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Construct Validity of the Chilean-Spanish Version of the Functional Status Score for the Intensive Care Unit: A Prospective Observational Study Using Actigraphy in Mechanically Ventilated Patients

  • Author Footnotes
    ∗ Camus-Molina and González-Seguel contributed equally to this work.
    Agustín Camus-Molina
    Footnotes
    ∗ Camus-Molina and González-Seguel contributed equally to this work.
    Affiliations
    Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

    Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

    School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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  • Author Footnotes
    ∗ Camus-Molina and González-Seguel contributed equally to this work.
    Felipe González-Seguel
    Correspondence
    Corresponding author Felipe González-Seguel, PT, MSc, Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Vitacura 5951, Vitacura, Santiago, Chile (2 2210 1111).
    Footnotes
    ∗ Camus-Molina and González-Seguel contributed equally to this work.
    Affiliations
    Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

    Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

    School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
    Search for articles by this author
  • Ana Cristina Castro-Ávila
    Affiliations
    School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile

    Department of Health Sciences, University of York, York, United Kingdom
    Search for articles by this author
  • Jaime Leppe
    Affiliations
    School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
    Search for articles by this author
  • Author Footnotes
    ∗ Camus-Molina and González-Seguel contributed equally to this work.

      Highlights

      • Measuring the physical functioning of critically ill patients remains a challenge.
      • Functional Status Score for the Intensive Care Unit (FSS-ICU) is a recommended physical functioning measure for patients in the intensive care unit (ICU).
      • Actigraphy provides a more objective comparison than other clinical instruments.
      • Actigraphy measures showed that high inactivity time had a worse FSS-ICU in the ICU.
      • Strong correlation exists between muscle strength, mechanical ventilation duration, and ICU length of stay.

      Abstract

      Objective

      To evaluate the construct validity (hypotheses testing) of the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) using continuous actigraphy from intensive care unit (ICU) admission to ICU discharge.

      Design

      The Chilean-Spanish version of the FSS-ICU was used in a prospective observational study to mainly evaluate its correlation with actigraphy variables. The FSS-ICU was assessed on awakening and at ICU discharge, while actigraphy variables were recorded from ICU admission to ICU discharge.

      Setting

      A 12-bed academic medical-surgical ICU.

      Participants

      Mechanically ventilated patients (N=30), of 92 patients screened.

      Interventions

      Not applicable.

      Main Outcome Measures

      Construct validity of the FSS-ICU Chilean-Spanish version was assessed by testing 12 hypotheses, including the correlation with activity counts, activity time (>99 counts/min), inactivity time (0-99 counts/min), muscle strength, ICU length of stay, and duration of mechanical ventilation.

      Results

      The median FSS-ICU was 19 points (interquartile range [IQR], 10-26 points) on awakening and 28.5 points (IQR, 22-32 points) at ICU discharge. There was no floor/ceiling effect of the FSS-ICU at awakening (0%/0%) and only a ceiling effect at ICU discharge that was acceptable (0%/10%). Less activity time was associated with better mobility on the FSS-ICU at both awakening (ρ=−0.62, P<.001) and ICU discharge (ρ=−0.79, P<.001). Activity counts and activity time were not correlated as expected with the FSS-ICU.

      Conclusions

      The Chilean-Spanish FSS-ICU had a strong correlation with inactivity time during the ICU stay. These findings enhance the available clinimetric properties of the FSS-ICU.

      Keywords

      List of abbreviations:

      CPAx (Chelsea Critical Care Physical Assessment Tool), FSS-ICU (Functional Status Score for the Intensive Care Unit), ICU (intensive care unit), ICU-AW (intensive care unit–acquired weakness), IMS (Intensive Care Unit Mobility Scale), IQR (interquartile range), LOS (length of stay), PFIT-s (Physical Function in Intensive Care Unit Test-scored), MRC-SS (Medical Research Council Sum Score)
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