Abstract
Background and Purpose Long-term acute care hospitals (LTACHs) have emerged for patients requiring medical care beyond a short stay. Minimal data have been reported on functional outcomes in this setting. The purposes of this study were: (1) to measure the clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) in an LTACH setting and (2) to explore the association between FSS-ICU score and discharge setting.
Participants Data were obtained from 101 patients (median age=70 years, interquartile range [IQR]=61–78; 39% female, 61% male) who were admitted to an LTACH. Participants were categorized into 1 of 5 groups by discharge setting: (1) home (n=14), (2) inpatient rehabilitation facility (n=26), (3) skilled nursing facility (n=23), (4) long-term care/hospice/expired (n=13), or (5) transferred to a short-stay hospital (n=25).
Methods Data were prospectively collected from a 38-bed LTACH in the United States over 8 months beginning in September 2010. Functional status was scored using the FSS-ICU within 4 days of admission and every 2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling, supine-to-sit transfers, unsupported sitting, sit-to-stand transfers, and ambulation. Each category was rated from 0 to 7, with a maximum cumulative FSS-ICU score of 35.
Results Cumulative FSS-ICU scores significantly improved from a median (IQR) of 9 (3–17) to 14 (5–24) at discharge. Median (IQR) cumulative discharge FSS-ICU scores were significantly different among the discharge categories: home=28 (22–32), inpatient rehabilitation facility=21 (15–24), skilled nursing facility=14 (8–21), long-term care/hospice/expired=5 (0–11), and transfer to a short-stay hospital=4 (0–7).
Discussion and Conclusions 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.
Long-term acute care hospitals (LTACHs) have emerged to provide care for patients who are critically ill and require medical treatment beyond the scope of a short-stay acute care hospital.1,2 Patients in an LTACH setting often are described as “chronically critically ill.” This term was coined by Girard and Raffin in a publication that described a group of patients who survived an initial episode of critical illness due to advances in intensive care, but remained dependent on intensive care measures.3 The chronically critically ill population presents unique challenges associated with prolonged dependence on mechanical ventilation and other intensive care therapies to address organ failure, infections, multiple comorbidities, and extensive skin, nutrition, and rehabilitative needs.2,4,5 Due to the longevity of care these patients require, it is medically and financially beneficial for short-term acute care hospitals to transfer them to facilities such as LTACHs.2
One study showed that 84.8% of patients admitted to LTACHs with ventilator dependency required physical therapy services.4 In that study, physical therapy and occupational therapy were found to be the second and third most common services accessed in an LTACH setting.4 The rapid growth of this population of patients would benefit from the skills and interventions that physical therapists can provide.
The importance of utilizing standardized outcome measures in physical therapist practice has been well documented and accepted as best practice.6 Despite increasing evidence supporting the role of physical therapists in the critical care environment, minimal data have been reported on how to measure functional improvements and outcomes of patients in an LTACH setting. One challenge is identifying an outcome measure that is adequately sensitive to the wide variety of functional statuses of patients at an LTACH, including those with a low functional level. Data collection in the critical care environment often utilizes “severity of illness” measures, such as the Acute Physiology and Chronic Health Evaluation (APACHE II), or mortality rates, with functional scales appearing less frequently. One reported functional measure is the Zubrod Score, a 5-point scale for global functional status (from a “fully active” rating of 0 to a “bedridden, no self-care” rating of 4). The broad categories of the Zubrod Score limit the usefulness for physical therapist practice.5 The Zubrod Score is reported in the literature as useful in measuring the functional level of patients in the weeks, months, and years following discharge from critical care episodes. This length of time is too broad to be sensitive for change that occurs during critical care hospitalization.7–9
Other measures that have been utilized in a limited capacity in critical care environments include the Johns Hopkins Hospital Function Acute Care Score (JHH-FACS), the University of Rochester Acute Care Evaluation (URACE), and the Functional Independence Measure (FIM). DiCicco and Whalen described the JHH-FACS and URACE as scoring systems that do not adequately quantify the functional abilities of patients in acute care who are bed-bound and have a lower level of function and as systems that are confusing and difficult to remember.10 The FIM is challenging to use in clinical practice at an LTACH due to the large number of items to score. The FIM also is designed to be multidisciplinary11 and includes high-level tasks such as performance on stairs. Additionally, the FIM consolidates all transfer types (from bed mobility to standing transfers) into one task, which may lead to a floor effect for the chronically critically ill population. The literature describing the use of the FIM for critical care environments states that it often is used in a self-report format several months after admission to an intensive care unit (ICU).12
The Physical Function ICU Test (PFIT) was recently described in a sample of 13 patients who were able to sit out of bed, stand from a chair, and march in place.13 Many patients in an LTACH setting are not able to perform these out-of-bed tasks. Additionally, the PFIT does not assess ambulation. As such, the PFIT is likely to have both floor and ceiling effects in an LTACH population. The PFIT did demonstrate reliability and good responsiveness to change,13 and thus may be advantageous to use as a supplement for documenting changes in mobility for a subpopulation identified in the critical care environment.
A recent publication demonstrated success with a novel measure, the Functional Status Score for the Intensive Care Unit (FSS-ICU), in a small sample of patients in a medical ICU.14 The FSS-ICU contains 2 functional tasks from the FIM and 3 additional tasks that are relevant and feasible to perform in the ICU setting. All 5 functional tasks are evaluated using the 7-point scoring system of the FIM, with higher scores indicating higher function. Zanni and colleagues used the FSS-ICU to describe the impairments of patients receiving therapy services in an ICU setting.14 However, this investigation included a small sample of patients located in a short-stay acute care hospital, requiring further research to investigate the utility of this measure in other physical therapist practice settings.
Building on the preliminary success of the FSS-ICU in a short-stay intensive care setting and the lack of other feasible functional outcomes, the purposes of our study were: (1) to measure the clinical utility of the FSS-ICU in an LTACH population and (2) to explore the association between FSS-ICU score and discharge setting.
Method
Data were prospectively collected from a 38-bed LTACH during a consecutive 8-month period beginning in September 2010. This project was initiated as a quality improvement initiative and was granted exempt status by the University of Pennsylvania Institutional Review Board to retrospectively extract the data. The patients were obtained from an LTACH located in an urban setting affiliated with a local academic medical center. As with other LTACHs, patient care was provided by a physician-led interdisciplinary team of medical professionals that included registered nurses, physical therapists, occupational therapists, speech therapists, case managers, clinical dietitians, and respiratory therapists. The therapy department staff consisted of 4 full-time equivalent physical therapists and 2 full-time equivalent occupational therapists.
Participants
All patients consecutively admitted to the LTACH from September 2010 to April 2011 were enrolled in the study. This time period was arbitrarily chosen by the clinicians to be feasible for quality improvement purposes. Patient demographics and outcome data were abstracted from the electronic patient medical record and are shown in Table 1.
Patient Characteristics (n=101)
Procedure
Functional status was assessed using the FSS-ICU as described by Zanni et al.14 The FSS-ICU is an ordinal scale similar to the FIM used in inpatient rehabilitation facilities, for which functional categories are rated on a scale from 1 to 7. The FSS-ICU includes tasks more appropriate for patients who are critically ill. The FSS-ICU consists of 3 preambulation categories (ie, rolling, supine-to-sit transfers, and unsupported sitting) and 2 ambulation categories (ie, sit-to-stand transfers and ambulation). Each functional category is rated using a scale of 1 to 7, with a score of 1 corresponding to total dependent assistance and score of 7 corresponding to complete independence. Similar to the Zanni et al study,14 a score of 0 is assigned if a patient is unable to perform a task due to physical limitations or medical status. Summation of the 5 categories provided a cumulative FSS-ICU score ranging from 0 to 35. Additional self-care and cognition categories were tested by the occupational therapists, but are not included in this article due to lack of consensus regarding the most appropriate tasks to assess. No information has previously been reported on the reliability of the FSS-ICU. We did not assess the reliability of this measure in our study because it was originally initiated as a quality improvement project, not a research study.
Admission FSS-ICU scores were completed by recording the lowest observed score for each FSS-ICU task over the first 4 days of admission (excluding weekend days, when no therapy services were provided). This procedure is similar to that of inpatient rehabilitation facilities (IRFs), which collect FIM scores during a 3-day period. Using the lowest observed score reflects the burden of care a patient requires at his or her worst performance level rather than at his or her best performance level. We chose to utilize a 4-day admission period rather than a 3-day period to allow increased opportunity to observe all 5 functional activities in this population with greater mobility limitations compared with an IRF population.
The FSS-ICU was reassessed at 14-day intervals to ensure regularly collected data. The lowest score that was observed for each FSS-ICU task in the final 3 days of the 14-day interval was recorded, again to allow increased opportunity to observe all 5 functional activities. We chose to reassess participants biweekly (instead of 24 hours prior to discharge as in IRFs) because unexpected discharges frequently occur with patients in LTACH settings. Thus, the last recorded biweekly reassessment occurring before discharge was used in the analysis as the discharge FSS-ICU score. The number of days between the last recorded biweekly assessment and the actual discharge date was determined.
For continuity of care, all attempts were made to have a single physical therapist complete the FSS-ICU assessment and provide a patient's care throughout the entire episode. Physical therapy interventions focused on early mobilization and consisted of functional tasks, therapeutic exercise, and balance activities that varied according to each patient's individual impairments and limitations. Occupational therapy interventions primarily included cognitive assessment and retraining, activities of daily living-related training, and group therapy sessions for social, behavioral, and physical interventions.
All therapists involved in the investigation were certified in the use of the FIM and worked frequently in the IRF located in the same hospital building. Additionally, the IRF's FIM coordinator provided an in-service to LTACH staff for supplemental training and remained available for consultation as needed. Routine communication occurred with the LTACH therapy staff to standardize FSS-ICU scoring.
Data Analysis
All statistical analyses were performed using SPSS for Windows version 18 (SPSS Inc, Chicago, Illinois). Descriptive statistics were used to define the cohort demographics and included median and interquartile range (IQR) for continuous variables and frequency for categorical data. Change scores were calculated by subtracting the admission cumulative FSS-ICU score from the discharge cumulative FSS-ICU score. A median (IQR) change score was computed for the entire sample and for each of the 5 discharge categories. Effect size was used to determine the magnitude of change in total FSS-ICU scores by calculating the difference between the median admission FSS-ICU score and the median discharge FSS-ICU score divided by the baseline IQR. Using the recommendations by Cohen, an effect size of 0.20 is small, 0.50 is moderate, and 0.80 or greater is considered large.15 A Wilcoxon signed ranks test was used to assess for differences between initial and discharge FSS-ICU scores. A Kruskal-Wallis test was used to compare the FSS-ICU scores by discharge setting. A P value of less than .05 was considered statistically significant for all analyses.
Results
One hundred thirteen patients were admitted to the LTACH during the 8-month period. One hundred one patients were included in the final analyses after exclusions were made for missing data (7), discharge from the therapy caseload (3), and physical therapy services not indicated (2) (Fig. 1). Patients were categorized into 1 of 5 groups by discharge setting as obtained from the medical record. These categories were home, acute IRF, skilled nursing facility (SNF), long-term care/hospice/expired, and transfer to a short-stay hospital (transfer). The long-term care/hospice/expired category included 5 patients discharged to a nursing home, 2 patients discharged to hospice, and 6 patients who expired at the facility. Patients discharged to a nursing home were placed in the long-term care category, as they no longer had skilled therapy goals.
Flow diagram of patients included in the final cohort for analysis. One hundred thirteen patients were admitted to the long-term acute care hospital (LTACH) over 8 months, and 111 patients received physical therapist examinations with baseline Functional Status Score for the Intensive Care Unit (FSS-ICU) scores. Ten patients were excluded, with 101 patients in the final cohort for analysis. SNF=skilled nursing facility, IRF=inpatient rehabilitation facility.
The characteristics of the cohort were collected retrospectively by chart review and are shown in Table 1. The majority of the patients were male (61%), with a median (IQR) age of 70.0 (61–78) years. Seventy-seven percent of the patients required ventilator support upon admission to the LTACH, with three quarters of the cohort admitted with a primary medical diagnosis of ventilator-dependent respiratory failure (78%). The median (IQR) length of stay for this cohort was 24 (19–43) days. Patients in this cohort received a median (IQR) of 3.3 (2.5–3.9) physical therapy sessions and 1.9 (1.2–2.6) occupational therapy sessions per week. The median (IQR) duration of a therapy session was 43.5 (37.5–51) minutes for physical therapy and 49.5 (42–60) minutes for occupational therapy. The difference between the date of the last FSS-ICU and the discharge date was a median (IQR) of 4 (1–7) days.
Cumulative FSS-ICU scores for the cohort significantly improved from a median (IQR) baseline score of 9 (3–17) to 14 (5–24) at discharge (z=−6.11, P<.001). All 5 categories of the FSS-ICU significantly improved from baseline to discharge, with the greatest improvements in the preambulation category of supine-to-sit transfers (Tab. 2). As expected, participants scored lower in the ambulation categories than the preambulation categories. The median sit-to-stand transfer score was 1 at both admission and discharge, with the median (IQR) admission ambulation score improving from 0 (0–1) to 1 (0–4) at discharge.
Functional Status Score for the Intensive Care Unit (FSS-ICU) Scores by Category
This study also examined the ability of the FSS-ICU to discriminate among various discharge settings. Of the 5 discharge categories, almost half of the patients transferred to an IRF or to an SNF, which is higher than what is reported in the literature.1 This difference may be attributed to the unique characteristics of this facility, as both the LTACH and the IRF share the same therapy and administrative staff. A quarter of the sample required return to the short-stay hospital and did not return to the LTACH.
Significant differences were found among the discharge FSS-ICU scores of the 5 discharge settings (H=43.11, df=4, P<.001). As Figures 2 and 3 demonstrate, patients discharged to the home ranked the highest in admission and discharge cumulative FSS-ICU scores. Patients discharged to an IRF or SNF ranked second and third, with median (IQR) discharge FSS-ICU scores of 21 (15–24) and 14 (8–21), respectively. As expected, the transfer and long-term care/hospice/expired groups demonstrated no gain in cumulative FSS-ICU scores, with scores remaining at a median of 4 and 5 at discharge, respectively. Sit-to-stand transfers and ambulation categories of the FSS-ICU remained a median of 0 for both the transfer group and the long-term care/hospice/expired group, further reflecting the limited functional ability in these patients (Tab. 3).
Admission cumulative Functional Status Score for the Intensive Care Unit (FSS-ICU) scores in 101 patients receiving physical therapy at a long-term acute care hospital categorized by discharge setting. The middle line of the box-and-whisker plot represents the median, and the box represents the interquartile range. Error bars represent the 2.5th and 97.5th centiles, and the circle is an extreme outlier. Significant differences were found among the admission FSS-ICU scores of the discharge categories with a P value of less than .001 (H=23.73, df=4). SNF=skilled nursing facility, IRF=inpatient rehabilitation facility.
Discharge cumulative Functional Status Score for the Intensive Care Unit (FSS-ICU) scores in 101 patients receiving physical therapy at a long-term acute care hospital categorized by discharge setting. The middle line of the box-and-whisker plot represents the median, and the box represents the interquartile range. Error bars represent the 2.5th and 97.5th centiles, and the asterisk and circles are extreme outliers. Significant differences were found among the discharge FSS-ICU scores of the discharge categories with a P value of less than .001 (H=43.11, df=4). SNF=skilled nursing facility, IRF=inpatient rehabilitation facility.
Functional Status Score for the Intensive Care Unit (FSS-ICU) Scores Stratified by Discharge Categorya
The effect size of rehabilitation in the LTACH was 0.25 for the FSS-ICU score for the entire sample. Effect sizes were greatest for those patients discharged to the home, an IRF, or an SNF (0.90, 0.91, and 0.80, respectively) compared with an effect size of 0 for those patients in the transfer and long-term care/hospice/expired groups. As reflected in the eTable, patients who were discharged to another facility at discharge (home, IRF, or SNF) demonstrated a greater change in the cumulative FSS-ICU scores than patients in the transfer or long-term care/hospice/expired category.
Discussion
Although physical therapists have a growing number of choices for outcome measures, we continue to search for the ideal measure to use in the critically ill population. A prior publication has shown the FSS-ICU as an emerging functional outcome measure in a single medical ICU.14 Because patients with chronic critical illness in an LTACH have distinct differences from those in acute care ICUs, further research was warranted. This study is the first to document the use of the FSS-ICU in a cohort of patients who were critically ill and receiving therapy services at an LTACH.
Use of the FSS-ICU did not significantly alter the physical therapist evaluation or treatment sessions, as all 5 FSS-ICU tasks are routinely assessed during each patient interaction. Total time to enter the data is estimated at less than 1 minute for each patient. Data were kept protected and stored in an Excel spreadsheet (Microsoft Corporation, Redmond, Washington). The Excel document was not part of the electronic medical record system that the university health system utilizes, which was an additional time component that represents an opportunity for improvement.
The physical therapy literature reports poor uptake of outcome measures into routine clinical practice. Jette et al6 reported the most common reasons that a sample of physical therapists cited for not using outcome measures. One reason that most applies to the use of an outcome measure in a busy LTACH setting is the time that is required for clinicians to utilize that outcome measure. Recording of scores in our investigation was estimated at less than 1 minute per patient and was not found to be burdensome for our staff.
Although the time requirements of the FSS-ICU were not a hindrance to collecting complete data in our investigation, efficiency would be improved if the FSS-ICU data collection is integrated into the health system's electronic medical record system, within the template for existing physical therapy documentation. Clinicians who implement the FSS-ICU in their practice should consider how to fully integrate the data system into their current documentation system. This integration also could facilitate efficient analysis and reporting.
Functional Independence Measure certification requires passing a 36-question online examination, and the training of physical therapists is at the discretion of each facility. In our health system, FIM training involves a 2-hour education session for the multidisciplinary team, followed by self-study and supervised practice as needed. We estimate that the implementation of an FSS-ICU training program would require less time because there are fewer categories to rate. The LTACH therapists in our study were already FIM certified, as they also may provide coverage in the IRF unit.
Because of the acuity of our patient population and the frequent occurrence of unexpected discharges from our setting, we chose to reassess each patient with the FSS-ICU every 2 weeks and use the most recent reassessment prior to leaving the hospital as the discharge FSS-ICU score. This method led to more frequent data collection than what may be necessary for other facilities or patient populations. We welcome the investigation of alternative methods in future scientific endeavors.
Despite these challenges, physical therapists in this investigation easily integrated the FSS-ICU into clinical practice. The physical therapy staff at the LTACH were familiar with FIM scoring due to providing regular coverage in the IRF unit. All 4 staff members were new graduates from Doctor of Physical Therapy programs that emphasize the importance of outcome measures. Additionally, hospital administration supported the use of outcome measures at our facility. At the conclusion of the data collection period for this project, the use of the FSS-ICU was suspended by the physical therapist staff in order for data analysis to give insight into its utility. Shortly thereafter, a new electronic medical record was implemented, and options are currently being explored to integrate the outcome measure into the electronic medical record to allow extraction of the data. The results of this investigation should encourage physical therapists to maintain the use of the FSS-ICU, even with the constraints that are common in clinical practice.
A prior study using patients in a medical ICU demonstrated an improvement in cumulative FSS-ICU scores from a median (IQR) score of 10 (5–13) at initial ICU assessment to 14 (10–23) at ICU discharge.14 Our study showed similar results, with an improvement in cumulative FSS-ICU scores from a median (IQR) of 9 (3–17) at baseline to 14 (5–24) upon discharge from the LTACH. Likewise, our cohort had a similar median (IQR) discharge ambulation score of 1 (0–4).14 Unlike this prior study, our cohort included all patients admitted to the LTACH, including those patients who transferred to the short-stay hospital, hospice, or long-term care facility and those who expired (n=38). When those 38 patients were removed, the median (IQR) cumulative FSS-ICU score improved from 11 (5–18) at admission to 21 (12–26) at discharge.
Multiple possibilities exist that may explain these improvements in results. Our cohort of LTACH patients received more consistent therapy interventions, receiving approximately 5 total therapy sessions per week compared with the 2 sessions in the study by Zanni et al.14 Unlike the patient prioritization that frequently occurs in acute care hospitals, the LTACH therapy staff were able to consistently meet the demands of the LTACH patient population. Likewise, LTACH patients had an expected minimum length of stay of 25 days, affording the opportunity for consistent provision of therapy services.
Future studies are recommended to assess the responsiveness of the FSS-ICU. Our study showed a small effect size (0.25) for our sample of patients with chronic critical illness, which included the transfer, hospice, long-term care, and expired patients (n=38). When computed for each of the 5 discharge categories, the effect size was large for the home, IRF, and SNF categories (0.90, 0.91, and 0.80, respectively). Limited studies using the FSS-ICU have been published that would allow comparison of these effect sizes, with further psychometric analysis of the responsiveness of the FSS-ICU warranted.
An outcome measure also should be sensitive to change. The sensitivity to change can be assessed by comparing the measure of interest with a criterion measure. For the purpose of this study, the criterion measure was whether the patient was transferred to a setting for further therapy (home, IRF, and SNF categories) or to a setting reflecting a decline in functional status (transfer and long-term care/hospice/expired categories). Our study showed that patients who were discharged to another facility (home, IRF, or SNF) demonstrated a greater change in the median (IQR) cumulative FSS-ICU scores (6 [3–9], 8 [6–11], and 6 [2–10], respectively) than patients who were in the transfer and long-term care/hospice/expired categories (0 [−2 to 1] and 2 [−2 to 3], respectively). The positive change score of 2 for the long-term care/hospice/expired category can be attributed to those patients in long-term care who may have demonstrated some improvement in functional status from admission to the LTACH. Because our study used the last recorded biweekly reassessment as the discharge FSS-ICU score, patients could have expired after this assessment occurred, falsely elevating a discharge FSS-ICU score for this discharge category. This method has limitations, as the location to which a patient is discharged can be influenced by factors other than the patient's functional status. These factors can include a patient's social disposition and insurance limitations that influence a discharge destination. Future studies should compare the FSS-ICU with multiple criterion measures to permit further analysis of the sensitivity and specificity of this outcome measure.
A challenging aspect of the LTACH patient population is the frequent change in patient status from chronic critical illness to acute critical illness. When this change occurs, it often results in a need for higher acuity of care and subsequent transfer of the patient to the short-stay acute care hospital. Thirty-three percent of patients initially enrolled in this study were transferred to the short-stay hospital and did not return. This factor poses a challenge in providing consistent therapy and determining how to best measure and account for these patients.
As with the acute care environment, therapists at an LTACH are asked to provide recommendations for discharge. We found that significant differences existed with the discharge FSS-ICU scores among the 5 discharge settings. As expected, patients who were discharged to the home functioned at a higher level, with a median (IQR) total discharge FSS-ICU score of 28 (22–32). Patients discharged to an IRF functioned at a slightly lower level with a median (IQR) total FSS-ICU score of 19 (15–25), and patients discharged to SNFs scoring a median (IQR) FSS-ICU score of 14 (8–21). The cumulative FSS-ICU scores for both the transfer and long-term care/hospice/expired groups did not change from admission to discharge, corresponding to the decline in medical status or plateau in functional status. Although further research is warranted on the responsiveness of the FSS-ICU, the results from our study are promising.
There are potential limitations with this study. Readers should use caution when generalizing the results of this study to other LTACH facilities. This was a single-site investigation using an LTACH affiliated with a nationally renowned acute care hospital. Patients are admitted to this facility from multiple urban academic hospitals, which can affect the acuity level of the patients and should be considered when making any comparisons. Baseline FSS-ICU scores can be influenced by factors such as the amount of therapy services and mobilization performed at the acute care hospital prior to LTACH transfer, which was not collected in this study. Also, we did not collect detailed information about the patient's comorbidities, premorbid status, presence of delirium, duration of ventilator support, length of prior hospitalization, and other summary indicators of disease severity such as the APACHE II score. Likewise, the amount of therapy and experience of the therapists can influence the gain in functional status. Despite this lack of information, the use of the FSS-ICU shows promise because it was able to demonstrate change in subsets of patients with chronic critical illness.
The FSS-ICU scores were collected at baseline and reassessed biweekly thereafter. Thus, the discharge assessment that was used in this analysis was the last reassessment performed prior to discharge. Although we found only a median (IQR) of 4 (1–7) days between the discharge assessment and discharge date, it is possible that the discharge FSS-ICU score underestimated a patient's actual functional status at discharge.
Conclusion
Measuring outcomes is now considered the standard of care for physical therapist practice and is essential to document the effectiveness of physical therapy interventions. As yet, outcome measures have not been developed specifically for patients with chronic critical illness to measure function in a long-term acute care hospital setting. This study documented the clinical utility of a recently published outcome measure that was originally used in patients in an acute ICU. Further research investigating the clinimetric properties of this tool should be undertaken. This research should include evaluating the construct validity and predictive ability of the FSS-ICU in LTACH units managing patients who are chronically critically ill.
Footnotes
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All authors provided concept/idea/research design and writing. Dr Thrush and Dr Rozek provided data collection and project management. Dr Thrush and Ms Dekerlegand provided data analysis. Dr Thrush provided study participants, facilities/equipment, clerical support, and consultation (including review of manuscript before submission). The authors acknowledge Kerry O'Donnell, PT, DPT, Sarah Klunk, OTR/L, MBA, and the therapists and leadership at Good Shepherd Penn Partners Specialty Hospital at Rittenhouse for their support and assistance with this project.
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A platform presentation of this research was given by Dr Thrush in the Acute Care Section at the Combined Sections Meeting of the American Physical Therapy Association; February 8–11, 2012; Chicago, Illinois.
- Received November 15, 2011.
- Accepted September 4, 2012.
- © 2012 American Physical Therapy Association
References
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