Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach.

BACKGROUND: There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients. METHODS: Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient. RESULTS: The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832). CONCLUSIONS: This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.

Brazilian version of the Nottingham Sensory Assessment: validity, agreement and reliability.

OBJECTIVES: To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS: The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS: Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS: The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.

Versão Brasileira da Avaliação Sensorial de Nottingham: validade, concordância e confiabilidade / Brazilian version of the Nottingham Sensory Assessment: validity, agreement and reliability

OBJETIVO: Verificar a concordância inter e intraexaminador, validade construtiva e consistência interna da versão brasileira do instrumento Nottingham Sensory Assessment para hemiparéticos após acidente vascular encefálico (AVE). MÉTODOS: O instrumento foi traduzido para língua portuguesa com base na sua versão original em Inglês por um tradutor bilíngue e, posteriormente, revertido para a língua inglesa. Vinte e um hemiparéticos foram avaliados por dois examinadores pela Avaliação Sensorial de Nottingham para pacientes pós-AVE (ASN) e pelo Protocolo de Desempenho Físico de Fugl-Meyer (FM). RESULTADOS: Foi encontrada correlação entre os instrumentos FM e ASN (0,752); excelente consistência interna da ASN (0,86); excelentes coeficientes de concordância interexaminador e intraexaminador para todos os itens da ASN, exceto temperatura e efeito teto significativo para ASN e FM. CONCLUSÃO: A versão brasileira da Nottingham Sensory Assessment cumpriu os critérios de concordância, consistência interna e validade concorrente, sendo um instrumento de rápida e fácil aplicação, podendo ser utilizada nos ambulatórios de neuroreabilitação para avaliar a função sensorial pós-AVE. O efeito teto significativo da ASN não limita seu uso, tendo em vista que, para os mesmos pacientes, o Protocolo de Fugl-Meyer também revelou efeito teto.

OBJECTIVES: To investigate the inter-rater and intra-rater reliability, construct validity and internal consistency of the Brazilian version of the Nottingham Sensory Assessment for Stroke Patients (NSA). METHODS: The instrument was translated into Portuguese from its original in English by a bilingual translator and was then back-translated into English. Twenty-one hemiparetics were evaluated by two examiners using the NSA and the Fugl-Meyer Assessment (FMA) of physical performance. RESULTS: Significant correlation were found between the FMA and the NSA (r=0.752). The NSA showed excellent internal consistency (0.86), and there were acceptable inter- and intra-rater reliability for all items of the NSA, except temperature. Significant ceiling effects were found for the NSA and the FMA. CONCLUSIONS: The Brazilian version of the NSA met the criteria for agreement, internal consistency and concurrent validity. It was quick and easy to apply, and it could be used within clinical practice in neuro-rehabilitation outpatient clinics to assess sensory functions following stroke. The significant ceiling effect for the NSA did not limit its use, given that for the same patients, the FMA also showed ceiling effects.