Evaluating functional change using the Physical Abilities and Mobility Scale in acute paediatric neurorehabilitation

Abstract

Background/Aims Childhood acquired brain injury is the leading cause of death and long-term disability among children and young people in the UK. Following a childhood brain injury, function is shown to improve within a specialist neurorehabilitation setting. Little evidence currently exists to demonstrate gross motor functional change within an acute hospital setting. The Physical Abilities and Mobility Scale is a valid and reliable outcome measure for use within inpatient paediatric neurorehabilitation following brain injury. The primary aim of this study was to evaluate how the gross motor function of paediatric patients with a new acquired brain injury changes during an acute hospital admission. Methods Data were collected for all patients admitted as an inpatient to one acute hospital over a 12-month period. The Physical Abilities and Mobility Scale was completed at baseline, at least weekly and again at discharge. Views relating to the utility of the Physical Abilities and Mobility Scale were sought among physiotherapists using the measure in order to inform acceptability. Results A total of 28 patients were included in this study. A Wilcoxon signed rank test was performed, which showed a highly significant improvement in function as scored on the Physical Abilities and Mobility Scale between baseline assessment (median 29.00, interquartile range 25.00–35.50) and discharge (median 85.00, interquartile range 75.00–95.00, Z=-4.624, P<0.001). A total of five patients (17.86%) were referred on for specialist residential neurorehabilitation. A post hoc analysis found that the rate of change of the Physical Abilities and Mobility Scale appeared to have an impact on final discharge destination, with slow improvers 18.60 times more likely to require specialist rehabilitation than others. The Physical Abilities and Mobility Scale was found to be acceptable among physiotherapists using it. Conclusions Children with a new acquired brain injury make significant improvements in gross motor function during a period of acute inpatient neurorehabilitation. Further work should look to refine the measure and gain a full understanding of its clinical utilities.

The Physical Abilities and Mobility Scale as a New Measure of Functional Progress in the PICU

“…The PAMS has not been studied in the ICU, but its utility in the pediatric inpatient population for tracking functional changes in relation to discharge disposition has been reported. 29 Furthermore, discharge to an inpatient rehabilitation facility (IRF) may be helpful in mitigating some of the functional deficits that patients experience after ICU stay. However, decisions regarding rehabilitation disposition are often made close to or after medical discharge readiness, requiring integration of multiple assessments, and are often further complicated by social and financial barriers to discharge to an IRF.…”

“…The PAMS has not been studied in the ICU, but its utility in the pediatric inpatient population for tracking functional changes in relation to discharge disposition has been reported. 29…”