Page 83 - ACCCN's Critical Care Nursing

60 S C O P E O F C R I T I C A L C A R E

most commonly used and validated instrument in the Physical activity associated with cardiac or pulmonary
literature, including with a variety of critically ill patient dysfunction may be assessed using perceived breathless-
groups (e.g. general ICU, ARDS, trauma and septic shock). ness (dyspnoea) during exercise by the modified Borg
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A recent comparison of two related instruments demon- scale, ranging from 0 (no dyspnoea) to 10+ (maximal).
strated that the 15D was more sensitive to clinically The Borg scale is commonly used with other physical
important differences in health status than EQ-5D in a activity instruments, e.g. the six-minute walk test
critical care cohort. 46 (6MWT). 51
MEASURES OF PHYSICAL FUNCTION MEASURES OF PSYCHOLOGICAL FUNCTION
FOLLOWING A CRITICAL ILLNESS AFTER A CRITICAL ILLNESS
A variety of instruments have been developed to examine The recovery process and trajectory for survivors of a criti-
the physical capacity of individuals, usually focusing on cal illness remains an important but under-researched
functional status ranging from independent to depen- area. 18,52 Exploration of the impact of the intensive care
dent. Table 4.2 describes some common instruments experience, including ongoing stress 53-56 and memories
used with individuals after an acute or critical illness. for the patient, 16,57-59 is now emerging in the literature as
Many other instruments exist for specific clinical cohorts, an important area of research and practice. Instruments
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including Katz’s ADL index, the Karnofsky performance that assess mental function after a critical illness focus on
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status, and the instrumental activities of daily living, psychological constructs, including anxiety, avoidance,
but these have not been used commonly with survivors depression and fear (see Table 4.3). Other instruments
of a critical illness. are also available to examine post-traumatic stress

TABLE 4.2 Common measures of physical function following a critical illness

Instrument Measurement Score range/comments
St George’s Respiratory COPD-specific items assessing three Item responses have empirical weights; higher scores indicate
173
Questionnaire (SGRQ), domains: symptoms (7 items), activity poorer health; used with patients with chronic lung disease,
(SGRQ-C) 174 (2 multi-part items), impacts (5 multi-part including ARDS
items)
Six-minute walk test (6MWT) 51 Walk distance, reflects functional capacity in Assesses walk function in patients with moderate heart failure,
respiratory or cardiac diseases ARDS
Barthel Index (BI) 175-177 10 items of functional status (Activities of Dependence: total = 0–4; severe = 5–12; moderate = 13–18;
Daily Living [ADLs]) slight = 19; independent = 20
Functional Independence Severity of disability in inpatient 18 activities of daily living in two themes: motor (13 items),
Measure (FIM) 178 rehabilitation settings cognitive (5 items); 7-point ordinal scales; score range
18–126 (fully dependent–functional independence)
Timed Up and Go (TUG) 179 Functional ability to stand from sitting in a ≤10 seconds = normal; ≤20 seconds = good mobility,
chair, walk 3 m at regular pace and return independent, can go out alone; 21–30 seconds = requires
to sit in the chair supervision/walk aid
Shuttle walk test (SWT) 180 10 m shuttle walk with pre-recorded audio Participant keeps pace with audio sounds; 12 levels of speed
prompts to complete a shuttle turn (0.5–2.37 m/second)
ARDS = Adult Respiratory Distress Syndrome

TABLE 4.3 Examples of common measures of psychological function after critical illness

Instrument Measurement Score range
Impact of event scale (IES); IES-R 182 15-item; assesses levels of post-traumatic distress; frequency of thoughts over past 7 days; 0 = no
181
two subscales: intrusive thoughts, avoidance thoughts; 5 = often; higher scores indicate
behaviours; revised form (IES-R) adds hyper- greater distress: scores ≥26 (combined intrusion
arousal subscale (7 items) 182 and avoidance) are significant
Hospital anxiety and depression 14 items; 4-point scale; measures mood disorders combined score ≥11 indicates a clinical disorder
scale (HADS) 89 in non-psychiatric patients; focuses on
psychological rather than physical symptoms of
anxiety and depression
Center for Epidemiologic Studies– 20-item self-report scale assessing frequency and score range 0–60; higher scores reflect increased
Depression Scale (CES–D) 183 severity of depressive symptoms experienced in symptoms and severity
the previous week