German version of the Chelsea Critical Care Physical Assessment Tool (CPAx-GE): translation, cross-cultural adaptation, validity, and reliability

Abstract

Purpose: To translate and cross-culturally adapt the Chelsea Critical Care Physical Assessment tool from English to German (CPAx-GE) and to examine its validity and reliability. Materials and methods: Following a forward-backward translation including an expert round table discussion, the measurement properties of the CPAx-GE were explored in critically ill, mechanically ventilated adults. We investigated construct, cross-sectional, and cross-cultural validity of the CPAx-GE with other measurement instruments at pre-specified timepoints, analysed relative reliability with intraclass correlation coefficients (ICCs) and determined absolute agreement with the Bland-Altman plots. Results: Consensus for the translated CPAx-GE was reached. Validity was excellent with >80% of the prespecified hypotheses accepted at baseline, critical care, and hospital discharge. Interrater reliability was high (ICCs > 0.8) across all visits. Limit of agreement ranged from À2 to 2 points. Error of measurement was small, floor, and ceiling effects limited. Conclusions: The CPAx-GE demonstrated excellent construct, cross-sectional, and cross-cultural validity as well as high interrater reliability in critically ill adults with prolonged mechanical ventilation at baseline, critical care, and hospital discharge. Consequently, the CPAx-GE can be assumed equal to the original and recommended in the German-speaking area to assess physical function and activity of critically ill adults across the critical care and hospital stay. Trial registration: German Clinical Trials Register (DRKS) identification number: DRKS00012983 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012983), registered on 20 September 2017, first patient enrolled on 21 November 2017. ä IMPLICATIONS FOR REHABILITATIONEarly rehabilitation of critically ill patients is recommended to prevent and treat the subsequent functional disability, but a suitable measurement instrument for the German-speaking area is lacking. The translated, cross-culturally adapted German CPAx demonstrated excellent validity and reliability in assessing physical function and activity in critically ill adults. Cross-sectional validity of the CPAx has been newly established and allows the use of this tool at clinically relevant time-points in the course of a critical illness. The CPAx-GE can therefore be used in clinical practice by German-speaking therapists to assess physical function and activity during early rehabilitation in the ICU and hospital.

Validity, inter-rater reliability, and feasibility of the Chelsea Physical Assessment Tool for assessing physical function in post-acute COVID-19 patients: A cross-sectional study

“…As mentioned before, the involvement of swallowing status in the assessment tools would be a better representation of the functional status [47]. To the 503 best of our knowledge, CPAx tool can be strengthened In line with previous studies, we did not detect a floor 507 or ceiling effect of CPAx [19,37,48]. This was previ- ing effect.…”

“…2.4.4. Sequential Organ Failure Assessment Score (SOFA score) Sequential Organ Failure Assessment Score is used to describe the degree of organ dysfunction from 0 (normal) to 4 (most abnormal) for six vital organs [19]. Manual muscle strength of six muscle groups (shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion) was evaluated on both sides using MRC scale.…”

Functional outcomes of patients in ICU using the Chelsea Critical Care Physical Assessment tool: An integrative review

“…Inter-rater reliability by observation is excellent with intraclass correlation coefficient (ICC) > 0.8 including 95% confidence interval (CI) on patient assessment with the translation of the German CPAx (Eggmann et al 2021 ). The constructed Bland–Altman’s plots confirm the high agreement of the CPAx-GE with a mean difference of 0.13 ± 0.15 (95% limit of agreement: −2.04 to 1.79) (Eggmann et al 2021 ). The inter-rater reliability of the Swedish CPAx tool (CPAx-Swe) is found to be satisfactory and applicable for use within the clinical setting (Holdar et al 2019 ).…”

Physical recovery of COVID‐19 pneumosepsis intensive care survivors compared with non‐COVID pneumosepsis intensive care survivors during post–intensive care hospitalization: The RECOVID retrospective cohort study

“…Use of CPAx is not yet ubiquitous; however, it has been translated into several languages and correlates well to other methods such as MRC-SS. [15][16][17][18][19] Taken together, the advantages of CPAx has experts to advocate for its use specifically in the functional assessment of post-ICU COVID-19 patients. 5 In contrast to the MRC-SS and the CPAx, the change in POP-HGS between ICU and hospital discharge in our study was not different for COVID-19 patients compared with non-COVID pneumosepsis patients.…”

“…The CPAx is an outcome measure designed to assess 10 domains of physical ability in the post‐ICU patient: respiratory function, cough, bed mobility, supine to sitting on the edge of the bed, dynamic sitting, sit to stand, standing balance, transferring from bed to chair, stepping, and grip strength. Use of CPAx is not yet ubiquitous; however, it has been translated into several languages and correlates well to other methods such as MRC‐SS 15–19 . Taken together, the advantages of CPAx has experts to advocate for its use specifically in the functional assessment of post‐ICU COVID‐19 patients 5 …”