Comprehensive assessment for hospital-acquired deconditioning in acute hospitals
Study design
A systematic evidence scan was undertaken, guided by relevant
methods and reporting frameworks (16, 18, 19).
Inclusion criteria
Whilst the literature search targeted assessment instruments
designed for, or tested on, older people (considered to be most
at risk of HAD), instruments relevant to any acute hospital
inpatient 18 years or older were also considered (2, 4, 12, 15).
Literature was included if:
• it reported on the development, psychometric testing and/
or clinical utility of assessment instruments (12, 15, 19, 20)
that assessed the performance of any body system relevant
to adult HAD;
• the instrument was applicable to change in performance of
any body system occurring during acute hospital admissions
(1, 2, 8–10, 19);
• the instrument used P-i-T or recent (last 2–3 days), assessment
time-frames (9); and
• the instrument could feasibly be administered at least twice
during an acute hospital stay (5, 8, 9, 15, 19).
Search strategy
A Population (P) – Intervention (I) – Time (T) framework was
applied: P = any acute hospital inpatient but in particular, older
people; I = assessment instruments relevant to detecting any
element of incipient HAD; and T = time-period of acute hospital
admissions (i.e. instruments with items appropriate for repeated
short-term application). The expanded search terms and syntax
for each database are reported in Table SI 1 . Library databases
(MEDLINE, CINAHL, PubMed, PsychInfo and Google Scho-
lar) were searched from database inception until January 2018.
Exclusion criteria
Literature was excluded if it:
• reported on condition- or disease-specific assessments of
body systems performance (e.g. cancer, trauma, stroke and
other neurological conditions, chronic respiratory conditions
or cardiac conditions). These conditions have predictable
management pathways, specific diagnostic codes, condition-
specific assessment items and time-frames of measurement,
and predictable functional changes;
• described screening (one-off) measures not designed to detect
change (19, 20);
• did not describe the assessment instrument;
• included assessment items with lengthy reflective time-
periods (2, 4, 12, 15);
• did not provide information on psychometric properties or
utility;
• was unavailable in full text or English language;
• reported conference abstracts or posters, described protocols
or findings of experimental studies, or presented expert opi-
nion or position papers. Experimental studies were excluded
because it was anticipated that defensible assessment/out-
come measures applied in experimental studies would have
been chosen on their published psychometric properties.
These assessments would therefore be detected in our search.
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2546
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Moreover, whilst experimental studies may have provided
information on sensitivity and minimal clinical significant
change, this information would be generalizable only to the
study population.
Literature identification process
Potentially-relevant articles were considered collaboratively by
author-pairs (using title and abstract). They then collaboratively
assessed full texts of potentially-relevant papers against inclu-
sion and exclusion criteria. If more than one paper described
psychometric testing of an assessment instrument, the earliest
paper was included, and the number of subsequent psychometric
testing papers was recorded. Disagreements were arbitrated by
a third author.
Hierarchy
Study design was assigned using the Australian National Health
and Medical Research Council hierarchy (22).
Critical evaluation
Items with measurement time-periods longer than 2–3 days were
excluded, because they were not feasible for repeated adminis-
tration during an acute inpatient stay. To evaluate psychometric
properties and clinical utility, the validated iCAHE Ready
Reckoner was applied by author-pairs (17). The iCAHE Ready
Reckoner seeks evidence from the developmental literature that
an assessment instrument demonstrates quality elements, but
does not record the statistics:
• validity (face, content, comparison and construct validity,
sensitivity testing and factor analysis);
• reliability (inter- and intra-tester, test-retest and/or internal
consistency assessment); and
• clinical utility (reported as relevance, efficiency and appli-
cability):
• item wording and simplicity of instructions: a score of 1
indicated items relevant for minimum reading age (23);
• fewer than 20 items (scored as 1): shorter instruments
are more likely to attract accurate responses than longer
instruments (minimize response burden) (24). The number
of instrument items was recorded;
• level of calculation difficulty: this scored 1 if item scores
could be calculated manually (as opposed to complex
calculations);
• administration time: this scored 1 for assessments admi-
nistered in less than 15 min (24). This information was
either extracted from the literature, or established by the
researchers. The mean administration time was recorded;
• normative values or cut-off-scores: if available, these items
each scored 1;
• target relevance: scored as 1 if relevant to older Australi-
ans in unplanned admissions to acute hospital beds); and
• no cost; or formal registration requirements: these items
each scored 1.
The iCAHE Ready Reckoner does not apply a specific thres-
hold to detect instrument quality. Higher total scores indicate
better quality instruments.
Item collation
All items in the included assessment instruments were extracted,
the measurement purpose was identified, items were cross-
J Rehabil Med 51, 2019