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 876 www.medicaljournals.se/jrm 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.