How to Score the Kansas University Acute Care Functional Outcomes Tool: A Practical Guide

In today’s healthcare landscape, demonstrating patient progress and functional improvement is paramount. Healthcare spending is under increasing scrutiny, and proving the value of acute hospital care through positive patient outcomes is more critical than ever. Tools that accurately measure functional status, patient satisfaction, and treatment efficiency are essential for controlling costs and improving care quality. While numerous outcome measurement tools exist, many are disease-specific or not sensitive enough for the unique challenges of acute care patients. This article focuses on the Kansas University Hospital Physical Therapy Acute Care Functional Outcomes tool – a practical and sensitive instrument designed to assess functional improvements in this setting. Understanding how to score and interpret this tool is crucial for physical therapists and healthcare providers aiming to effectively document and demonstrate patient progress in acute care.

Understanding the KUH Acute Care Functional Outcomes Tool

The Kansas University Hospital (KUH) Physical Therapy Acute Care Functional Outcomes tool was developed to address the need for a sensitive measure of functional mobility in acute care, particularly for intensive care patients. Unlike some broader functional assessments, this tool is specifically tailored to capture the nuances of functional change in patients who may be experiencing significant medical complexities and limitations. The KUH tool assesses four key categories of mobility:

Bed Mobility: The ability to move and adjust position while in bed, including transitioning from lying down to sitting at the edge of the bed.
Transfers (Bed to Chair): The ability to safely move between a bed and a chair.
Gait (Walking on Level Surfaces): The ability to walk on even surfaces, with or without assistive devices.
Walking Distance: The distance a patient can walk.

Each of these categories is scored on an ordinal scale from 0 to 7, with higher scores indicating greater independence. This scale allows clinicians to track even small but clinically meaningful improvements in patient function during their acute care stay.

Step-by-Step Guide to Scoring the KUH Tool

To effectively utilize the KUH Acute Care Functional Outcomes tool, it’s essential to understand the scoring criteria for each category. Below is a detailed breakdown of each scoring level:

1. Bed Mobility Scoring

This section assesses the patient’s ability to move and change position in bed.

7 – Complete Independence: The patient can independently move and adjust position in bed without any assistance or devices.
6 – Modified Independence: The patient performs bed mobility independently but with safety considerations, using assistive devices like bed rails, having the head of the bed elevated, using an overhead trapeze, or requiring more time than usual.
5 – Supervision: The patient requires supervision, verbal cues, or setup assistance to perform bed mobility tasks safely and effectively.
4 – Minimal Assistance: The patient performs 75% or more of the bed mobility activity and requires only minimal physical assistance.
3 – Moderate Assistance: The patient performs 50-74% of the bed mobility activity and requires moderate physical assistance.
2 – Maximum Assistance: The patient performs 25-49% of the bed mobility activity and requires maximum physical assistance.
1 – Total Assistance: The patient performs less than 25% of the bed mobility activity and requires total physical assistance.
0 – Cannot Assess/Activity Not Appropriate: The patient’s condition prevents assessment of bed mobility, or bed mobility is not an appropriate activity for the patient at this time.

2. Transfers (Bed to Chair) Scoring

This section evaluates the patient’s ability to transfer safely between a bed and a chair.

7 – Complete Independence: The patient can independently transfer between bed and chair without any assistance or devices.
6 – Modified Independence: The patient performs transfers independently but with safety considerations, using assistive devices, or requiring more time than usual.
5 – Supervision: The patient requires supervision, verbal cues, or setup assistance for safe and effective transfers.
4 – Minimal Assistance: The patient performs 75% or more of the transfer and requires only minimal physical assistance.
3 – Moderate Assistance: The patient performs 50-74% of the transfer and requires moderate physical assistance.
2 – Maximum Assistance: The patient performs 25-49% of the transfer and requires maximum physical assistance.
1 – Total Assistance: The patient performs less than 25% of the transfer and requires total physical assistance.
0 – Cannot Assess/Activity Not Appropriate: The patient’s condition prevents assessment of transfers, or transfers are not an appropriate activity for the patient at this time.

3. Gait (Walking on Level Surfaces) Scoring

This section assesses the patient’s ability to walk on level surfaces.

7 – Complete Independence: The patient can walk independently on level surfaces without any assistance or devices.
6 – Modified Independence: The patient walks independently but with safety considerations, using assistive devices, or requiring more time than usual.
5 – Supervision: The patient requires supervision, verbal cues, or setup assistance for safe and effective walking.
4 – Minimal Assistance: The patient performs 75% or more of the walking task and requires only minimal physical assistance.
3 – Moderate Assistance: The patient performs 50-74% of the walking task and requires moderate physical assistance.
2 – Maximum Assistance: The patient performs 25-49% of the walking task and requires maximum physical assistance.
1 – Total Assistance: The patient performs less than 25% of the walking task and requires total physical assistance.
0 – Cannot Assess/Activity Not Appropriate: The patient’s condition prevents assessment of gait, or walking is not an appropriate activity for the patient at this time.

4. Walking Distance Scoring

This section measures the distance the patient is able to walk.

7 – > 201 feet
6 – 151-200 feet
5 – 101-150 feet
4 – 51-100 feet
3 – 31-50 feet
2 – 11-30 feet
1 – 1-10 feet
0 – Cannot Assess/Activity Not Appropriate: The patient’s condition prevents assessment of walking distance, or walking is not an appropriate activity for the patient at this time.

Interpreting KUH Tool Scores and Measuring Change

The KUH Acute Care Functional Outcomes tool is designed to be administered at initial physical therapy assessment and again at discharge. This allows clinicians to quantify the change in a patient’s functional abilities during their acute care stay.

To calculate the change score, simply subtract the initial score from the discharge score for each category, and for the total score. A positive change score indicates improvement in function. The study validating the KUH tool demonstrated that the mean change score for patients discharged home was significantly higher than for those discharged to skilled nursing facilities, highlighting the tool’s sensitivity to functional improvement in different patient populations within acute care.

Furthermore, the research showed a strong correlation between the change scores on the KUH tool and the Functional Independence Measure (FIM), a widely recognized “gold standard” for measuring inpatient functional outcomes. However, the KUH tool was found to be more sensitive to changes in mobility, particularly for patients with smaller increments of improvement that might not be captured by the FIM’s broader categories. Specifically, the study noted that a significant percentage of patients who showed no improvement on the FIM did demonstrate improvement on the KUH scale, particularly in bed mobility, transfers, and gait.

Benefits of Using the KUH Acute Care Functional Outcomes Tool

The KUH Acute Care Functional Outcomes tool offers several key benefits for physical therapists and healthcare facilities:

Sensitive to Acute Care Changes: The tool is specifically designed to detect functional changes in the acute care setting, even subtle improvements in patients with complex medical conditions.
Quantifiable Data for Reimbursement: In an era of increasing emphasis on value-based care, the KUH tool provides quantifiable data to document patient progress and justify the need for continued skilled physical therapy services, which is crucial for reimbursement from Medicare and other payers.
Improved Communication: Using a standardized and valid tool like the KUH tool facilitates communication among physical therapists, physicians, and other members of the healthcare team regarding patient functional status and progress. It provides objective data to support the importance of physical therapy interventions in achieving positive patient outcomes.
Quality Improvement Initiatives: The KUH tool can be used to track performance improvement and monitor the quality of physical therapy services within acute care settings. The data collected can inform quality improvement initiatives and help optimize patient care pathways.

Conclusion

The Kansas University Hospital Physical Therapy Acute Care Functional Outcomes tool provides a valuable and practical method for scoring and documenting functional mobility in acute care patients. Its sensitivity to change, ease of use, and relevance to the acute care environment make it a strong asset for physical therapists seeking to demonstrate patient progress, improve communication, and contribute to quality healthcare delivery. By understanding how to score and interpret this tool, clinicians can effectively utilize it to enhance patient care and contribute to the growing body of evidence supporting the value of physical therapy in acute care.

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(12.) American Physical Therapy Association, John’s Hopkins Hospital Function Acute Care Score Information, www.acutept. org/id6.html, Retrieved May 2008 Centers for Disease Control and 13. Prevention, 2008, www.cdc.gov/ nchs/about/otheract/icd9/icfhome.htm Retrieved May 2008

Bonnie Bauer Swafford, PT
Manager of Physical Therapy
Rehabilitation Services GO 38 Wescoe
Kansas University Hospital
3901 Rainbow
Kansas City, KS 66160