The Chelsea Critical Care Physical Assessment tool (CPAx) is increasingly recognized as a vital instrument for evaluating the physical function of adults in intensive care units (ICUs). This article delves into a prospective study that rigorously investigated the predictive validity of the CPAx, specifically at ICU discharge, in anticipating 90-day outcomes for critically ill adults. Understanding the effectiveness of tools like CPAx is crucial for optimizing patient care pathways and resource allocation in post-ICU recovery.
This clinimetric study was designed to test four pre-defined hypotheses centered on the CPAx’s ability to forecast patient outcomes. Adult participants, all critically ill and requiring mechanical ventilation for 72-144 hours, were enrolled in the research. The primary focus was to determine if the CPAx could accurately predict whether patients would be residing at home within 90 days post-ICU discharge. The study hypothesized a moderate accuracy level (AUROC = 0.750) for this prediction. Secondary hypotheses broadened the scope to examine the CPAx’s capacity to differentiate between various hospital discharge destinations, its correlation with subsequent health-related quality of life, and its relationship to the length of ICU stay.
The findings of the study revealed a robust accuracy (AUROC = 0.778) for the CPAx administered at ICU discharge in predicting the likelihood of patients returning home within 90 days. Furthermore, the research demonstrated a significant positive trend in CPAx scores across different discharge groups. Scores progressively increased from the “undesirable” discharge group, to the “rehabilitation” group, and were highest in the “home” discharge group (p < 0.05). Specifically, statistical analysis indicated significant correlations in both physical function (r = 0.261) and mental function (r = 0.193) as measured by CPAx and discharge destination. Interestingly, baseline CPAx scores, measured at the beginning of the study period, showed an expected negative correlation with the duration of ICU stay (r = -0.443), suggesting that initial physical function is related to the length of intensive care required.
In conclusion, the Chelsea Critical Care Physical Assessment tool (CPAx) demonstrates good predictive validity for projecting both residence at home within 90 days and general discharge destinations for critically ill adults discharged from the ICU. While the CPAx proves valuable in predicting these outcomes, the study suggests it may not be as effective in predicting subsequent health-related quality of life. These results underscore the clinical utility of CPAx in a predictive capacity, particularly in identifying patients’ rehabilitation needs and potential recovery trajectories. A noteworthy finding for clinical practice is that a CPAx score of ≥18 at critical care discharge exhibits a sensitivity of 80% and a specificity of 70% in predicting a return to home within 90 days. Consequently, the CPAx emerges as a potentially valuable tool for healthcare professionals to identify rehabilitation needs, guide decisions regarding patient recovery pathways, and screen individuals who may benefit from follow-up care after hospital discharge.
This study was registered with the German Clinical Trials Register (DRKS), identification number DRKS00012983.
IMPLICATIONS FOR REHABILITATION
The Chelsea Critical Care Physical Assessment tool (CPAx) serves as a validated and reliable tool for assessing physical function and activity in critically ill adults. Beyond its evaluative capabilities, the CPAx can be instrumental in predicting rehabilitation requirements. The tool has shown moderate to good predictive validity, with three out of the four initial hypotheses being confirmed by the study’s findings. A critical threshold of a CPAx score of ≥18 at ICU discharge offers a clinically relevant benchmark, indicating an 80% sensitivity and 70% specificity for predicting a patient’s return to home within 90 days. Therefore, the CPAx holds considerable promise in helping clinicians identify critically ill adults who would benefit from rehabilitation services, inform prognostication regarding their recovery journey, and effectively triage patients for post-discharge follow-up programs.
