19 items
present; specifically, all components of reliability have
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been evaluated, and both norms and cut-off scores have
been published. Similarly, if clinicians were interested
in the appetite domain, they would consider the NSIC
or the MNA. In this case, clinicians might select the
NSIC, given that the only difference between measures
is that more validity constructs have been evaluated for
the NSIC compared with the MNA. After our updates,
it is apparent that the reliability of the MNA has been
evaluated more extensively than the NSIC; hence, it
may be more appropriate to select the MNA based on
psychometric properties.
Measurement instruments with sound psychometric
properties and clinical utility are particularly critical
during acute hospital admission when HAD is likely
to occur. In fact, HAD has been the focus of many
initiatives, but there is still large variability in mea-
sures, definitions, and categorizations (6). Hence, the
selection of tools that are valid, reliable, and of clinical
utility help to ensure quality in research studies, as well
as clinical care. We applaud the work of Gordon et
al. and recommend their findings for identification of
resources that can help measure a variety of domains
relevant to HAD. We also suggest that the additional
papers and revised iCAHE scores we provide on the
instruments be included so that the most comprehen-
sive assessment and selection can be made.
ACKNOWLEDGEMENTS
This research contribution was supported by the Foundation for
Physical Therapy’s Center of Excellence in Physical Therapy
Health Services and Health Policy Research and Training Grant.
The authors have no conflicts of interest to declare.