A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Science in Physiotherapy.
Johannesburg 2017 / Background: There is limited research available on the use of outcome measures in intensive care
units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a
measure of morbidity related to physical function and assesses respiratory function and functional
abilities of critically ill patients.
Objectives: The objectives of this study were to establish the effect of the use of the CPAx tool on ICU
and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the
CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx
scores and severity of illness or general morbidity during ICU admission; and to establish
physiotherapists’ perceptions and views towards the use of the CPAx tool in their daily clinical practice
in ICU.
Design: The study consisted of two parts. Part one was a quasi-experimental design with a historical
matched control group. Part two was a survey-based design.
Methods: The study took place in a South African public sector hospital. Twenty six participants each
were recruited into the experimental and control groups. Participants from the control group were
matched with participants in the experimental group according to age, gender, diagnosis and acute
physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure
assessment (SOFA) scores were calculated for participants in the experimental group on alternate
weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants
and historical control group were done using an independent t-test. Pearson’s correlation coefficient
was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA
scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was
completed by the research assistants who administered the CPAx tool to participants in the experimental
group in order to determine their perceptions of the tool.
Results: The mean age for the CPAx group was 37.88 (±13.37) years and for the control group was
37.81 (±12.21) years. The CPAx group consisted of 14 (53.8%) participants who underwent surgical
procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The control group consisted
of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with
traumatic orthopaedic injuries. The mean initial SOFA score for the CPAx group was 2.42 (±1.79) and
for the control group was 4.15 (±2.6). A p=0.03 indicates that there was a statistically significant
difference between the two groups with regards to initial SOFA scores. The mean SOFA score at ICU
discharge for the CPAx group was 1.80 (±0.42) and for the control group was 2.87 (±1.81). A p=0.05
indicates that there was a statistically significant difference between the two groups with regards to
SOFA scores at ICU discharge.
The mean initial CPAx score for the experimental group was 29.73 points (±14.81) and the mean CPAx
score at ICU discharge was 36.15 (±8.33). The mean CPAx scores changed by 9.45 points between
admission and discharge from ICU for participants who underwent surgical procedures and the mean
CPAx scores changed by 3.9 points between admission and discharge from ICU for participants who
sustained traumatic orthopaedic injuries. The mean ICU LOS for the CPAx group was 5.84 days (±7.43)
and for the control group was 4.56 days (±5.25). The mean hospital LOS for the CPAx group was 17.43
(±16.68) days and for the control group was 19.31 days (±15.79); however, in both cases differences
were not statistically significant.
APACHE II scores had a very weak negative correlation with initial CPAx scores. APACHE II scores
had a very weak positive correlation with CPAx scores at ICU discharge. There was a statistically
significant difference between the two groups with regards to initial SOFA scores (p=0.05). Initial SOFA
scores had a statistically significant moderate negative correlation with initial CPAx scores (r=-0.45,
p=0.02). Initial SOFA scores had a weak negative correlation with CPAx scores at ICU discharge. Initial
CPAx scores had a moderate positive correlation with SOFA scores at ICU discharge. CPAx scores at
ICU discharge had a very strong statistically significant positive correlation with SOFA scores at ICU
discharge (r=0.80, p=0.05).The CPAx tool proved to be more responsive in a surgical population than
in a trauma population. Clinicians had positive perceptions of the CPAx tool in the management of
critically ill patients.
Discussion: Participants in the CPAx group were well matched with those in the historical control group
with regards to age, gender, diagnoses and severity of illness. Those in the CPAx group had lower
extent of organ dysfunction than those in the control group which might account for their shorter period
of hospitalisation. Patients with a higher risk for mortality on admission into the ICU displayed lower
functional abilities and, in turn, lower CPAx scores were measured. A greater change in CPAx scores
was observed for participants recovering from surgical interventions compared to those recovering from
traumatic orthopaedic injuries. Participants with low morbidity at the time of ICU admission seemed to
have a greater ability to perform functional activities during their ICU stay. Limitations of the study
included a small patient sample, a limited number of research assistants as well as lack of content
validation of the questionnaire used. A multi-centre trial on the use of CPAx in ICU patient management
could yield a wider perception of physiotherapists regarding the usefulness of the tool in daily clinical
practice. Measuring the effect of the CPAx tool on participants’ length of mechanical ventilation could
also be an interesting clinical outcome to consider.
Conclusion: The data presented in this study show that the use of the CPAx tool does not have an
influence on ICU and hospital LOS in a small sample of surgical and trauma participants. The tool
appears to be more useful when used in the care of patients who are recovering from surgical
procedures rather than those who sustained complex traumatic injuries. Physiotherapy clinicians that
participated in the study supported the use of the CPAx tool in this single-centre trial and generally had
positive perceptions towards the use of the tool. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23194 |
| Date | January 2017 |
| Creators | Whelan, Megan |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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