Inter‐rater reliability of activity measure for post‐acute care ‘6‐Clicks’ inpatient mobility short form in the intensive care unit

Abstract

Objective: Examine the inter-rater reliability of the activity measure for post-acute care (AM-PAC) inpatient mobility short form (IMSF) when completed by physical therapists (PTs), during routine clinical practice, in a variety of patients with critical illness. Methods: A prospective observational evaluation at single, large academic hospital in the United States. Patients (n = 76) in surgical, medical and neurological intensive care units (ICUs) were evaluated as part of routine clinical practice using the AM-PAC IMSF administered by eight PTs with at least 6 months of experience using this tool. One of two reference rater PTs observed the physical therapy session, and simultaneously scored the AM-PAC IMSF. The reference rater and clinical PTs were blinded to each other's scores with a minimum of 10 assessments completed by each clinical PT. Bland-Altman plots were constructed and intra-class correlation coefficients (ICC) were computed using a random intercept (physical therapy session) model. Results: Eighty one assessments (five patients assessed twice) were scored by both a clinical PT and reference rater PT (total assessments = 162). Bland-Altman plots revealed a mean difference in AM-PAC IMSF scoring of 0.0 (95% limits of agreement: −3.0 to +3.0), with an ICC (95% confidence interval) of 0.957 (0.947-0.964). The ICC (95% confidence interval) for patients in surgical, medical and neurological ICUs was

Clinical instruments for bedside functional assessment: Convergent validity among the AM‐PAC ‘6‐Clicks’ and BMAT

“…The '6-Clicks' tool is a commonly used instrument to measure mobility (Jette et al, 2007;Jette et al, 2014aJette et al, , 2014b in acute and post-acute settings (Dima et al, 2020;Hiser et al, 2020;Hoyer et al, 2018). In this study, the lowest level of convergent validity was seen in the Orthopaedic admitting service.…”

An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients

“…The AM‐PAC is scored based on the amount of assistance a patient needs to complete specific mobility tasks (e.g., getting out of bed) and is completed by clinicians based on patient input, observation, clinician judgment or input from family members of a patient's capacity for mobility. It has been shown to be valid in this population and to have excellent interrater reliability between nursing and physical therapy (Hiser et al, 2020; Hoyer et al, 2017; Jette et al, 2015). The JH‐MGC is displayed in Figure 1 with AM‐PAC scores on the left and corresponding JH‐HLM goals on the right.…”

Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study

“…11 In clinical practice at Essentia Health, total scores and percent impairment are calculated in the EHR based on item scores entered into an electronic flowchart by occupational and physical therapists. In this study, scale scores were calculated from total scores to allow for comparison with research by Jette et al 9 Previous research on the reliability of 6-Clicks showed high overall intraclass correlation coefficients in the general acute care patient population (daily activity=0.783, basic mobility=0.849), 11 within an intensive care unit (ICU) patient population (basic mobility=0.957), 20 and within a neuroscience inpatient department (basic mobility: physical therapist pairs=0.91, nurse pairs=0.97). 21 However, intraclass correlation coefficient ranges between rater pairs were more variable in the general acute care patient population, as were weighted kappa scores, with more variability seen between occupational therapists than physical therapists.…”