Introduction:
Intensive Care Unit-Acquired Weakness (ICU-AW) is a prevalent complication among individuals who survive critical illness. This condition leads to generalized muscle weakness and significant functional deficits, impacting patients’ recovery and long-term well-being. While subjective descriptions of ICU-AW are abundant in medical literature, the importance and application of objective measurement tools remain areas requiring further investigation. This study was undertaken to assess the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx), a key Critical Care Assessment Tool, by examining the correlation between CPAx scores and patient discharge location as an indicator of functional outcome.
Methods:
As part of a service enhancement initiative, the CPAx was implemented within an 11-bed intensive care unit (ICU). Data were collected prospectively for patients admitted to the ICU 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 discharge from the ICU or death was analyzed. Upon hospital discharge, patients were categorized into seven groups based on their ongoing rehabilitation and care requirements. Descriptive statistical analyses were employed to explore the relationship between the CPAx score at ICU discharge and the location of hospital discharge, providing insights into the tool’s effectiveness as a critical care assessment tool.
Results:
The study cohort of 499 patients presented diverse discharge outcomes. A significant portion, 171 patients (34.3%), were discharged home without needing continuous rehabilitation or care services. A further 131 patients (26.2%) were discharged with community support needs, while 28 patients (5.6%) were transferred to inpatient rehabilitation facilities for a 6-week program. A smaller group of 27 patients (5.4%) required nursing home level care upon discharge. Sadly, 80 patients (16.0%) succumbed to their illness while in the ICU, and an additional 37 patients (7.4%) passed away during their hospital stay post-ICU. Statistical analysis revealed a significant difference in median CPAx scores across these discharge groups (P<0.0001). This indicates that the critical care assessment tool, CPAx, effectively differentiates between patient groups with varying functional needs at the time of hospital discharge.
Conclusion:
This study demonstrates that the CPAx score, when assessed at ICU discharge, exhibits construct validity by effectively distinguishing between patient groups with differing functional needs at hospital discharge. The CPAx, as a critical care assessment tool, shows limited floor and ceiling effects in survivors of critical illness, suggesting its broad applicability across a range of patient functional levels. Importantly, the findings highlight that a considerable proportion of patients recovering from critical illness require ongoing post-discharge care and rehabilitation services, underscoring the importance of critical care assessment tools like CPAx in identifying and addressing these needs.
