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Measuring Physical Function in the PICU: Development and Testing of a Children's Version (Age 2-18 yr) of the Chelsea
Alexandra H Ferguson1, Kellie A Stockton2, Sarah E Wright1
1Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
Insights
A new tool, the children's Chelsea Critical Care Physical Assessment (cCPAx), reliably measures physical function in critically ill children. Low scores indicate significant immobility and reduced physical function in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Medicine
- Clinical Outcome Measurement
Background:
- Assessing physical and respiratory function in critically ill children is crucial for recovery.
- Existing tools may not be suitable or easily administered in the pediatric intensive care unit (PICU) setting.
- There is a need for a reliable and user-friendly outcome measure for this population.
Purpose of the Study:
- To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children.
- To validate the adapted tool in a cohort of pediatric patients.
Main Methods:
- A modified Delphi study involving 27 international panelists adapted the Chelsea Critical Care Physical Assessment (CPAx) tool for children aged 2-18 years, creating the children's CPAx (cCPAx).
- Prospective testing was conducted in a single-center tertiary PICU on 54 patients admitted for over 24 hours.
- Inter-rater reliability was assessed, and the tool's completion rate was determined.
Main Results:
- Three Delphi iterations achieved over 80% consensus on cCPAx items.
- The prospective cohort study involved 54 patients (median age 5.5 years), with 38 invasively ventilated.
- Inter-rater reliability for the cCPAx was excellent (ICC = 0.998), with a completion rate of 74%.
Conclusions:
- The Delphi methodology successfully developed the cCPAx tool, proving it feasible and clinically relevant for assessing physical morbidity in PICU patients aged 2-18.
- Low overall cCPAx scores suggest significant physical impairment and immobility among critically ill children in the PICU.
- The cCPAx tool can aid in monitoring and managing physical recovery in pediatric intensive care settings.
Objectives:
To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children in the PICU.
Design:
Modified Delphi study to adapt the Chelsea Critical Care Physical Assessment (CPAx) tool for use in children 2-18 years old, with subsequent prospective testing in a single-center cohort.
Setting:
Single-center tertiary PICU.
Subjects:
Delphi process in 27 panelists (including physiotherapists, occupational therapists, and pediatric intensivists from seven countries from January 2018 to March 2018). Cohort study in 54 patients admitted to PICU for greater than 24 hours over a 3-month period (April 2018 to June 2018), with median age 5.5 years (interquartile range [IQR], 3-12.75 yr), 33 of 54 male, and 38 of 54 invasively ventilated.
Interventions:
None.
Measurements And Main Results:
Three Delphi iterations were required to reach greater than or equal to 80% consensus in all the children's CPAx (cCPAx) items. In the subsequent cohort study, six physiotherapists used the cCPAx tool and scored 54 participants, with a total 106 observations. The median cCPAx tool score was 14.50 (IQR, 3-25) out of a possible total of 50. Inter-rater reliability for 30 randomly selected participants was excellent (intraclass correlation coefficient, 0.998). Completion rate of cCPAx in the 54 patients occurred in 78 of 106 occasions (74%).
Conclusions:
The cCPAx tool content that was developed using Delphi methodology provided a feasible and clinically relevant tool for use in assessing physical morbidity in PICU patients 2-18 years old. Overall, the cCPAx scores were low, demonstrating low levels of physical function and high levels of immobility during PICU care.
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