Comprehensive assessment for hospital-acquired deconditioning in acute hospitals
during static and dynamic balance with no gait aid, and
walking. Items are scored on a 3-point scale (“unable”,
“able” and “independent”). Scores are scaled to 100,
with higher scores indicating better mobility levels.
Activity Measure for Post-Acute Care (AM-PAC) “6
Clicks” instrument (32). This was developed specifi-
cally for hospitalized elderly people. All questions are
measured point-in-time. Three questions are about
perceived difficulty “turning in bed”, “sitting down and
standing up from a chair”, and “moving from lying to
sitting on the side of the bed”. The questions ask about
help required from others to “move from bed to chair”,
“walk in the hospital room” and “climb 3–5 steps with a
railing”. Four level responses (scored 1–4) are applied
to each item (“unable”, “a lot”, “a little” and “none”),
with higher scores indicating fewer problems.
Hierarchy of evidence
All included papers described diagnostic studies
(National Health and Medical Reserach Council
(NHMRC) Level II) (22).
Measurement period. The COOP/WONCA instrument
requires a 4-week reflection period, and thus was exclu-
ded from further consideration (27). The MNA items
with 3-month reflection periods (30) were also exclu-
ded. In addition, the reflective interview questions, and
some objective measures in the NSIC (28) and SPPB
(29) were excluded because they, like the COOP/
WONCA and reflective MNA questions, were more
appropriate for comprehensive screening, at hospital
admission, of general health status, or current frailty
state, rather than detection throughout the hospital stay
of altered performance of body systems, which could
indicate incipient HAD (1–4). The excluded MNA
items comprised usual food intake, recent weight
loss and psychological stress or acute disease within
the past 3 months, and the excluded NSIC and SPPB
items comprised usual dietary habits; usual alcohol
intake; tooth or mouth problems; isolation; literacy;
polypharmacy; body mass index (BMI); finances; and
self-perceived health status. BMI lacks sensitivity to
detect meaningful change over short time-periods, such
as an acute hospital admission (33, 34).
Psychometric and utility properties. Table I reports
the psychometric and utility properties of the included
assessment instruments. Despite excluding items from
MNA, NSIC and SPPB, the psychometric properties of
these instruments were reported, because some items
remained relevant to the purpose of this research. All
included instruments demonstrated moderate to good
evidence of validity and clinical utility, but only 2
401
scored well for reliability testing (TUG (25), DEMMI
(31)). Four of the instruments reported population
norms (25, 28–30). Of the possible total score of 19,
the highest scoring instrument was TUG (25) (84%),
followed by SPPB (26) and DEMMI (31) (79%), then
NSIC (28) and PPT (26) (68%), then MNA (30) (63%)
and, finally, AM-PAC “6-Clicks” (31) (58%).
Table SII 1 reports the 53 items related to any aspect
of body systems’ performance that was assessed in at
least 1 of the included instruments, compared with
the Creditor list (12). This table highlights that no
instrument assessed urinary incontinence or osteo-
porosis. Considering the measurement time-periods,
any change in osteoporosis state will take longer to
occur than during an acute hospital admission, and
therefore it is rejected on time-frame. Urinary incon-
tinence should, however, be considered for inclusion
in a composite HAD instrument, as change can occur
in this element within days (35).
Compilation of items. Table II reports instruments,
item measurement time-frames, the body systems
performance measured by each assessment item, and
the assessment items. Muscle strength was the most
commonly-measured HAD element (5 instruments);
followed by mobility, balance, fitness, activities of
daily living and walking distance (4 instruments), then
Table I. Ready reckoner
AM-PAC
TUG PPT NSIC SPPB MNA DEMMI 6 Clicks
Validity
Face
Content
Construct
Comparison
Sensitivity
Factors
Reliability
Inter-tester
Intra-tester
Test-retest
Internal consistency
Clinical utility
< 20 items
Number of items
Manual scoring
< 15 min admin time
Estimated time (min)
Norms
Cut-off scores
appropriate to Australia
No cost
No registration/limitations
Total
% Total
1 1 1 1 1 1 1
1
1
1
1
0 1
1
1
1
0 1
1
0
1
1 1
1
1
1
1 0
1
1
1
0 1
1
1
1
0 1
1
0
1
1
1
1
1
1 1
0
0
1 0
1
0
0 0
0
0
1 0
0
0
1 1
1
1
1 0
0
0
0
1
14
1
1
< 10
1
1
1
1
1
17
89 1
7
1
1
10
0
1
1
1
1
14
74 1
10
1
1
5–7
1
0
1
1
1
13
68 1
5
1
1
15
1
1
1
1
1
15
79 1
18
1
1
15
1
0
1
1
1
12
63 1
15
1
1
5–9
0
0
1
1
1
15
79 1
6
1
1
5
0
0
1
1
1
11
58
TUG: Timed Up and Go Test (25); PPT: Physical Performance Test (26); NSIC:
Nutrition Screening Initiative Checklist (28); SPPB: Short Physical Performance
Battery (29); MNA: Mini Nutritional Assessment (30); DEMMI: de Morton
Mobility Index (31); AM-PAC 6 Clicks: Activity Measure for Post-Acute Care
(AM-PAC ‘6 Clicks’) (32).
J Rehabil Med 51, 2019