The Six-Clicks Mobility Measure: A Useful Tool for Predicting Discharge Disposition

Pfoh, Elizabeth R.; Hamilton, Aaron; Hu, Bo; Stilphen, Mary; Rothberg, Michael B.

doi:10.1016/j.apmr.2020.02.016

Cited by 32 publications

(33 citation statements)

References 17 publications

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“…Our results confirm and extend those of other studies demonstrating a link between functional impairments and discharge destination in COVID-19, 7 as well those supporting the prognostic significance of AM-PAC scores in mixed 13,23 and diagnosis-specific patient groups. 11,24 The similarity in the threshold scores and accuracy of prediction between this and other [11][12][13] demonstrate that the relationship between AM-PAC scores and discharge destination is robust, and applicable even in the setting of a global pandemic.…”

Section: Discussionsupporting

confidence: 92%

Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

Tevald

Clancy

Butler

et al. 2021

Archives of Physical Medicine and Rehabilitation

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OBJECTIVE To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with COVID-19. DESIGN Retrospective cohort study SETTING An academic health system in the United States consisting of five inpatient hospitals. PARTICIPANTS Adult patients (N=1486) urgently or emergently admitted, tested positive for COVID-19, and had at least 1 AM-PAC assessment. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES Discharge destination, hospital length of stay, in-hospital mortality, and readmission. RESULTS 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (OR = 0.867 and 0.833, respectively) and activity scores (OR = 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (AUC = 0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, while specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (OR = 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged LOS (OR = 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC = 0.659-0.679). AM-PAC scores did not predict re-hospitalization. CONCLUSION Functional status as measured by the AM-PAC “6-clicks” measures of mobility and activity are independent predictors of key clinical outcomes individual hospitalized with COVID-19.

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Section: Discussionsupporting

confidence: 92%

Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

Tevald

Clancy

Butler

et al. 2021

Archives of Physical Medicine and Rehabilitation

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“…As an example, research partnerships at Cleveland Clinic and Johns Hopkins have explored the potential of functional assessments to predict discharge disposition among hospitalized patients. [18][19][20] Despite these growing areas of research in acute care, considerable work remains to generate the evidence needed to optimize physical therapy delivery in the inpatient setting. We need to improve our ability to quantify patients' multidimensional care needs and identify actionable targets that may be achieved during hospitalization with appropriate allocation of skilled therapy services.…”

mentioning

confidence: 99%

Physical Therapy in the COVID-19 Pandemic: Forging a Paradigm Shift for Rehabilitation in Acute Care

Keeney

2020

Physical Therapy

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“…For our full sample, we found higher AUC for 6-Clicks scores related to discharge disposition to SNFs or to institutions generally than a number of recent studies. This includes findings from a study with adults age 55 and over with cardiovascular disease, 7 as well as research with general acute care patients receiving rehabilitation 13 15 and patients in ICUs. 14 Our results also showed higher AUC for our diagnostic groups of patients admitted for trauma, spinal fusions excluding cervical or major lower joint replacements or Open access reattachments than either our full sample or other research for both discharge to SNFs, as well as to other institutions.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence supports the use of the Activity Measure for Post-Acute Care (AM-PAC) 5 6 '6-Clicks' inpatient daily activity and basic mobility short forms, which are standardised functional assessment tools for predicting the discharge disposition of medical and surgical hospital inpatients. [7][8][9][10][11][12][13][14][15] 6-Clicks assesses two functional domains: daily activities (eg, self-care, such as dressing and toileting) and basic mobility (eg, movement, such as walking and moving from one position to another). 9 12 Items represent types of activities occupational and physical therapists routinely assess in acute care settings and those important when evaluating patients for postacute care.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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

et al. 2021

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ObjectivesTo evaluate the predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled nursing facilities, including by diagnostic group (trauma injury, major lower joint replacement/reattachment, spinal fusion excluding cervical), as well as assess the effect of the short forms on 30-day inpatient readmissions.DesignRetrospective, observational cohort study of electronic health record data.SettingFive hospitals in a multistate, integrated healthcare system serving a large, rural US population.ParticipantsThe population-based adult (age ≥18) sample of acute care hospitalised patients receiving rehabilitation services included 10 316 patients with 12 314 hospital admissions from the year prior to 6-Clicks implementation (1 June 2015–31 May 2016) (pre-6-Clicks cohort) and 10 931 patients with 13 241 admissions from the year after 6-Clicks implementation (1 January 2017–31 December 2017) (post-6-Clicks cohort). Patients were admitted for major lower joint replacement/reattachment, spinal fusion excluding cervical, trauma injury or another reason.InterventionOccupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort.Primary and secondary outcomesDischarge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions.ResultsAreas under the receiver operating characteristic curve were 0.82–0.92 (daily activity) and 0.87–0.94 (basic mobility) for discharge to home or skilled nursing facilities, with trauma and spinal fusion patients having the highest values. Daily activity and basic mobility standardised positive and negative predictive values were highest for the three diagnostic groups compared with the full study sample. Few significant differences in 30-day readmissions were seen between pre- and post-6-Clicks cohorts.Conclusions6-Clicks performed well when distinguishing between discharge home or skilled nursing facilities, especially by diagnostic group, supporting use by occupational and physical therapists in discharge planning. Future research could assess where additional intervention or training may reduce 30-day readmissions.

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The Six-Clicks Mobility Measure: A Useful Tool for Predicting Discharge Disposition

Cited by 32 publications

References 17 publications

Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

Physical Therapy in the COVID-19 Pandemic: Forging a Paradigm Shift for Rehabilitation in Acute Care

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

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