Reliability, validity and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) following an e-learning programme: A clinimetric study

Abstract

Objectives

To investigate inter- and intra-rater reliability, content and concurrent validity, and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) – a measurement instrument for physical function and activity for patients with a critical illness – from multidisciplinary, German-speaking healthcare professionals.

Methods

This was a prospective, longitudinal, clinimetric study. Participants who completed a novel German CPAx e-learning were invited to participate in a voluntary, web-based, piloted, two-round survey. The two rounds were separated by 3–4 weeks to limit recollection of the two patient videos within the e-learning. Following informed consent, we collected participants’ characteristics, their CPAx ratings and scoring-duration for the two video cases, content validity indexes along with questions on the practicability of the CPAx. Data was analysed descriptively, quantitatively using Bayesian methods, and qualitatively with an inductive content approach.

Results

In total, 61 clinicians (53 (87 %) physiotherapists, 6 (10 %) nurses, 2 (3 %) occupational therapists) from Switzerland (37 (64 %)), Germany (13 (22 %)), and Austria (8 (14 %)) participated. Inter- (n = 61) and intra-rater (n = 35) reliability for the CPAx were excellent (intraclass correlation coefficients of > 0.8). Content validity index of the CPAx showed a high relevance (> 0.9), though novice users slightly differed from the expert rating (concurrent validity). Healthcare professionals described the CPAx as a practical tool to plan and evaluate physical rehabilitation with a total scoring duration of 5 min, whereby lack of routine, time, and application were seen as barriers in clinical practice.

Conclusions

This study demonstrated the German CPAx as a highly reliable (between and within raters), relevant and practical tool across professions, settings, and countries. These results support an online training, whereby future work should focus on consensus and application into clinical practice.

Implications for Clinical practice

Following an e-learning, the CPAx can be used reliably by multidisciplinary, German-speaking healthcare professionals potentially enhancing physical rehabilitation.