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Vol. 31. Issue 3.
Pages 131-146 (July - September 2020)
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Vol. 31. Issue 3.
Pages 131-146 (July - September 2020)
Original article
Adaptation and validation of the ICU Mobility Scale in Spain
Adaptación y validación de la UCI Mobility Scale en España
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S. Arias-Riveraa,b, M. Raurell-Torredàc,
Corresponding author
, I.J. Thuissard-Vasallod, C. Andreu-Vázqueze, C.L. Hodgsonf,g, Grupo IMS-Es 1, Grupo MOviPre 2
a Hospital Universitario de Getafe, Getafe, Madrid, Spain
b CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
c Facultad Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
d Escuela de Doctorado e Investigación. Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
e Departamento Farmacia y Biotecnología, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
f Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
g Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
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Tables (5)
Table 1. ICU Mobility Scale Spanish version (IMS-Es).
Table 2. Overall change assessment scale.
Table 3. Patient characteristics.
Table 4. Mobility scores and MRC-SS.
Table 5. Results of the validation analysis.
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Additional material (1)
Abstract
Objective

To adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es).

Method

Descriptive metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study.

Results

After obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r = .389; p < .001) and significant comparison between groups with and without ICU-acquired weakness (p < .001). Divergent validity: no correlation between IMS-Es and BMI [r(95%CI)=-.112((-.232)-(.011))], weight [r(95%CI)=-.098((-.219)-(.026))], Charlson [r(95%CI)=-.122((-.242)-(.001))] and Barthel [r[95%CI]=-.037((-.160)-(.087))] and no differences between sexes (p = .587) or BMI categories (p = .412). Predictive validity: moderate and significant correlations with post-ICU hospital stay [r(95%CI)=-.442((-.502)-(-.377))] and physical component of SF-12 (PCS) [r(95%CI) = .318(.063-.534)]; patients without active mobilisation in ICU increased risk of hospital mortality [OR(95%CI) = 3.769(1.428-9.947)]. Interobserver reliability: very good concordance between nurses [CCI (95%CI) = .987(.983-.990)] and nurse-physiotherapist [CCI (95%CI) = .963(.948-.974)]. Sensitivity to change: small effect on discharge from ICU (d = .273) and moderate effect at 3 months after hospital discharge (d = .709). Minimal difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity.

Conclusions

The IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.

Keywords:
Critical care
early mobilization
muscle weakness
validation studies
validity
reliability
responsiveness
Resumen
Objetivo

Adaptar la ICU Mobility Scale (IMS) al ámbito de las unidades de cuidados intensivos (UCI) de España y evaluar las propiedades métricas de la IMS versión española (IMS-Es).

Método

Estudio descriptivo de carácter métrico desarrollado en dos fases. Fase 1, adaptación al español de la IMS mediante equipo de enfermeras y fisioterapeutas (traducción, piloto, retrotraducción y acuerdo). Fase 2, análisis de propiedades métricas (validez convergente, divergente y predictiva, fiabilidad interobservador, sensibilidad y diferencia mínima importante) de la IMS-Es. Se registraron características de los pacientes (Barthel, Charlson, IMC, sexo), nivel de sedación/agitación (RASS), estancias en UCI y hospital, supervivencia, calidad de vida (SF-12), debilidad muscular (MRC-SS) y movilidad (IMS-Es) en los pacientes del estudio multicéntrico nacional MOviPre.

Resultados

Tras obtener la IMS-Es, se implementó en 645 pacientes de 80 UCI españolas entre abril y junio de 2017. Validez convergente: moderada correlación entre IMS-Es y MRC-SS (r = 0,389; p < 0,001) y comparación significativa entre grupos con y sin debilidad adquirida en la UCI (p < 0,001). Validez divergente: no correlación entre IMS-Es e IMC [r(IC95%)=-0,112((-0,232)–(0,011))], peso [r(IC95%)=-0,098((-0,219)–(0,026))], Charlson [r(IC95%)=-0,122((-0,242)–(0,001))] y Barthel [r[IC95%]=-0,037((-0,160)–(0,087))] y sin diferencias entre sexos (p = 0,587) ni categorías de IMC (p = 0,412). Validez predictiva: moderadas y significativas correlaciones con estancia en hospital post-UCI [r(IC95%)=-0,442((-0,502)–(-0,377))] y componente físico del SF-12 (PCS) [r(IC95%) = 0,318(0,063–0,534)]; pacientes sin movilización activa en UCI mayor riesgo de mortalidad hospitalaria [OR(IC95%) = 3,769(1,428–9,947)]. Fiabilidad interobservador: muy buena concordancia entre enfermeras [CCI(IC95%) = 0,987(0,983–0,990)] y entre enfermera-fisioterapeuta [CCI(IC95%) = 0,963(0,948–0,974)]. Sensibilidad al cambio: efecto pequeño al alta de UCI (d = 0,273) y moderado a los 3 meses del alta hospitalaria (d = 0,709). Diferencia mínima importante: punto de corte de la diferencia de 2 puntos, sensibilidad 91,1% y especificidad 100,0%.

Conclusiones

La IMS-Es es útil, válida y fiable para ser implementada, por enfermeras de UCI y fisioterapeutas, al valorar la movilidad de los pacientes críticos.

Palabras clave:
Cuidados intensivos
Movilización precoz
Debilidad muscular
Estudio de validación
Validez
Fiabilidad
Sensibilidad

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