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Acute Care Index of Function

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Purpose

The ACIF is meant to assess basic mobility, mental status impairment, activity limitations, and can assist in discharge placement decisions.

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Instrument Details

Acronym ACIF

Area of Assessment

Functional Mobility
Cognition
Activities of Daily Living

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Key Descriptions

  • 20-item instrument with activities to measure cognition and functional mobility
  • Four subscales:
    o Mental Status (MS): 4 activities, each scored 0 for ‘no’ and 1 or 2 for ‘yes’. The score is divided by 6 to get MS subscore.
    o Bed Mobility (BM): 4 activities, each scored 0 for ‘unable,’ 4 for ‘dependent,’ and 10 for ‘independent.’ The score is divided by 40 to get BM subscore
    o Transfers (T): 6 activities, each scored 0 for ‘unable,’ 4 for ‘dependent,’ and 10 for ‘independent.’ The score is divided by 60 to get T subscore
    o Mobility (M): 6 activities, each scored 0 for ‘unable,’ 4 for ‘dependent,’ and 10/20/30 for ‘independent.’ The score is divided by 70 (if wheelchair items are not used) or divided by 100 (if wheelchair items are used) to get M subscore.
  • Total Score: [(MS) + (BM) + (T x 2) + (M x 2)] / 6.
  • Score ranges from 0-1, or reported in percentages. Score of 0 means that a subject is unable to perform any of the activities, while a score of 1 indicates that the subject is independent in all activities.
  • For measurement dimension:
    o Unable: Patient cannot physically assist to perform the activity
    o Dependent: Patient assists to perform the activity but requires physical or verbal assistance to complete the activity
    o Independent: Patient performs the activity meeting all stated criteria without verbal or physical assistance.
  • Guidelines:
    o The patient is not allowed to use bed rails, tables, or armrests during the performance of items 5 to 8.
    o The patient may use any method that is functional to carry out a task.
    o Note that rating of physical assistance for sitting or standing balance applies to Functional Tests & Measures in Acute Care 6 patients who require assistance to maintain the position as well as patients who cannot meet the other stated criteria.
    o In rating transfers, the rater is allowed to perform the necessary setup for a transfer if the patient is not being tested specifically on wheelchair setup.
    o The patient can be tested with any mobility devices that are functional for him/her.
    o In rating gait with or without a device, the patient may use any prosthesis or orthosis necessary.

Number of Items

20

Equipment Required

  • Mat
  • Wheelchair
  • Assistive Devices
  • Stairs

Time to Administer

12 minutes

Required Training

Reading an Article/Manual

Required Training Description

Reading the instructions and the guidelines in assessing each individual item/activity.

Age Ranges

Adults

18 - 64

years

Instrument Reviewers

Tri Pham, Medical Student from UT Southwestern

Body Part

Upper Extremity
Lower Extremity
Back

ICF Domain

Body Function
Activity

Measurement Domain

Cognition
Motor
Activities of Daily Living

Mixed Populations

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Interrater/Intrarater Reliability

Mixed Patient Population (Van Dillen & Roach, 1988; n = 91; mean age = 53 years (5.6); had diagnoses of cerebrovascular accident (n = 24), multiple sclerosis (n = 13), Parkinson's disease (n = 10), spinal cord injury (n = 12), head injury (n = 7), craniotomy (n = 11), neuropathy (n = 8), dementia (n = 4), amyotrophic lateral sclerosis (n = 1), or myasthenia gravis (n = 1); raters were 6 physical therapists (PTs) in neurology acute care department)

  • Excellent inter-rater reliability for all subsets and total score (ICC = 0.98 – 1.00)
  • Adequate inter-rater reliability for ranking 10 patients descriptions by PTs (Cohen’s weighted Kappa = 0.75)

 

ICU Patients (Bissett et al., 2016; n = 42; mean age = 59 year (19); 8 physiotherapists serve as assessors)

  • Excellent inter-rater reliability for ACIF total score (ICC = 0.94)
  • Excellent inter-rater reliability for all ACIF components ICC = 0.81-0.94)

 

SICU Patients (Jones & Widener, 2003; n = 21)

Excellent inter-rater reliability (ICC = 0.9969)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Mixed Patient Population (Van Dillen & Roach, 1988; n = 10)

  • Excellent concurrent validity between ACIF total score and PTs’ assessment of functional independence (r = 0.81)

 

Predictive Validity

Mixed Patient Population (Roach and Van Dillen, 1988; n = 75; cerebrovascular accident (CVA) (n = 36), multiple sclerosis (n = 10), Parkinson's disease (n = 7), primary and metastatic lesions of the

central nervous system (n = 6), head injury (n = 4), lumbar stenosis (n = 2), and miscellaneous neurological diagnoses (ie, Guillain-Barre syndrome, spinal cord injury, and syringomyelia) (n =10))

  • 100% of the patients who scored less than or equal to 0.30 were discharged to a nursing facility. Of the patients who scored in the 0.31-0.70 range, 65% were discharged to a rehabilitation facility. Finally, 72% of the patients scoring greater than 0.70 on the ACIF were discharged to home.

 

Concurrent Validity

Mixed Patient Population (Van Dillen & Roach, 1988; n = 10)

  • Excellent concurrent validity between ACIF total score and PTs’ assessment of functional independence (r = 0.81)

 

Predictive Validity

Mixed Patient Population (Roach and Van Dillen, 1988; n = 75; cerebrovascular accident (CVA) (n = 36), multiple sclerosis (n = 10), Parkinson's disease (n = 7), primary and metastatic lesions of the

central nervous system (n = 6), head injury (n = 4), lumbar stenosis (n = 2), and miscellaneous neurological diagnoses (ie, Guillain-Barre syndrome, spinal cord injury, and syringomyelia) (n =10))

  • 100% of the patients who scored less than or equal to 0.30 were discharged to a nursing facility. Of the patients who scored in the 0.31-0.70 range, 65% were discharged to a rehabilitation facility. Finally, 72% of the patients scoring greater than 0.70 on the ACIF were discharged to home.

 

ICU Patients (Bissett et al., 2016; n = 42; mean age = 59 year (19); 8 physiotherapists serve as assessors)

Adequate predictive validity between ACIF score at ICU discharge with home discharge (AUC of ROC was 0.79, with sensitivity of 0.78 and specificity of 0.47)

(Bissett et al., 2016; n = 42; mean age = 59 year (19); 8 physiotherapists serve as assessors)

Adequate predictive validity between ACIF score at ICU discharge with home discharge (AUC of ROC was 0.79, with sensitivity of 0.78 and specificity of 0.47)

Construct Validity

Convergent Validity

ICU Patients (Bissett et al., 2016; n = 42; mean age = 59 year (19); 8 physiotherapists serve as assessors)

  • Excellent convergent validity between ACIF and ICU Mobility Scale (r = 0.84)

 

SICU Patients (Jones & Widener, 2003; n = 21)

  • Excellent convergent validity between ACIF at discharge and final discharge location (r = 0.67)
  • Adequate convergent validity between initial ACIF and discharge location (r = 0.58)
  • Adequate convergent validity between initial ACIF and Acute Physiology and Chronic Health Evaluation (r = -0.51)
  • Adequate convergent validity between ACIF at discharge and Acute Physiology and Chronic Health Evaluation (r = -0.38)

Floor/Ceiling Effects

ICU Patients (Bissett et al., 2016; n = 42; mean age = 59 year (19); 8 physiotherapists serve as assessors)

  • Adequate floor effects of 10%
  • Excellent ceiling effect of 0%

Orthopedic Surgery

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Minimally Clinically Important Difference (MCID)

Lower Extremity Orthopedic Patients (Roach et al., 1998; n = 173; mean age = 67.9 years (20.5))

The mean discharge score for bed mobility was 57.63% with a standard deviation of 31.59%. This large degree of variability makes it difficult to set a value for MCID.

Construct Validity

Convergent Validity

Lower Extremity Orthopedic Patients (Roach et al., 1998; n = 173; mean age = 67.9 years (20.5))

  • Poor convergent validity of ACIF at discharge with minutes of physical therapy received (r = 0.15)

Responsiveness

Lower Extremity Orthopedic Patients (Roach et al., 1998; n = 173; mean age = 67.9 years (20.5))
  • Statistically significant changes of 6.27% on mental status score, and changes of 15.64%, 18.42%, and 15.42% for bed mobility, transfer/mobility, and ACIF total score, respectively

Bibliography

Van Dillen, L. R., & Roach, K. E. (1988). Reliability and validity of the Acute Care Index of Function for patients with neurologic impairment. Physical therapy68(7), 1098-1101.

Roach, K. E., & Van Dillen, L. R. (1988). Development of an Acute Care Index of Functional status for patients with neurologic impairment. Physical therapy, 68(7), 1102–1108. https://doi.org/10.1093/ptj/68.7.1102

Roach, K. E., Ally, D., Finnerty, B., Watkins, D., Litwin, B. A., Janz-Hoover, B., ... & Curtis, K. A. (1998). The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower-extremity orthopedic problems. Physical therapy78(1), 19-24.

Scherer, S. A., & Hammerich, A. S. (2008). Outcomes in cardiopulmonary physical therapy: acute care index of function. Cardiopulmonary Physical Therapy Journal19(3), 94.

Bissett, B., Green, M., Marzano, V., Byrne, S., Leditschke, I. A., Neeman, T., ... & Paratz, J. (2016). Reliability and utility of the Acute Care Index of Function in intensive care patients: An observational study. Heart & Lung45(1), 10-14.

Jones, L. A., & Widener, G. L. (2003). AN EXPLORATORY STUDY ON THE RELIABILITY OF THE ACUTE CARE INDEX OF FUNCTION IN THE CRITICALLY ILL. Cardiopulmonary Physical Therapy Journal14(1), 17.

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