RESUMO
Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.
Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.
Assuntos
Unidades de Terapia Intensiva , Adulto , Humanos , Estudos Retrospectivos , Curva ROCRESUMO
Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.
Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.
RESUMO
BACKGROUND: The functional gait assessment (FGA) is a reliable instrument to evaluate walking balance in the Brazilian older population. However, other measurement properties need investigation. OBJECTIVE: To determine the construct and criterion validity of the FGA-Brazil and its ceiling and floor effects. METHODS: Sociodemographic, clinical, and anthropometric data were collected from 126 older adults. Participants completed the Mini-mental state examination followed by the FGA-Brazil, Berg balance scale (BBS), gait speed, and the Falls Efficacy Scale-International. Six months later, the participants were interviewed by telephone about their fall history. Exploratory factor analysis was used to determine the structural validity. We also determined the construct validity of the FGA-Brazil, using hypothesis testing, by investigating the differences between groups using the Mann-Whitney U test. Criterion validity was determined using the Spearman correlation between the FGA-Brazil and the other balance and gait measures, and using the Receiver Operator Characteristic curve. RESULTS: Participants' mean age was 69.3⯱â¯7.4 years, and 84 (69.4%) were female. Factor analysis resulted in two factors explaining 53.3% of the total variance. Moderate and high significant correlations were found between the FGA-Brazil and gait speed (râ¯=â¯0.65) and BBS (râ¯=â¯0.80). A significant difference in the FGA-Brazil median score between older adults with low and high concern about falls was observed. The cutoff score recommended for predicting falls was 22 or less. No ceiling and floor effects were observed. CONCLUSION: We recommend the FGA-Brazil to determine the risk of falls in community-dwelling older adults.
Assuntos
Marcha , Avaliação Geriátrica/métodos , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Vida Independente , Masculino , Modalidades de Fisioterapia , Equilíbrio Postural/fisiologiaRESUMO
OBJECTIVE: To analyse the construct validity, test-retest reliability and responsiveness of the Brazilian version of Quick-DASH (QD-Br) in patients with upper limb disorders. METHOD: Participants completed the full Brazilian DASH, the QD-Br and the SF-12 Brazil questionnaires at the beginning of treatment, after 48-72h and the after 2-12 months. Construct validity was analysed by Pearson's correlation coefficient (r). To evaluate the test-retest reliability we used the Intraclass Correlation Coefficient (ICC) and the Cronbach's alpha coefficient to test the internal consistency. Responsiveness was analysed by Standardized Response Mean (SRM) and Effect Size (ES). The Minimal detectable change (MDC) score was based upon calculations of the standard error of measurement (SEM), confidence interval of 95%. RESULTS: The construct validity presented strong direct correlation with the total QD-Br score and the Brazilian DASH (r = 0.91), a moderate inverse correlation between the total QD-Br score and the physical component of the SF- 12 Brazil (r = -0.55) and weak inverse correlation between the QD-Br and the mental component of SF-12 Brazil (r = -0.49). The ICC test-retest showed good reliability of 0.81 (0.72-0.87). QD-BR presented high responsiveness, with ES of 1.06 and SRM of 0.94. The MDC was 17.27 points. CONCLUSION: These results provide evidence that the QD-Br was a valid, reliable and responsive instrument when utilized in patients with upper limb traumatic and no-traumatic disorders in the Brazilian population.