Sommers Juultje, Vredeveld Tom, Lindeboom Robert, Nollet Frans, Engelbert Raoul H H, van der Schaaf Marike
J. Sommers, PT, MSc, Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
T. Vredeveld, PT, MSc, Education of Physical Therapy, ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
Phys Ther. 2016 Oct;96(10):1658-1666. doi: 10.2522/ptj.20150339. Epub 2016 Apr 14.
Intensive care unit (ICU) stays often lead to reduced physical functioning. Change in physical functioning in patients in the ICU is inadequately assessed through available instruments. The de Morton Mobility Index (DEMMI), developed to assess mobility in elderly hospitalized patients, is promising for use in patients who are critically ill.
The aim of this study was to evaluate the clinimetric properties of the DEMMI for patients in the ICU.
A prospective, observational reliability and validity study was conducted.
To evaluate interrater and intrarater reliability (intraclass correlation coefficients), patients admitted to the ICU were assessed with the DEMMI during and after ICU stay. Validity was evaluated by correlating the DEMMI with the Barthel Index (BI), the Katz Index of Independence in Activities of Daily Living (Katz ADL), and manual muscle testing (MMT). Feasibility was evaluated based on the percentage of participants in which the DEMMI could be assessed, the floor and ceiling effects, and the number of adverse events.
One hundred fifteen participants were included (Acute Physiology and Chronic Health Evaluation II [APACHE II] mean score=15.2 and Sepsis-related Organ Failure Assessment [SOFA] mean score=7). Interrater reliability was .93 in the ICU and .97 on the wards, whereas intrarater reliability during the ICU stay was .68. Validity (Spearman rho coefficient) during the ICU stay was .56, -.45, and .57 for the BI, Katz ADL, and MMT, respectively. The DEMMI showed low floor and ceiling effects (2.6%) during and after ICU discharge. There were no major adverse events.
Rapid changes in participants' health status may have led to underestimation of intrarater reliability.
The DEMMI was found to be clinically feasible, reliable, and valid for measuring mobility in an ICU population. Therefore, the DEMMI should be considered a preferred instrument for measuring mobility in patients during and after their ICU stay.
重症监护病房（ICU）住院常常导致身体机能下降。现有的评估工具对ICU患者身体机能变化的评估并不充分。德莫顿运动指数（DEMMI）是为评估老年住院患者的活动能力而开发的，有望用于危重病患者。
本研究旨在评估DEMMI在ICU患者中的测量学特性。
进行了一项前瞻性观察性可靠性和有效性研究。
为评估评分者间和评分者内的可靠性（组内相关系数），在ICU住院期间及出院后，使用DEMMI对入住ICU的患者进行评估。通过将DEMMI与巴氏指数（BI）、日常生活活动能力的凯茨独立指数（Katz ADL）和徒手肌力测试（MMT）进行相关性分析来评估有效性。基于能够进行DEMMI评估的参与者百分比、地板效应和天花板效应以及不良事件数量来评估可行性。
纳入了115名参与者（急性生理与慢性健康状况评分系统II [APACHE II]平均评分为15.2，脓毒症相关器官功能衰竭评估 [SOFA]平均评分为7）。在ICU中评分者间可靠性为0.93，在病房为0.97，而在ICU住院期间评分者内可靠性为0.68。在ICU住院期间，与BI、Katz ADL和MMT的有效性（斯皮尔曼等级相关系数）分别为0.56、-0.45和0.57。在ICU出院期间及之后，DEMMI显示出较低的地板效应和天花板效应（2.6%）。未发生重大不良事件。
参与者健康状况的快速变化可能导致对评分者内可靠性的低估。
发现DEMMI在测量ICU患者的活动能力方面具有临床可行性、可靠性和有效性。因此，DEMMI应被视为测量ICU患者住院期间及出院后活动能力的首选工具。
