Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review
Susan Gordon, Karen A. Grimmer, Sarah Barras
College of Nursing and Health Sciences, Flinders University, 5042 Adelaide, Australia. E-mail: firstname.lastname@example.org
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 one 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 can occur insidiously and rapidly as a result of enforced bed rest, immobilization or sedentary behaviours. While hospital-acquired deconditioning can occur in people of any age, it is particularly problematic in elderly people, as it can lead to irreversible functional decline. Hospital-acquired deconditioning is preventable with proactive, comprehensive regular assessment to detect changes in the performance of body systems. The time-period of assessment must be short, so that repeated assessments can be made during an acute hospital admission. At present there is no comprehensive, time-sensitive assessment instrument for hospital-acquired deconditioning. Based on a systematic scan of the literature, this paper proposes a core set of items that could be developed into a comprehensive, standardized assessment instrument for regular application by any healthcare provider during an acute inpatient stay, to identify incipient hospital-acquired deconditioning. The assessment items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity.
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