Journal of Rehabilitation Medicine 51-6 | Page 3

J Rehabil Med 2019; 51: 397–404 REVIEW ARTICLE ASSESSMENT FOR INCIPIENT HOSPITAL-ACQUIRED DECONDITIONING IN ACUTE HOSPITAL SETTINGS: A SYSTEMATIC LITERATURE REVIEW Susan GORDON, PhD 1 , Karen A. GRIMMER, PhD 1,2 and Sarah BARRAS, PhD 3 From the 1 College of Nursing and Health Sciences, Flinders University, South Australia, 2 Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University and 3 Australian Health Services Alliance, Melbourne, Victoria, Australia Objectives: To systematically identify literature re- porting on assessment instruments relevant for inci- pient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. Study selection: Papers reporting psychometric pro- perties of assessment instruments to detect change in body function and structure, relevant to hospital- acquired deconditioning were selected. Included in- struments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric pro- perties and utility were assessed using a validated instrument. Data extraction: Hospital-acquired deconditioning assessment items. Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthro­ pometrics, gait, balance, mobility, activities of daily living, and skin integrity. Conclusion: These assessment items provide the ba- sis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospi- tal inpatient function for incipient hospital-acquired deconditioning. Key words: hospital-acquired deconditioning; HAD; assess- ment; inter-professional practice; quality care; discharge planning; functional decline; frailty; systematic evidence scan; psychometric properties; utility; older people; acute hospital admission. Accepted Feb 26, 2019; Epub ahead of print Mar 15, 2019 J Rehabil Med 2019; 51: 397–404 Correspondence address: Sue Gordon, Chair of Restorative Care in Ageing, A partnership position funded by ACH group and Flinders Uni- versity, College of Nursing & Health Sciences, Clinical Teaching and Education Centre at ViTA, 17 Rockville Avenue, Daw Park, South Aus- tralia 5041, Australia. E-mail: [email protected] LAY ABSTRACT Hospital-acquired deconditioning can occur insidiously and rapidly as a result of enforced bed rest, immobiliza- tion or sedentary behaviours. While hospital-acquired deconditioning can occur in people of any age, it is par- ticularly problematic in elderly people, as it can lead to irreversible functional decline. Hospital-acquired decon- ditioning is preventable with proactive, comprehensive regular assessment to detect changes in the perfor- mance of body systems. The time-period of assessment must be short, so that repeated assessments can be made during an acute hospital admission. At present there is no comprehensive, time-sensitive assessment instrument for hospital-acquired deconditioning. Ba- sed on a systematic scan of the literature, this paper proposes a core set of items that could be developed into a comprehensive, standardized assessment instru- ment for regular application by any healthcare provi- der during an acute inpatient stay, to identify incipient hospital-acquired deconditioning. The assessment items measured anthropometrics, gait, balance, mobility, acti- vities of daily living, and skin integrity. D econditioning is “a complex process of physio- logical change following a period of inactivity, bedrest or sedentary lifestyle” (1, p. 16). Older people are particularly at risk (1–5), as deconditioning in this age group can quickly progress to irreversible functio- nal deterioration and frailty (3, 4, 6, 7), decreased life expectancy and quality of life. Hospital-acquired deconditioning (HAD) can occur within days for adults of any age, during acute hospital admissions involving enforced bed rest, immobiliza- tion and/or sedentary behaviours (2–4, 7). There is no standard definition of HAD, and no agreement on common HAD elements, or assessment practices (1–4, 8–10). HAD changes can be insidious, and if undetected, can delay safe discharge from hospital and/ or require additional recuperative care (5–7, 9). It is counterintuitive that HAD should occur in healthcare settings, where it could be reasonably expected that health should improve, not decline (2, 4, 12). How­ ever, HAD is a reality in many countries (2, 4, 12). It is coded as M62.81 (generalized muscle weakness) in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), a system used by healthcare providers to code diagnoses, symptoms and procedures related to hospital care (8). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2546