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.
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