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Clinimetric properties of the Perme Intensive Care Unit Mobility Score -a multicenter study for minimum important
Ricardo Kenji Nawa1, Marcio Luiz Ferreira De Camillis2, Monique Buttignol1,3
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Background:
The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes.
Objective:
To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score).
Methods:
This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score.
Results:
A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98).
Conclusion:
Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.
Insights
The Perme Intensive Care Unit Mobility Score (Perme Score) effectively measures patient mobility in ICUs. A minimum clinically important difference of 7.0 points was established, demonstrating its responsiveness and clinical relevance.
Area of Science:
- Clinical assessment and measurement
- Intensive care unit (ICU) outcomes
- Patient mobility evaluation
Background:
- Validated instruments are crucial for accurate patient assessment and outcome measurement in clinical settings.
- The Perme Intensive Care Unit Mobility Score (Perme Score) is utilized for assessing mobility in critically ill patients.
- Establishing the psychometric properties of clinical instruments enhances their reliability and utility.
Purpose of the Study:
- To determine the minimum clinically important difference (MCID) for the Perme Score.
- To evaluate the responsiveness of the Perme Score to changes in patient mobility.
- To assess other clinimetric properties including floor/ceiling effects, internal consistency, and predictive validity of the Perme Score.
Main Methods:
- Retrospective, multicentric study involving 1,200 adult patients from four ICUs.
- Receiver Operating Characteristic (ROC) curve analysis was used to estimate the MCID.
- Hosmer and Lemeshow goodness-of-fit test was employed for ROC curve calibration.
Main Results:
- An area under the curve (AUC) of 0.96 indicated strong performance in identifying clinically relevant mobility changes.
- An optimal cut-off value of 7.0 points was established for the Perme Score's MCID.
- The Perme Score demonstrated good predictive validity for hospital mortality and ICU length of stay, with minimal floor/ceiling effects at discharge.
Conclusions:
- The study successfully established the MCID and responsiveness of the Perme Score.
- Findings support the Perme Score's utility as a reliable measure of mobility status in the ICU.
- The established clinimetric properties enhance confidence in using the Perme Score for patient management and research.
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