CPAx for Assessing Functional Status of COVID-19 Patients After Intensive Care Unit Discharge
Condition: Post Intensive Care Unit Syndrome; Covid19
MeSH terms: COVID-19
Study type: Observational

Summary: 
      The present assessment tools for assessing physical function after intensive care unit (ICU)
      can be categorized as (1) functional tests (2) walk tests (3) strength test (4)
      Health-related quality of life (HRQOL). Strength tests such as Medical Research Council Scale
      and HRQOL (e.g. Short form-36 (SF-36) tests may require awakening and appropriate mental
      health. However, mental impairments were seen in a considerable number of patients (2). Walk
      tests such as Six-Minute Walk Test (6MWT) or Timed Up&Go (TUG) can be impractical, some
      patients could not be able to perform these due to severe impairment. These tests require
      space to perform and may require management of several drips, drains, and oxygen delivery
      systems while the patient is walking and turning which render the test difficult to carry
      out. Among these three specific tools, CPAx seems to be the assessment tool that can be
      considered easy to use in the clinical setting due to the short time required for assessment
      and relatively minimal use of equipment (hand dynamometer for grip strength measurement).

      This study aims to investigate validation of Chelsea Critical Care Physical Assessment Tool
      in the assessment of the functional status of COVID patients discharged from ICU and
      investigate the feasibility of commonly used assessment tools for assessing physical function
      after ICU in COVID patients discharged from ICU.
    

Detailed description: 
      The present assessment tools for assessing physical function after intensive care unit (ICU)
      can be categorized as (1) functional tests (2) walk tests (3) strength test (4)
      Health-related quality of life (HRQOL). Strength tests such as Medical Research Council Scale
      and HRQOL (e.g. SF-36) tests may require awakening and appropriate mental health. However,
      mental impairments were seen in a considerable number of patients (2). Walk tests such as
      Six-Minute Walk Test (6MWT) or Timed Up&Go (TUG) can be impractical, some patients could not
      be able to perform these due to severe impairment. These tests require space to perform and
      may require management of several drips, drains, and oxygen delivery systems while the
      patient is walking and turning which render the test difficult to carry out. Among functional
      tests, the Physical Function in Intensive Care Test (PFIT) Functional Status Score for the
      ICU and the Chelsea Critical Care Physical Assessment Tool (CPAx) are specifically designed
      to assess function after ICU while Barthel and Katz are nonspecific to this population.
      According to a systematic review of 26 different outcome measures, the CPAx and the Physical
      Function in Intensive Care Test demonstrated the strongest psychometric properties, however,
      the Physical Function in Intensive Care Test has a significant floor effect. The PFIT and
      CPAx may be more suitable for the assessment of patients who may never reach the ability to
      perform submaximal exercise tests.

      Among these three specific tools, CPAx seems to be the assessment tool that can be considered
      easy to use in the clinical setting due to the short time required for assessment and
      relatively minimal use of equipment (hand dynamometer for grip strength measurement).

      Patients over 18 years of age who suffered COVID-19 pneumonia and stayed in ICU and
      discharged will be included in the study. Patients who are able to follow at least 2 of the
      commands from De Jonghe and colleagues' awakening criteria will be evaluated within 48 hours
      discharge. Patients will be assessed by using Chelsea Critical Care Physical Assessment Tool,
      Barthel Index, Katz Index, 5 times Sit-To-Stand test, 30 seconds Sit-To-Stand test, Glasgow
      coma scale, handheld dynamometers, Medical Research Council sum score (MRC-SS) and modified
      Medical Research Council dyspnea scale. The number (%) of the patients who will be able to
      complete the tests will be recorded. Another physiatrist will also complete Chelsea Critical
      Care Physical Assessment Tool at the same time without discussion and will be blinded to
      score of the other rater. Patients' demographic characteristics such as age, gender,
      comorbidities will be recorded. Length of stay in ICU, duration of mechanical ventilation,
      history of Extra Corporeal Membrane Oxygenation (ECMO), presence of tracheostomy, intubation
      status, the sequential organ failure assessment score (SOFA score) at the day of ICU
      admission and acute physiology and chronic health evaluation (APACHE II) on ICU admission
      will be recorded.

      For construct validation, the correlation between CPAx and Barthel, Katz, Medical Research
      Council sum score and grip strength will be calculated. Kappa and weighed Kappa analysis will
      be conducted for inter-rater reliability. Descriptive analysis (Number (%) of the patients
      who will be able to complete the tests) will be performed to assess feasibility.

      This study aims to investigate validation of the Chelsea Critical Care Physical Assessment
      Tool in the assessment of the functional status of COVID patients discharged from ICU and
      investigate the feasibility of commonly used assessment tools for assessing physical function
      after ICU in COVID patients discharged from ICU.
    

Intervention name(s): Chelsea Critical Care Physical Assessment Tool
Intervention type(s): Other
Intervention description(s): Chelsea Critical Care Physical Assessment Tool is a bedside assessment tool firstly reported in 2013 to measure physical morbidity in the critical care population, consisting of 10 items (respiratory function, cough, moving within the bed, supine to sitting on the edge of bed, dynamic sitting, standing balance, sit to stand, transferring from bed to chair, stepping, and grip strength) rated on a 6-point scale from complete dependency (level=0) to independency (level=5). Therefore, the CPAx sum score ranges from 0 (worst condition) to 50 (best functioning/independence)
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Adult patients (patients over 18 years of age) who suffered COVID-19 pneumonia and stayed
        in ICU and discharged and who who are able to follow at least 2 of the commands from De
        Jonghe and colleagues' awakening criteria (presented below)

        De Jonghe and colleagues' awakening criteria

        Can patient follow the command? "Open/close your eyes." "Look at me." "Open your mouth and
        stick out your tongue." "Nod your head." "Raise your eyebrows when I have counted to 5."
      
Keywords: post-intensive care syndrome; COVID-19; functional status; coronavirus