Measuring Physical Function in the PICU: Development and Testing of a Children’s Version (Age 2–18 yr) of the Chelsea Critical Care Physical Assessment Tool

Abstract

Objectives: To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children in the PICU. Design: Modified Delphi study to adapt the Chelsea Critical Care Physical Assessment (CPAx) tool for use in children 2–18 years old, with subsequent prospective testing in a single-center cohort. Setting: Single-center tertiary PICU. Subjects: Delphi process in 27 panelists (including physiotherapists, occupational therapists, and pediatric intensivists from seven countries from January 2018 to March 2018). Cohort study in 54 patients admitted to PICU for greater than 24 hours over a 3-month period (April 2018 to June 2018), with median age 5.5 years (interquartile range [IQR], 3–12.75 yr), 33 of 54 male, and 38 of 54 invasively ventilated. Interventions: None. Measurements and Main Results: Three Delphi iterations were required to reach greater than or equal to 80% consensus in all the children’s CPAx (cCPAx) items. In the subsequent cohort study, six physiotherapists used the cCPAx tool and scored 54 participants, with a total 106 observations. The median cCPAx tool score was 14.50 (IQR, 3–25) out of a possible total of 50. Inter-rater reliability for 30 randomly selected participants was excellent (intraclass correlation coefficient, 0.998). Completion rate of cCPAx in the 54 patients occurred in 78 of 106 occasions (74%). Conclusions: The cCPAx tool content that was developed using Delphi methodology provided a feasible and clinically relevant tool for use in assessing physical morbidity in PICU patients 2–18 years old. Overall, the cCPAx scores were low, demonstrating low levels of physical function and high levels of immobility during PICU care.