PMID- 25554262 OWN - NLM STAT- MEDLINE DCOM- 20151009 LR - 20220321 IS - 1879-1409 (Electronic) IS - 0305-4179 (Linking) VI - 41 IP - 2 DP - 2015 Mar TI - The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: an observational study. PG - 241-7 LID - S0305-4179(14)00423-9 [pii] LID - 10.1016/j.burns.2014.12.002 [doi] AB - INTRODUCTION: Severe burn leads to a state of hypercatabolism, resulting in rapid muscle loss and long-term disability. As survival rates from severe burn are improving, early rehabilitation is essential to facilitate functional recovery. However, there is no way of measuring the degree of disability in the acute stages, and hence, no marker of functional recovery. This hampers both communication and research into interventions to improve functional outcomes. The Chelsea Critical Care Physical Assessment tool (CPAx) is a simple objective measure of function, designed and validated in the general Intensive Care Unit (ICU) cohort. The aim of this study was to test the responsiveness of the CPAx in the burns ICU (BICU) cohort and validate its use. METHODS: Observational study of 52 BICU patients admitted for over 48h. All patients were assessed on the CPAx retrospectively for pre-admission, and prospectively at ICU admission, ICU discharge (or final ICU assessment for non-survivors) and hospital discharge. Analysis of variance, post hoc between group differences in median CPAx score, and floor and ceiling effect (i.e. the percentage of patients scoring full marks (50), or zero) for the four time points were completed. Minimal clinically important difference (MCID) was estimated as half of the standard deviation of the CPAx score at ICU discharge. RESULTS: A total of 30 patients were included in the final analysis; mean age was 47.1 years (SD 21.2), 63.3% were male, with a median burn total body surface area (TBSA) of 30% (IQR 11.3-48.8). There was a significant difference in the analysis of variance in median CPAx scores at all four time points (p<.001). In survivors, the differences in CPAx scores post hoc were significant for all time points (p<.05), aside from ICU discharge and hospital discharge. The CPAx MCID for BICU patients was six. Twenty-three (86.7%) patients scored full marks or zero on the CPAx pre-admission. For survivors, no patients scored full marks or zero on the CPAx at ICU and hospital discharge. On ICU admission 66.7% (n=20) scored zero on the CPAx and no patients scored 50. CONCLUSIONS: The CPAx score appears to be able to detect improvements in physical function as patients recover from acute severe burn. It has a limited floor and ceiling effect in the acute setting and a change in CPAx score of 6 represents clinically important progress. Further work is required in a larger cohort. CI - Copyright (c) 2014 Elsevier Ltd and ISBI. All rights reserved. FAU - Corner, Evelyn J AU - Corner EJ AD - Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK; Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK. Electronic address: e.corner13@imperial.ac.uk. FAU - Hichens, Louise V AU - Hichens LV AD - Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK. Electronic address: Louise.Hichens@nbt.nhs.uk. FAU - Attrill, Kate M AU - Attrill KM AD - Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK. Electronic address: kate.attrill@chelwest.nhs.uk. FAU - Vizcaychipi, Marcela P AU - Vizcaychipi MP AD - Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK; Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK. Electronic address: m.vizcaychipi@imperial.ac.uk. FAU - Brett, Stephen J AU - Brett SJ AD - Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK; Centre for Perioperative Medicine and Critical Care Research, Imperial College NHS Healthcare Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, England, UK. Electronic address: stephen.brett@imperial.ac.uk. FAU - Handy, Jonathan M AU - Handy JM AD - Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK; Chelsea and Westminster NHS Foundation Trust, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK. Electronic address: j.m.handy@imperial.ac.uk. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PT - Validation Study DEP - 20141229 PL - Netherlands TA - Burns JT - Burns : journal of the International Society for Burn Injuries JID - 8913178 SB - IM MH - Adult MH - Aged MH - Analysis of Variance MH - Burns/*rehabilitation MH - Critical Care/methods/*standards MH - *Disability Evaluation MH - Female MH - Humans MH - Intensive Care Units/standards MH - Male MH - Middle Aged MH - Outcome Assessment, Health Care MH - Patient Admission/statistics & numerical data MH - Patient Discharge/statistics & numerical data MH - Recovery of Function/*physiology MH - Retrospective Studies MH - United Kingdom OTO - NOTNLM OT - Burns OT - Critical care OT - Disability evaluation OT - Outcome measure OT - Physiotherapy OT - Rehabilitation EDAT- 2015/01/03 06:00 MHDA- 2015/10/10 06:00 CRDT- 2015/01/03 06:00 PHST- 2014/09/11 00:00 [received] PHST- 2014/12/03 00:00 [revised] PHST- 2014/12/04 00:00 [accepted] PHST- 2015/01/03 06:00 [entrez] PHST- 2015/01/03 06:00 [pubmed] PHST- 2015/10/10 06:00 [medline] AID - S0305-4179(14)00423-9 [pii] AID - 10.1016/j.burns.2014.12.002 [doi] PST - ppublish SO - Burns. 2015 Mar;41(2):241-7. doi: 10.1016/j.burns.2014.12.002. Epub 2014 Dec 29.