Highlights
- •Few measures of function can be used longitudinally across all levels of function.
- •The Activity Measure for Post-Acute Care (AM-PAC) offers flexible administration across a broad range of function.
- •The 6-item AM-PAC Inpatient Mobility Short Form (IMSF) is widely used in hospitals.
- •Two new AM-PAC items improve measurement at very low levels of function.
- •The 8-item AM-PAC Expanded IMSF is recommended for use among patients with low function.
Abstract
Objective
To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute
Care [AM-PAC]) for patients at the lowest levels of function.
Design
Item replenishment for existing item response theory (IRT) derived measure via (1)
idea generation and creation of potential new items, (2) item calibration and field
testing, and (3) longitudinal pilot test.
Setting
Two tertiary acute care hospitals.
Participants
Consecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short
Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated.
Results
Fifteen new AM-PAC items were developed, 2 of which improved mobility measurement
at the lower levels of functioning. Specifically, with the 2 new items, the floor
effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth
were greater, and there was greater measurement sensitivity in longitudinal pilot
testing.
Conclusion
Adding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical
power, measurement breadth, and sensitivity.
Keywords
List of abbreviations:
AM-PAC (Activity Measure for Post-Acute Care), CAT (computerized adaptive test), CFI (comparative fit index), DIF (differential item functioning), GPCM (generalized partial credit IRT model), ICU (intensive care unit), IMSF (Inpatient Mobility Short Form), IRT (item response theory), JHH (Johns Hopkins Hospital), NEAT (nonequivalent groups with anchor test), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (root mean square error of approximation), TLI (Tucker-Lewis Index), UPMC (University of Pittsburgh Medical Center)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 12, 2020
Footnotes
Supported by the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant.
A.J. is a founder of CREcare, LLC, which licenses and distributes the AM-PAC. He holds stock in the company and receives royalties from Boston University from license fees generated from the AM-PAC. The other authors have nothing to disclose.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
