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Identifying Clinically Relevant Functional Strata to Direct Mobility Preservation Among Patients Hospitalized With Medical Conditions

      Abstract

      Objective

      To develop a system to guide interpretation of scores generated from the newly developed item response theory (IRT)-based Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), which assesses 3 important domains of function: Mobility, Daily Activities, and Applied Cognition.

      Design

      Cross-sectional data was used to inform a modified Delphi approach to establish FAMCAT cutpoints delineating various functional ability levels.

      Setting

      Large midwestern academic teaching hospital.

      Participants

      Patients hospitalized to an inpatient medical service (N=2049).

      Interventions

      Not applicable.

      Main Outcome Measures

      FAMCAT Basic Mobility, Daily Activity, and Applied Cognition scores.

      Results

      IRT-based score estimation data was successfully integrated with expert clinical feedback using a modified Delphi process to arrive at consensus yielding 4 functional level strata (ranging from bed-based mobility to independent mobility) for both the FAMCAT Mobility and Daily Activity scales; 1 cutpoint was supported to delineate 2 functional strata for Applied Cognition.

      Conclusions

      Meaningful cutpoints were established for each FAMCAT domain using a data-informed, modified Delphi process for achieving consensus. The resulting FAMCAT interpretation guide may be used to develop an ability-matched mobility preservation program and identify patients who may require a higher level of supervision based on the resulting FAMCAT scores.

      Keywords

      List of abbreviations:

      FAMCAT (Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test), IRT (item response theory)
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