Outcomes in cardiopulmonary physical therapy: acute care index of function.

To determine effectiveness of physical therapy interventions and improve delivery of care, physical therapists are increasingly using outcome tools to gather data on patient status at the initial examination and following treatment in a variety of health care settings. Outcome assessment in acute care settings, however, remains a difficult challenge due to the extreme variation in patient acuity and the types of interventions used to manage their conditions.1 Medical outcomes for patients in acute care settings include complication rates or number of hospital days,2 however, these measures are not useful for physical therapists. Physical therapy outcomes in acute care, like outcome measures in other settings, should include measures of a patient's ability to function in the environment. Currently, there is a lack of literature reporting measurement of physical therapy outcomes for patients in acute care settings, and there are no clear recommendations for specific outcome tools to be used in this setting. As recently as 1998, the statement was made, “Unfortunately, very little direct clinical evidence has been published demonstrating the impact of physical therapy on patient outcomes in the acute care setting.”3 Physical therapy outcomes in acute care should capture the functional status of patients at the time of their discharge from the inpatient setting. Functional status should include items such as mobility, self care and ambulation, and the amount of assistance needed to perform these activities. Several studies have measured the functional status outcome of patients following an acute care stay, using tools such as the Katz Activity of Daily Living Instrument,4 the Nottingham Health Profile,4 Barthel Index,5 and Duke Activity Status Index.6 However, each of these studies measured outcome retrospectively by phone call to the patient after the patient had returned home, and did not specifically measure functional status at time of discharge. The Katz Index of Independence in Activities of Daily Living is often used by nursing professionals to evaluate functional status in hospitalized patients, but has not consistently been used by physical therapists.7,8 The Katz instrument measures of function include bathing, dressing, toileting, eating, transferring, and remaining continent, but does not address other functions such as mental status and the ability to move in bed, which are important functional activities for patients in the acute setting. Therefore, The Acute Care Index of Function (ACIF)9 was developed to address mental status, low level activities such as bed mobility, and other aspects of mobility. Information about patient's functional status may also be used to determine discharge placement, such as whether a patient's functional ability allows for return to home, or whether additional care in a rehabilitation or skilled nursing facility is necessary.9 Few instruments focus on the functional skills of the patient that are necessary in the acute care setting and are also useful in predicting discharge placement. Neither the Katz nor other instruments5–7 of function were developed to predict discharge status of hospitalized patients. The ACIF was developed by Roach and Van Dillen9 to measure the following issues: (1) functional status at levels of function required in acute care and (2) prediction of discharge placement. Additional objectives in developing the Acute Care Index of Function included ease of administration and ability to reflect changes in functional status. In this review, we will address the background of the ACIF, followed by discussion of the reliability, validity, responsiveness to change and ability to predict discharge status, and conclude with thoughts on future directions. Background of Instrument The ACIF was developed by physical therapists in the acute neuromedicine/surgical unit of a hospital because no suitable instrument existed that could measure basic mobility for the patients in this setting which could also be used to assist in discharge placement decisions.9 This section will address development of the ACIF in regard to feasibility, the ability to reflect change, the development of the scoring system, and the types of patients.