Predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) in critically ill, mechanically ventilated adults: a prospective clinimetric study

Reliability, validity and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) following an e-learning programme: A clinimetric study

OBJECTIVES

To investigate inter- and intra-rater reliability, content and concurrent validity, and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) - a measurement instrument for physical function and activity for patients with a critical illness - from multidisciplinary, German-speaking healthcare professionals.

METHODS

This was a prospective, longitudinal, clinimetric study. Participants who completed a novel German CPAx e-learning were invited to participate in a voluntary, web-based, piloted, two-round survey. The two rounds were separated by 3-4 weeks to limit recollection of the two patient videos within the e-learning. Following informed consent, we collected participants' characteristics, their CPAx ratings and scoring-duration for the two video cases, content validity indexes along with questions on the practicability of the CPAx. Data was analysed descriptively, quantitatively using Bayesian methods, and qualitatively with an inductive content approach.

RESULTS

In total, 61 clinicians (53 (87 %) physiotherapists, 6 (10 %) nurses, 2 (3 %) occupational therapists) from Switzerland (37 (64 %)), Germany (13 (22 %)), and Austria (8 (14 %)) participated. Inter- (n = 61) and intra-rater (n = 35) reliability for the CPAx were excellent (intraclass correlation coefficients of > 0.8). Content validity index of the CPAx showed a high relevance (> 0.9), though novice users slightly differed from the expert rating (concurrent validity). Healthcare professionals described the CPAx as a practical tool to plan and evaluate physical rehabilitation with a total scoring duration of 5 min, whereby lack of routine, time, and application were seen as barriers in clinical practice.

CONCLUSIONS

This study demonstrated the German CPAx as a highly reliable (between and within raters), relevant and practical tool across professions, settings, and countries. These results support an online training, whereby future work should focus on consensus and application into clinical practice.

IMPLICATIONS FOR CLINICAL PRACTICE

Following an e-learning, the CPAx can be used reliably by multidisciplinary, German-speaking healthcare professionals potentially enhancing physical rehabilitation.

Which Outcomes Should We be Using in Critical Care Nutrition Trials?

Selecting appropriate outcome measures is a critical component of clinical trial design. Core outcome sets, which utilize stakeholder input to define the most important outcomes for a particular research question, are valuable in improving the consistency of research, such that conclusive recommendations can be made. Alongside these core outcomes, exploratory outcomes are keys to providing novel insights into disease pathophysiology and treatment response. Surrogate outcomes developed through exploratory methods may enable intervention at an earlier stage, with the potential for prevention rather than management of the sequalae of critical illness.

Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability

BACKGROUND

Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation.

METHOD

CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability.

RESULTS

The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983-0.994) and at "B" 0.994 (0.990-0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996-0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland-Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge.

CONCLUSION

CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.

Effect of Algoplaque Hydrocolloid Dressing Combined with Nanosilver Antibacterial Gel under Predictive Nursing in the Treatment of Medical Device-Related Pressure Injury

It was aimed at the clinical value of predictive nursing and Algoplaque hydrocolloid dressing (AHD) combined with nanosilver antibacterial gel in treating medical device-related pressure injury (MDRPI). 100 patients, who underwent surgery in Chongqing Qijiang District People's Hospital from February 2019 to February 2020, were selected as the research objects and were randomly divided into the experimental group (50 cases) and the control group (50 cases). For the characterization test, a nanosilver antibacterial gel was created first. Patients in both groups received predictive nursing, but those in the experimental group received AHD and nanosilver antibacterial gel, and those in the control group received gauzes. MDRPI incidence, pressed skin injury severity, comfort level, clothing changes, nursing satisfaction, and other factors were all compared. The particle size of the nanosilver gel was 45-85 nm, with a relatively homogeneous distribution with the medium size, according to the findings. The incidence of MDRPI in the experimental group was lower than that in the control group significantly (6% vs. 30%, P < 0.05). The degree of injury of pressured skin in the experimental group was milder than that in the control group (P < 0.05), the degree of comfort and nursing satisfaction was higher in the experimental group than in the control group (P < 0.05), and dressing change count was lower than that in the control group (P < 0.05). In the treatment of MDRPI, predictive nursing and AHD using nanosilver antibacterial gel showed high clinical application value.