Patient-Reported Mobility: A Systematic Review

Reliability and validity of the Chinese version of the functional status score for the ICU (FSS-ICU) after translation and cross-cultural adaptation

PURPOSE

The Functional Status Score for the Intensive Care Unit (FSS-ICU) is designed to assess the physical functional status of patients in ICU settings. This study aimed to translate and culturally adapt the FSS-ICU for the Chinese context and to evaluate its reliability and validity.

METHODS

Following Beaton's translation model, the original FSS-ICU was subjected to forward translation, back-translation, and synthesis. After cultural adaptation and preliminary testing, the Chinese version of the FSS-ICU was established, and then two rehabilitation therapists assessed the functional status of 51 ICU patients using this scale, evaluating its reliability and validity.

RESULTS

The Chinese version of the FSS-ICU exhibits excellent internal consistency with a Cronbach's alpha coefficient of 0.934. The inter-rater and intra-rater correlation coefficients are 0.995 and 0.997, respectively. Both item-level and scale-level content validity indices are 1.00. The FSS-ICU demonstrates good convergent validity with other physical function assessment tools (Medical Research Council Sum-Score, grip strength, the Intensive Care Unit Mobility Scale), with |rs| values all above 0.5, and satisfactory discriminant validity with non-physical function assessment indicators (body mass index, blood glucose), with |rs| values all below 0.2. Additionally, it demonstrated no ceiling or floor effects.

CONCLUSION

The Chinese FSS-ICU, demonstrating strong reliability and validity, can serve as an effective assessment tool for physical function in ICU patients.

Measures of perceived mobility ability in community-dwelling older adults: a systematic review of psychometric properties

OBJECTIVES

The objective of this systematic review was to synthesise the psychometric properties of measures of perceived mobility ability and related frameworks used to define and operationalise mobility in community-dwelling older adults.

METHODS

We registered the review protocol with PROSPERO (CRD42022306689) and included studies that examined the psychometric properties of perceived mobility measures in community-dwelling older adults. Five databases were searched to identify potentially relevant primary studies. We qualitatively summarised psychometric property estimates and related operational frameworks. We conducted risk of bias and overall quality assessments, and meta-analyses when at least three studies were included for a particular outcome. The synthesised results were compared against the Consensus-based Standards for the Selection of Health Measurement Instruments criteria for good measurement properties.

RESULTS

A total of 36 studies and 17 measures were included in the review. The Late-Life Function and Disability Index: function component (LLFDI-FC), lower extremity functional scale (LEFS), Mobility Assessment Tool (MAT)-short form (MAT-SF) or MAT-Walking, and Perceived Driving Abilities (PDA) Scale were identified with three or more eligible studies. Most measures showed sufficient test-retest reliability (moderate or high), while the PDA scale showed insufficient reliability (low). Most measures had sufficient or inconsistent convergent validity (low or moderate) or known-groups validity (low or very low), but their predictive validity and responsiveness were insufficient or inconsistent (low or very low). Few studies used a conceptual model.

CONCLUSION

The LLFDI-FC, LEFS, PDA and MAT-SF/Walking can be used in community-dwelling older adults by considering the summarised psychometric properties. No available comprehensive mobility measure was identified that covered all mobility domains.

Health-Related Quality of Life (HRQOL) Instruments and Mobility: A Systematic Review

Physical function is one of the most important constructs assessed in health-related quality of life (HRQOL), and it could be very useful to assess movement ability from the perspective of the patient. The objective of this study was to compare the content of the domains related to mobility covered by the HRQOL questionnaires based on the International Classification of Functioning, Disability and Health (ICF) and to evaluate their quality according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. For this, a systematic review was carried out in the databases Scopus, Web of Science and Science Direct. The inclusion criteria were development and/or validation studies about generic HRQOL measures, and the instruments had to include items related to mobility and studies written in English or Spanish. The comparison of content was performed using the ICF coding system. A total of 3614 articles were found, 20 generic HRQOL instruments were identified and 120 (22.4%) mobility-related items were found. Walking was the most represented category. Low-quality evidence on some measurement properties of the generic HRQOL instruments was revealed. The CAT-Health is a useful questionnaire to be used in rehabilitation due to its psychometric properties and its content.

Measures of movement and mobility used in clinical practice and research: a scoping review

OBJECTIVE

The first objective of this scoping review was to identify all the tools designed to measure movement or mobility in adults. The second objective was to compare the tools to the conceptual definitions of movement and mobility by mapping them to the International Classification of Functioning, Disability and Health (ICF).

INTRODUCTION

The concepts of movement and mobility are distinct concepts that are often conflated, and the differences are important to patient care. Movement is a change in the place or position of a part of the body or of the whole body. Mobility is derived from movement and is defined as the ability to move with ease. Researchers and clinicians, including nurses, physiotherapists, and occupational therapists who work with adults and in rehabilitation, need to be confident that they are measuring the outcome of interest.

INCLUSION CRITERIA

This scoping review considered studies that included participants who are adults, aged 19 and older, with any level of ability or disability. The concepts of interest were tools that measured movement or mobility relative to the human body. Studies were considered regardless of country of origin, health care setting, or sociocultural setting.

METHODS

CINAHL, Health and Psychosocial Instruments, MEDLINE, and Embase were searched in June 2018 and OpenGrey, Dissertation Abstracts International, and Google Scholar were searched in November 2018. The searches were limited to articles in English, and the date range was from the inception of the database to the current date. Data were extracted from the studies using a custom data extraction tool. Once tools were identified for analysis, they were coded using the table format developed by Cieza and colleagues.

RESULTS

There were 702 unique tools identified, with 651 of them available to be coded for the ICF. There were 385 ICF codes used when coding the tools. From these codes, the percentage of codes of the defining attributes of movement and mobility that were covered could be calculated, as well as the percentage of tool items that were linked to the antecedents, consequences, or defining attributes of movement or mobility.

CONCLUSIONS

Although there are many tools that measure only movement or mobility, there are many that measure a mixture of the defining attributes as well as the antecedents and consequences. The tool name alone should not be considered a guarantee of the concept measured, and tool selection should be done with a critical eye. This study provides a starting point from which clinicians and researchers can find tools that measure the concepts of movement and mobility of interest and importance to their patient population.

International Classification of Functioning, Disability, and Health Domains of 60 Physical Functioning Measurement Instruments Used During the Adult Intensive Care Unit Stay: A Scoping Review

BACKGROUND

There has been a recent surge in the creation and adaptation of instruments to measure physical functioning (PF) in the intensive care unit (ICU). Selecting the right measurement instrument depends on understanding the core constructs that it measures in terms of the International Classification of Functioning, Disability and Health (ICF) domains.

PURPOSE

The purpose of this study was to map systematically the ICF domains and subdomains included in the PF measurement instruments used for adult patients during the ICU stay.

DATA SOURCES

A systematic search was carried out in Cochrane CENTRAL, PubMed, CINAHL, and LILACS as well as a hand search up to May 17, 2017.

STUDY SELECTION

Study selection included all types of research articles that used at least 1 PF measurement instrument in adult patients within the ICU.

DATA EXTRACTION

Study design, year of publication, study population, and the measurement instruments reported were recorded. A consensus of experts analyzed the ICF domains included in each instrument.

DATA SYNTHESIS

We found 181 articles containing 60 PF measurement instruments used during the ICU stay. Twenty-six ICF domains were identified, 38 instruments included Mobility, and 13 included Muscle function.

LIMITATIONS

Studies not written in English or Spanish were excluded.

CONCLUSIONS

There are numerous PF measurement instruments used in adult patients in the ICU. The most frequent ICF domain measured is Mobility. This study highlights the ICF domains contained in the instruments that can be used clinically, providing a complete database of instruments that could facilitate selection of the most appropriate measure based on the patients' needs.

Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke, assessed by the ABILOCO questionnaire

BACKGROUND

The identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions.

OBJECTIVE

To investigate which impairment measures would best predict locomotion ability in people with chronic stroke.

METHODS

Individuals (n=115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke.

RESULTS

Age, sex, and time since stroke did not significantly correlate with the ABILOCO scores (-0.07<ρ<0.05; 0.48<p<0.99). Measures of motor impairments and walking speed were significantly correlated with the ABILOCO scores (-0.25<r<0.57; p<0.001), but only walking speed and strength were kept in the regression model. Walking speed alone explained 35% (F=55.5; p<0.001) of the variance in self-reported locomotion ability. When strength was included in the model, the explained variance increased to 37% (F=31.4; p<0.001).

CONCLUSIONS

Walking speed and lower limb strength best predicted locomotion ability as perceived by individuals who have suffered a stroke.

Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors

Introduction: Understanding determinants of community mobility disability is critical for developing interventions aimed at preventing or delaying disability in older adults. In an effort to understand these determinants, capturing and measuring community mobility has become a key factor. The objectives of this paper are to present and illustrate the signal processing workflow and outcomes that can be extracted from an activity and community mobility measurement approach based on GPS and accelerometer sensor data and 2) to explore the construct validity of the proposed measurement approach using data collected from healthy older adults in free-living conditions. Methods: Personal, functional impairment and environmental variables were obtained by self-report questionnaires in 75 healthy community-living older adults (mean age = 66 ± 7 years old) living on the island of Montreal, QC, Canada. Participants wore, for 14 days during waking hours on the hip, a data logger incorporating a GPS receiver with a 3-axis accelerometer. Time at home ratio (THR), Trips out (TO), Destinations (D), Maximal distance of destinations (MDD), Active time ratio (ATR), Steps (S), Distance in a vehicle (DV), Time in a vehicle (TV), Distance on foot (DF), Time on foot (TF), Ellipse area (EA), and Ellipse maximum distance (EMD) were extracted from the recordings. Results: After applying quality control criteria, the original data set was reduced from 75 to 54 participants (28% attrition). Results from the remaining sample show that under free-living conditions in healthy older adults, location, activity and community mobility outcomes vary across individuals and certain personal variables (age, income, living situation, professional status, vehicle access) have potential mitigating effects on these outcomes. There was a significant (yet small) relationship (rho < 0.40) between self-reported life space and MDD, DV, EA, and EMD. Conclusion: Wearability and usability of the devices used to capture free-living community mobility impact participant compliance and the quality of the data. The construct validity of the proposed approach appears promising but requires further studies directed at populations with mobility impairments.

The Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log: cross-cultural adaptation and psychometric properties

Instruments to measure movement abilities from a patient's perspective are generally unavailable across diverse cultures and languages. The aim of this study was to translate, culturally adapt, and validate the Italian version of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) confidence scale. This study was an observational multicenter study. The Italian version of the OPTIMAL confidence scale (OPTIMAL-I) was developed following forward-backward translation and pretesting with a small group of patients. Reliability was measured by internal consistency (Cronbach α), and a factor analysis was carried out to explore the internal structure. Convergent validity was measured by comparing the OPTIMAL-I with the Italian version of the Activities-specific Balance Confidence (ABC-I). The process for obtaining the OPTIMAL-I required 3 months and it was administered to 290 outpatients in two different rehabilitation clinics. OPTIMAL-I showed high acceptability, high internal consistency (Cronbach's α=0.963), and high test-retest stability (intraclass correlation coefficient=0.92, P=0.001). Convergent validity with ABC-I was also high (r=0.56-0.86; P<0.001). Using factor analysis, we found evidence for a four-factor structure related to 'confidence with high-loads lower-extremity mobility', 'confidence with low-loads lower-extremity mobility', 'confidence with upper-extremity mobility', and 'confidence with trunk mobility' that explained 78.83% of the total variance. The OPTIMAL-I showed good psychometric properties and its use can be recommended for measuring confidence in Italian patients receiving physical therapy services. Future studies should focus on divergent validity and construct validity.