Oct. 09, 2021
Hospital-acquired functional losses in mobility and capacity for self-care, in part mediated by loss of muscle mass, can slow recovery and put patients at increased risk for falls, institutionalization, rehospitalization and death. Multiple studies have shown that rehabilitation services administered during hospitalization can slow or prevent functional losses. But it's often difficult for hospital staff to determine exactly what services a patient requires and to deliver these services in a timely fashion. Consequently, only a fraction of patients who could benefit from rehabilitation services actually receive them during the course of a hospital stay.
The absence of an efficient, data-driven, standardized means to assess the rehabilitation needs of hospitalized patients is a critical barrier to preserving and improving their functional abilities. In an article published in 2021 in the Archives of Rehabilitation Research and Clinical Translation, lead author Andrea L. Cheville, M.D., and co-authors note the need for a new, more effective care model and describe their efforts to identify scalable solutions for these challenges. Dr. Cheville is a physiatrist and chair of Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minnesota.
Research goals
After reviewing various available models for patient assessment and the delivery of hospital-based rehabilitation care, Dr. Cheville and co-authors sought to develop a precise, efficient patient-reported, multidomain functional assessment tool to measure the functional status of patients in the acute care setting. They developed and validated the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), characterized the measure's psychometric performance, and established clinically actionable score strata that link to easily implemented mobility preservation plans for these patients.
Methods
According to Dr. Cheville and co-authors, because patients on medical services or patients readmitted to surgical services fail to receive consistent, timely rehabilitation services, these patients served as the target population for the FAMCAT. To develop an appropriate tool, the team recruited 4,495 participants and used a multistage process. As a starting point, the team expanded and refined the existing Activity Measure of Post-Acute Care (AM-PAC) item banks to optimize their salience for hospitalized patients. They then administered candidate items to a calibration cohort of 2,341 patients and estimated multidimensional item response theory models to calibrate the item banks. After determining parameters for the FAMCAT, they administered it to 2,154 hospitalized patients in a validation cohort and estimated its psychometric characteristics.
"We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to facilitate multiple assessments during a hospital stay," explains Dr. Cheville. "The FAMCAT simultaneously estimated three correlated traits — basic mobility, daily activities and applied cognition — all of which are relevant to hospital-based rehabilitation service delivery."
Results
Overall, Dr. Cheville and co-authors conclude that their initial study of the FAMCAT has demonstrated that this tool has potential to provide an efficient means to address "a long-standing need for structured, sensitive and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery."
The investigators are hopeful that their use of both novel and established methods, including collateral test-taking information (response times) and the adaptive measurement of change, will optimize the FAMCAT's efficiency.
The first assessments of these efforts are scheduled to be published in a 2022 supplement of the Archives of Physical Medicine and Rehabilitation.
For more information
Cheville AL, et al. Improving the delivery of function-directed care during acute hospitalizations: Methods to develop and validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT). Archives of Rehabilitation Research and Clinical Translation. 2021;3:1.