Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review
Susan Gordon, Karen A. Grimmer, Sarah Barras
Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning.
Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018.
Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess 1 or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider.
Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument.
Data extraction: Hospital-acquired deconditioning assessment items.
Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity.
Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.
Hospital-Acquired Deconditioning (HAD) can occur insidiously and rapidly as a result of prolonged bed rest or immobilization, often associated with hospitalisation. While HAD can occur in people of any age, it is particularly problematic in elderly people as it can lead to irreversible functional decline. HAD is preventable with proactive quality care. Comprehensive regular assessment to detect critical changes in body systems performance is one way of identifying incipient HAD. The time period of assessment must be short so that repeated assessments can be made during a hospital admission. There is no comprehensive, time-sensitive assessment instrument for HAD. From a literature scan, this paper proposes a core set of assessment items which could be developed into a comprehensive, standardized, sensitive assessment instrument for regular application during hospitalization, to identify incipient HAD. Assessment items comprise balance, mobility and function.
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