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402 S. Gordon et al. Table II. Relevant hospital-acquired deconditioning (HAD) assessment items, and the body systems they address, from included instruments TUG PPT NSIC SPPB MNA DEMMI AM-PAC ”6 clicks” Measurement period Muscle strength Aerobic capacity/fitness/respiratory function Vasomotor stability/balance Anthropometrics Skin integrity Mobility Activities of daily activities P-i-T    P-i-T  Recent P-i-T    P-i-T P-i-T    P-i-T   Walking distance Gait speed Appetite Incontinence Total            (implied)       5 4 4 1 1 4 4 4 3  (implied)   Totals  0 6 6 2 7 5 3 4 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). gait speed (3 instruments) and appetite (2 instruments). No HAD element was measured in the same way across instruments. Table III reports a compilation of specific assessment items extracted from included instruments, which relate to the body systems performance measures outlined in Table II. For all but incontinence, the in- cluded screening instruments provide at least 1 way of measuring each element (see shading in the table). The HAD assessment items include standing and functional balance, functional mobility (in bed, and ambulatory), anthropometrics, skin integrity, a range of practical activities of daily living across instruments, circumferential limb measurements (arm and/or calf), appetite and incontinence. DISCUSSION As hypothesized, this study of the evidence found no single instrument that contained a comprehensive list of assessment items to detect incipient HAD during an acute hospital admission. The 7 relevant assessment instruments provided a variety of ways in which P-i-T, or assessments in the past few days, of the performance of different body systems could be undertaken. Whilst the application of all instruments identified in this review might provide a comprehensive assessment of incipient HAD, this would be inefficient, and unneces- sary. Not only would there be significant repetition of measurement, and duplication of effort, but there would be interpretation challenges related to correla- ting the different assessment approaches taken for the same HAD element in different instruments (see Table SII 1 ). Our research suggests that the current clinical as- sessment gap could be filled by a new comprehensive assessment instrument, based on the items identified from this search. Any new assessment instrument for HAD requires psychometric and utility testing. Even though the sug- gested assessment items come from instruments with moderate-good validity and utility, a new assessment battery needs to re-establish validity (particularly construct and content validity, item redundancy and sensitivity). A scoring rubric is essential so that Table III. Collated assessment measures of items relevant to incipient hospital-acquired deconditioning (HAD) TUG NSIC SPPB Rises from chair/turning &/or sitting down again Walking distance Pressure sores or skin ulcers Mid arm circumference Calf circumference Climbing a flight of stairs Picking up something from the floor Walking backwards Jumping Standing balance Bed mobility Activities of daily living Appetite Continence 6 m 2.44 m MNA DEMMI AM-PAC 6 Clicks Additional item 5, 10, 20 or 50 m Hospital room Assessment could be sourced from other instruments 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). The tools which provide an option to measure the HAD assessment item are shaded. www.medicaljournals.se/jrm