High intertester reliability of the Cumulated Ambulation Score for the evaluation of basic mobility in patients with hip fracture

Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie; Moos, Malene; Hovmand, Bente; Ekdahl, Charlotte; Kehlet, Henrik

doi:10.1177/0269215509342330

Cited by 60 publications

(73 citation statements)

References 27 publications

(37 reference statements)

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“…• getting in and out of bed (from supine in bed to sitting at the side of the bed to standing or transfer to sitting in chair placed beside the bed, and return to the supine position in bed) • sitting to standing to sitting from a chair with armrests • indoor walking, with an appropriate aid allowed in transfer and walking if necessary 32 Each activity is scored from 0 to 2 (0 = not able despite human assistance and verbal cueing, 1 = able with verbal cueing and/or human assistance from 1 or more individuals, 2 = able safely without human assistance or verbal cueing), making up a total score of 0-6 reflecting the scale from bedbound to independent mobilization. 32,33 In addition to routine treatment, a physiotherapist tested the patients after AHA surgery using CAS on PODs 1-7.…”

Section: Physical Performancementioning

confidence: 99%

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Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

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Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods:Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion:Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour amélio-rer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7).Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes.Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de c...

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Section: Physical Performancementioning

confidence: 99%

“…32,33 In addition to routine treatment, a physiotherapist tested the patients after AHA surgery using CAS on PODs 1-7. A total of 8 skilled physiotherapists participated in data collection.…”

Section: Physical Performancementioning

confidence: 99%

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

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“…Patients with hemiarthroplasty were not allowed to perform > 90° flexion, adduction or internal rotation of the hip. Before inclusion, all of the patients followed a short in-hospital physical therapy programme without strength training, focused on the regaining of basic mobility activities [18,19] , before being discharged to their own homes. Patients were recruited from four outpatient geriatric municipality health centres from September 2010 to August 2011.…”

Section: Patientsmentioning

confidence: 99%

Feasibility of progressive strength training shortly after hip fracture surgery

Overgaard¹

2013

WJO

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AIM:To investigate the feasibility of a 6-wk progressive strength-training programme commenced shortly after hip fracture surgery in community-dwelling patients. METHODS:This prospective, single-blinded cohort study evaluated 31 community-dwelling patients from four outpatient geriatric health centres aged 60 years or older, who started a 6-wk programme at a mean of 17.5 ± 5.7 d after hip fracture surgery. The intervention consisted primarily of progressive fractured kneeextension and bilateral leg press strength training (twice weekly), with relative loads commencing at 15 and increasing to 10 repetitions maximum (RM), with three sets in each session. The main measurements included progression in weight loads, hip fracture-related pain during training, maximal isometric knee-extension strength, new mobility score, the timed up and go test, the 6-min walk test and the 10-meter fast speed walk test, assessed before and after the programme. RESULTS:Weight loads in kilograms in the fractured limb knee-extension strength training increased from 3.3 ± 1.5 to 5.7 ± 1.7 and from 6.8 ± 2.4 to 7.7 ± 2.6, respectively, in the first and last 2 wk (P < 0.001). Correspondingly, the weight loads increased from 50.3 ± 1.9 to 90.8 ± 40 kg and from 108.9 ± 47.7 to 121.9 ± 54 kg in the bilateral leg press exercise (P < 0.001). Hip fracture-related pain was reduced, and large improvements were observed in the functional outcome measurements, e.g. , the 6-min walk test improved from 200.6 ± 79.5 to 322.8 ± 68.5 m (P < 0.001). The fractured limb knee-extension strength deficit was reduced from 40% to 17%, compared with the non-fractured limb. Ten patients reported knee pain as a minor restricting factor during the last 10 RM knee-extension strength-training sessions, but with no significant influences on performance. CONCLUSION:Progressive strength training, initiated shortly after hip fracture surgery, seems feasible and does not increase hip fracture-related pain. Progressive strength training resulted in improvement, although a strength deficit of 17% persisted in the fractured limb compared with the non-fractured limb. Core tip: The recovery of strength and function in patients with hip fractures is an on-going challenge. We aimed to evaluate the feasibility of a 6-wk progressive lower limb strength-training programme. To our knowledge, this was the first study to implement such a program successfully in an outpatient geriatric setting within 2-3 wk after hip fracture surgery. Training loads, muscle strength and functional performances improved without an increase in hip fracture-related pain, which

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“…Now we find that interobserver reproducibility of the A-test is very good (kappa coefficient was 0.81-0.92). By interpretation of Landis and Koch, the A-test is found in the same gradation of reproducibility as the CAS, which has the simplest scale and strong evidence of highly reliable test for recovery assessment of elderly patients with hip fracture 5 . In their intertester reliability study of the CAS, kappa coefficient was very high for all three items (0.92-0.97) 5 .…”

Section: Discussionmentioning

confidence: 87%

“…The Cumulated Ambulation Score (CAS) with a simple three-level ordinal scale was designed to monitor functional recovery of older people who were surgically treated for hip fractures and in this population it has excellent reliability [3][4][5] . The University of Iowa Level of Assistance Scale (ILAS) 6, 7 has a complex seven-level scale and demonstrated moderate reliability in a population of patients who underwent arthroplasty for osteoarthritis of the hip and knee.…”

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confidence: 99%

The A-test: Reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward

Vukomanović¹,

Djurović²,

Popović

et al. 2014

VOJNOSANIT PREGL

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High intertester reliability of the Cumulated Ambulation Score for the evaluation of basic mobility in patients with hip fracture

Abstract: The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.

Cited by 60 publications

References 27 publications

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Feasibility of progressive strength training shortly after hip fracture surgery

The A-test: Reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward

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