The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study

Abstract

Objective To develop a scoring system to measure physical morbidity in critical care -the Chelsea Critical Care Physical Assessment Tool (CPAx). Method The development process was iterative involving content validity indices (CVI), a focus group and an observational study of 33 patients to test construct validity against the Medical Research Council score for muscle strength, peak cough flow, Australian Therapy Outcome Measures score, Glasgow Coma Scale score, Bloomsbury sedation score, Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score, days of mechanical ventilation and inter-rater reliability. Participants Trauma and general critical care patients from two London teaching hospitals. Results Users of the CPAx felt that it possessed content validity, giving a final CVI of 1.00 (P < 0.05). Construct validation data showed moderate to strong significant correlations between the CPAx score and all secondary measures, apart from the mental component of the SF-36 which demonstrated weak correlation with the CPAx score (r = 0.024, P = 0.720). Reliability testing showed internal consistency of α = 0.798 and inter-rater reliability of κ = 0.988 (95% confidence interval 0.791 to 1.000) between five raters. Conclusion This pilot work supports proof of concept of the CPAx as a measure of physical morbidity in the critical care population, and is a cogent argument for further investigation of the scoring system.

Nursing Interventions: Effects of Coma Arousal Technique on the Clinical Outcomes of Unconscious Patients

“…It is hoped that with intense and repetitive stimulation, the patient will awaken and return to a higher level of functioning. Coma arousal therapy is believed to provide the sensory stimulation needed to activate the reticular system, which is responsible for maintaining consciousness (Corner et al, 2012) (20) . So, the critical care nurse play a more active and meaningful role through application of coma arousal technique into the conventional care for patients with altered level of consciousness to enhance recovery (Christakou et al,2013) (21) .…”

“…The shift in these bio-chemicals has been proven to decrease anxiety, depression, hyperactivity and in attention ((Mandeep et al, 2013) (30) . Additionally, touch has been shown to increase the immune system's cytotoxic capacity, thereby helping our body maintain its defenses against pathogens (Corner et al, 2012) (20) . This may explain why patients in the study group displayed more comfort behaviors as measured by MASS than the control group.…”

The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: An observational study

“…The Chelsea Critical Care Physical Assessment (CPAx) tool is a functional scoring system designed and validated for general ICU patients [8,9]. It is comprised of ten commonly assessed components of physical function, which are graded on a Guttman scale from dependent to independent (0-5), giving an overall score from zero to fifty.…”

Validez y confiabilidad de las escalas de evaluación funcional en pacientes críticamente enfermos. Revisión sistemática

“…El tamaño muestral de los estudios varió entre 20 y 116 participantes, en total fueron 302 participantes, de los cuales 48,2% eran hombres y 51,8% mujeres. Un estudio no reportó el tamaño muestral según sexo 38,39 . En 2 estudios se describió la edad de la muestra, cuyos promedios fueron entre 51,0 y 64,5 años [40][41][42][43] (Tabla 1).…”

“…Los principales factores de riesgo para el desarrollo de la DAUCI son el reposo prolongado en cama, la hiperglicemia, la sepsis, el uso de corticoesteroides y bloqueadores neuromusculares 1, [3][4][5][6][7][8][9][10][11][12] . Fisiopatológicamente, estos factores se asocian con un desbalance entre la síntesis y degradación de proteínas musculares, asociado a necrosis de las miofibrillas, produciéndose una disminución rápida y significativa de la masa muscular que puede llegar a 15% los primeros 7 días de la enfermedad crítica, además de una disminución de la densidad mineral ósea 13,14 .…”