Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties

Abstract

Introduction It is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear. Methods A systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness. Results Fourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures. Conclusion Evidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.

Patient Perspectives on Key Outcomes for Vocational Rehabilitation Interventions Following Traumatic Injury

“…Injuries result in substantial disability, accounting in 2013 for 10% of disability-adjusted life years [ 2 ] globally. Problems with physical [ 5 ], psychological [ 6 ], social [ 7 ], and occupational functioning [ 8 ], pain [ 9 ] reduced quality of life [ 10 ], and fatigue [ 11 ] are common post-injury, with many trauma survivors experiencing long-term disability [ 12 ].…”

Monitoring independence in daily life activities after trauma in humanitarian settings: Item reduction and assessment of content validity of the Activity Independence Measure-Trauma (AIM-T)

“…The monitoring and evaluation of quality of trauma care is essential to inform policy and clinical decision making, but also to adapt interventions at different levels [5,6]. Survival rates, occurrence of secondary complications and 'process indicators', such as length of stay, are commonly used measures to monitor quality of trauma care [7][8][9]. A patient's functioning, particularly in terms of independence in meaningful daily activities and participation in life situations following trauma care, is now also increasingly recognized [7,[10][11][12][13].…”

“…Survival rates, occurrence of secondary complications and 'process indicators', such as length of stay, are commonly used measures to monitor quality of trauma care [7][8][9]. A patient's functioning, particularly in terms of independence in meaningful daily activities and participation in life situations following trauma care, is now also increasingly recognized [7,[10][11][12][13]. However, the most common measures of functioning used in trauma research were not originally developed for patients after trauma [6].…”

Nursing interventions and activities for patients with multiple traumas: An integrative review

“…Furthermore, these patients with trauma usually present changes in mobility, which can be temporary or permanent problems. Movement restriction affects the performance of most daily living activities and also increases the risk of complications from immobility (Calthorpe et al., 2019). As a consequence, mobility changes are usually reflected in the most common Nursing Diagnosis: Impaired Physical Mobility (00085), defined as a “limitation of independent and purposeful physical movement of the body or one or more extremities” (Herdman et al., 2021, p. 284).…”

“…Health care teams and patients’ understanding and perceptions of bed rest greatly influence successful early mobilization and specific nursing interventions and activities. Integrating a multidisciplinary mobility program in the acute care setting can decrease secondary complications and hospital length of stay ultimately improving patient outcomes (Calthorpe et al., 2019).…”