The Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A Prospective Cohort Study

Thrush, Aaron; Rozek, Melanie; Dekerlegand, Jennifer

doi:10.2522/ptj.20110412

Cited by 101 publications

(77 citation statements)

References 10 publications

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“…The Functional Status Score for ICU (FFS-ICU) is also in development [15]. The FSS-ICU has more similarities to the CPAx scale, in that it grades patients on a Guttman scale from 1 to 7, dependent on their level of assistance required, and it assesses five of the same functional tasks: ambulation, rolling, sitting, supine to sitting, and sit-to-stand transfers.…”

Section: Discussionmentioning

confidence: 99%

“…The University of Rochester Acute Care Evaluation (URACE) [14] and the Functional Status Score for Intensive Care (FSS-ICU) [15] are both functional scoring systems from North America in the early stages of development. Both are potentially useful; however, they are very much in their infancy, and further psychometric evaluation is essential.…”

Section: Introductionmentioning

confidence: 99%

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Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

et al. 2014

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IntroductionIntensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Although ICU-AW is well described subjectively in the literature, the value of objective measures has yet to be established. This project aimed to evaluate the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing the association between CPAx scores and hospital-discharge location, as a measure of functional outcome.MethodsThe CPAx was integrated into practice as a service-improvement initiative in an 11-bed intensive care unit (ICU). For patients admitted for more than 48 hours, between 10 May 2010 and 13 November 2013, the last CPAx score within 24 hours of step down from the ICU or death was recorded (n = 499). At hospital discharge, patients were separated into seven categories, based on continued rehabilitation and care needs. Descriptive statistics were used to explore the association between ICU discharge CPAx score and hospital-discharge location.ResultsOf the 499 patients, 171 (34.3%) returned home with no ongoing rehabilitation or care input; 131 (26.2%) required community support; 28 (5.6%) went to inpatient rehabilitation for <6 weeks; and 25 (5.0%) went to inpatient rehabilitation for >6 weeks; 27 (5.4%) required nursing home level of care; 80 (16.0%) died in the ICU, and 37 (7.4%) died in hospital. A significant difference was found in the median CPAx score between groups (P < 0.0001). Four patients (0.8%) scored full marks (50) on the CPAx, all of whom went home with no ongoing needs; 16 patients (3.2%) scored 0 on the CPAx, all of whom died within 24 hours. A 0.8% ceiling effect and a 3.2% floor effect of the CPAx is found in the ICU. Compliance with completion of the CPAx stabilized at 78% of all ICU admissions.ConclusionThe CPAx score at ICU discharge has displayed construct validity by crudely discriminating between groups with different functional needs at hospital discharge. The CPAx has a limited floor and ceiling effect in survivors of critical illness. A significant proportion of patients had a requirement for postdischarge care and rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

et al. 2014

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“…However, there is no consensus in the profession to the tool of choice. Some of the frequently used outcome measures are the Barthel Index, 4,5 the Berg balance scale, 6 the Functional Independence Measure (FIM), 7,8 the Functional Status Score for the Intensive Care Unit (FSS-ICU) scale, 9,10 the Physical Function ICU Test (PFIT), 1 the Perme Intensive Care Unit Mobility scale, 11 and the Short Form-36. 12 Several studies were carried out to investigate the clinical use of these outcome tools.…”

mentioning

confidence: 99%

The Functional Status Score for the Intensive Care Unit Scale: Is It Reliable in the Intensive Care Unit? Can It Be Used to Determine Discharge Placement?

Ragavan

Greenwood

Bibi

2016

Journal of Acute Care Physical Therapy

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The authors have no conflicts of interest and no source of funding to declare. ABSTRACTPurpose: To date there is little available information about the reliability of the Functional Status Score for the Intensive Care Unit (FSS-ICU) scale in the intensive care unit (ICU) environment. The purpose of this study is 2-fold: first to determine the FSS-ICU scale's interrater reliability; second to examine whether a relationship exists between a patient's FSS-ICU score on the day of ICU-to-regular ward transfer and the patient's ultimate discharge destination. Methods:The interrater reliability of the FSS-ICU scale was tested among 6 physical therapists who routinely worked in the ICU. The FSS-ICU scores on the day of ICU-to-ward transfer and final discharge destination were collected prospectively from 26 patients who received physical therapy intervention. Discharge destinations were divided into 5 categories: home, acute rehabilitation unit (ARU), skilled nursing facility (SNF), assisted living facility (ALF), and others. Results:Interrater reliability of the FSS-ICU scale was high (intraclass correlation coefficient = 0.992, 95% confidence interval) among the physical therapists who routinely worked in the ICU settings, and the median cumulative FSS-ICU scores on the day of ICU-to-ward transfer were significantly different among each of the discharge categories.

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“…This is based on several factors: 1) more physical therapists/personnel would have allowed more frequent measurement of functional and other quality of lifestyle parameters, as well as follow-up of patient outcomes after discharge from the LTACH; 2) the intermediate nature of outcome measures themselves (handgrip, SPPB, 4 gait speed, and 6 MWD) reduced their sensitivity (floor effect) to detect smaller, meaningful changes; and 3) other assessments, such as the Functional Status Scale for the ICU [42], the Chelsea Critical Care Physical Assessment [43], and the ICU mobility scale [44] may have provided additional insights into these patients’ functional status and response to our rehabilitation program, but were not yet validated in this population or available at the start of this pilot. Lastly, although feasibility of the MRP may be questioned since only 15% of those who met criteria enrolled into the study, we maintained strict inclusion and exclusion criteria, since we did not have ample therapists to insure patients’ safety if we enrolled more functionally impaired patients who might not safely tolerate the MRP.…”

Section: Discussionmentioning

confidence: 99%

A multimodal rehabilitation program for patients with ICU acquired weakness improves ventilator weaning and discharge home

Verceles

Wells

Sorkin

et al. 2018

Journal of Critical Care

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Purpose To compare the effects of adding a progressive multimodal rehabilitation program to usual care (MRP + UC) versus UC alone on 1) functional mobility, strength, endurance and 2) ventilator weaning and discharge status of patients with ICU-acquired weakness (ICUAW) receiving prolonged mechanical ventilation (PMV). Methods Randomized pilot trial of an individualized MRP + UC versus UC in middle-aged and older ICU survivors with ICUAW receiving PMV. Outcomes compare changes in strength, mobility, weaning success and discharge home from a long-term acute care hospital (LTACH) between the groups. Results Eighteen males and 14 females (age 60.3 ± 11.9 years) who received PMV for ≥14 days were enrolled. Despite no significant differences between groups in the changes in handgrip, gait speed, short physical performance battery or 6-min walk distance after treatment, the MRP + UC group had greater weaning success (87% vs. 41%, p < 0.01), and more patients discharged home than UC (53 vs. 12%, p = 0.05). Post hoc analyses, combining patients based on successful weaning or discharge home, demonstrated significant improvements in strength, ambulation and mobility. Conclusion The addition of an MRP that improves strength, physical function and mobility to usual physical therapy in LTACH patients with ICUAW is associated with greater weaning success and discharge home than UC alone.

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The Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A Prospective Cohort Study

Abstract: Patients receiving therapy at an LTACH demonstrate significant improvements from admission to discharge using the FSS-ICU. This outcome tool discriminates among discharge settings and successfully documents functional improvements of patients in an LTACH setting.

Cited by 101 publications

References 10 publications

Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

The Functional Status Score for the Intensive Care Unit Scale: Is It Reliable in the Intensive Care Unit? Can It Be Used to Determine Discharge Placement?

A multimodal rehabilitation program for patients with ICU acquired weakness improves ventilator weaning and discharge home

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