Functional outcomes of medical and trauma patients in a critical care unit using the Chelsea Critical Care Physical Assessment tool

Abstract

Introduction: The use of outcome measures by healthcare providers in daily clinical practise assists to better follow a patient’s condition progress in order to provide effective quality of care. The role of physiotherapists in the intensive care unit promotes lung function and facilitates early patient mobilization to prevent complications. The implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool in daily use will benefit both patients and clinicians as patient specific rehabilitation will be encouraged. Aim: The purpose of this study was to determine the functional outcomes using the Chelsea Critical Care Physical Assessment tool in critically ill patients admitted in the trauma and medical critical care units. Research design: This was a quantitative prospective observational cohort study. Methodology: The first part of this study was an Integrative literature review which followed a framework for evidence synthesis as outlined by Arksey and O’Malley. The main study was a prospective quantitative observational study which followed the STROBE guidelines for observational studies. The study population included adult patients admitted in the trauma and medical Intensive Care Units (ICU), as well as patients admitted in High Care (HC) units who were diagnosed with trauma or a medical condition. Participants were patients in the critical care units who were recruited from three teaching hospitals in the Tshwane district. Physiotherapists working in the ICU and HC units were trained on how to use the CPAx tool, before they assessed patients. Ethical clearance was granted by the university of Pretoria Research Ethics committee. Written consent was obtained from the recruited patients and physiotherapists. A retrospective consent was obtained from patients who were unable to give consent at the initial assessment or from their families. Data was collected every second day in ICU and HC until each patient was discharged out of HC. Data Analysis: Data from the integrative review was analysed thematically. Data analysis was executed by a statistician using the program IBM SPSS Statistics version 28. Results were compared between the patients diagnosed with a medical and trauma conditions. Results: The results of the integrative review showed that the CPAx tool is comprehensive, it enhances the accuracy of patient assessment and assists physiotherapists to draw up patient specific treatment plans to address the identified impairments. The main study highlighted that the respiratory function, the cough reflex, rolling in the bed and grip strength improved quicker. An increase in CPAx scores correlated with improvement in the GCS in both groups. The trauma patients spent less days in the ICU and HC with slightly lower scores when compared to medical patients.

Conclusion: Holistic intensive care specific outcomes are rare in the physiotherapy profession. The CPAx tool includes both the respiratory and musculoskeletal assessment in critically ill patients. Patients can be assessed from when they are sedated or unresponsive. Evaluating the functional outcomes using the tool encouraged patient specific rehabilitation programmes and frequent use of the tool by physiotherapists

Clinical implications: the CPAx tool is an innovative tool to measure physical function in the critical care population. The tool is efficient in assisting to develop fir critically ill patients.