Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
Heart Lung. 2014 Jan-Feb;43(1):19-24. doi: 10.1016/j.hrtlng.2013.11.003. Epub 2013 Nov 19.
The objectives of this study were to develop a scale for measuring the highest level of mobility in adult ICU patients and to assess its feasibility and inter-rater reliability.
Growing evidence supports the feasibility, safety and efficacy of early mobilization in the intensive care unit (ICU). However, there are no adequately validated tools to quickly, easily, and reliably describe the mobility milestones of adult patients in ICU. Identifying or developing such a tool is a priority for evaluating mobility and rehabilitation activities for research and clinical care purposes.
This study was performed at two ICUs in Australia. Thirty ICU nursing, and physiotherapy staff assessed the feasibility of the 'ICU Mobility Scale' (IMS) using a 10-item questionnaire. The inter-rater reliability of the IMS was assessed by 2 junior physical therapists, 2 senior physical therapists, and 16 nursing staff in 100 consecutive medical, surgical or trauma ICU patients.
An 11 point IMS scale was developed based on multidisciplinary input. Participating clinicians reported that the scale was clear, with 95% of respondents reporting that it took <1 min to complete. The junior and senior physical therapists showed the highest inter-rater reliability with a weighted Kappa (95% confidence interval) of 0.83 (0.76-0.90), while the senior physical therapists and nurses and the junior physical therapists and nurses had a weighted Kappa of 0.72 (0.61-0.83) and 0.69 (0.56-0.81) respectively.
The IMS is a feasible tool with strong inter-rater reliability for measuring the maximum level of mobility of adult patients in the ICU.
本研究旨在开发一种测量成人 ICU 患者最高移动水平的量表，并评估其可行性和评分者间信度。
越来越多的证据支持 ICU 中早期活动的可行性、安全性和有效性。然而，目前尚无经过充分验证的工具可快速、简便、可靠地描述 ICU 成人患者的移动里程碑。确定或开发此类工具是评估移动性和康复活动以用于研究和临床护理目的的当务之急。
该研究在澳大利亚的 2 家 ICU 进行。30 名 ICU 护理和物理治疗人员使用 10 项问卷评估“ICU 移动量表（IMS）”的可行性。2 名初级物理治疗师、2 名高级物理治疗师和 16 名护理人员对 100 例连续的内科、外科或创伤 ICU 患者进行了 IMS 的评分者间信度评估。
根据多学科的意见制定了 11 分 IMS 量表。参与临床医生报告称，该量表清晰易懂，95%的受访者报告称完成量表评估不到 1 分钟。初级和高级物理治疗师的评分者间信度最高，加权 Kappa（95%置信区间）为 0.83（0.76-0.90），而高级物理治疗师和护士以及初级物理治疗师和护士的加权 Kappa 分别为 0.72（0.61-0.83）和 0.69（0.56-0.81）。
IMS 是一种可行的工具，具有较强的评分者间信度，可用于测量 ICU 成人患者的最大移动水平。
