Introduction:
Intensive Care Unit-Acquired Weakness (ICU-AW) is a frequent complication among individuals who survive critical illness, leading to widespread muscle weakness and impaired physical function. While subjective descriptions of ICU-AW are prevalent, the clinical utility of objective measurement tools remains under investigation. This study was designed to assess the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by examining the correlation between CPAx scores and patient discharge location from the hospital, as an indicator of functional recovery.
Methods:
The CPAx was implemented as a quality improvement initiative within an 11-bed intensive care unit (ICU). Data were collected from patients admitted for more than 48 hours between May 10, 2010, and November 13, 2013. For each patient (n = 499), the final CPAx score recorded within 24 hours prior to ICU discharge or death was analyzed. Upon hospital discharge, patients were categorized into seven groups based on their needs for ongoing rehabilitation and care. Statistical analysis was performed to explore the relationship between ICU discharge CPAx scores and the location of hospital discharge.
Results:
Out of the 499 patients included in the study, 171 (34.3%) were discharged home without requiring further rehabilitation or care services. A significant proportion, 131 patients (26.2%), needed community support, while 28 patients (5.6%) were transferred to inpatient rehabilitation facilities for a 6-week program. Additionally, 27 patients (5.4%) required nursing home level care. Sadly, 80 patients (16.0%) died while in the ICU, and a further 37 patients (7.4%) died during their hospital stay. The study revealed a statistically significant difference in median CPAx scores across these patient groups (P<0.0001).
Conclusion:
This research demonstrates that the CPAx score obtained at ICU discharge exhibits construct validity by effectively differentiating between patient groups with varying functional needs at the time of hospital discharge. The Chelsea Critical Care Physical Assessment tool shows limited floor and ceiling effects in individuals recovering from critical illness. A considerable number of patients required continued care and rehabilitation after discharge, highlighting the importance of functional assessments in this population.
