| Objectives:To introduce,chinesize and revise the Chelsea Critical Care Physical Assessment Tool(CPAx),and test it reliability and validity of the Chinese version CPAx scale.To explore the clinical application value of Chinese version CPAx scale in the diagnosis of ICU acquired weakness(ICU-AW)and ascertain its threshold by taking MRC-Score?48 as the standard,and to provide a foundation for the assessment of ICU-AW in critically illness patients in China.Methods:Firstly,we communicated with the original author and his teamwork and then obtained the right to chinesize the CPAx scale.And then the original version CPAx scale was translated into Chinese version CPAx scale according to the diagnostic tool translation guidelines which developed by ISPOR translation and cultural adaptation task force in 2005.Secondly,The researcher and one nursing graduate student used the Chinese version CPAx scale and MRC-Score scale to independently assessment 200 critical patients who come from an ICU of a third grade class A hospital in GanSu province.Thirdly,the software SPSS22.0 and AMOS 23.0 were used to test the item discrimination,validity and reliability of the scale.At the same time,there are 9 chinese experts who are good at critical care medicine?intensive care?intensive rehabilitation were invited to identify the contents of the Chinese version CPAx scale and test its expert validity.Finally,taking the MRC-Score?48 as the standard to apply the Chinese version CPAx scale to diagnosis ICU-AW,and then calculating the area under the ROC curve,the youlden index and the consistency test,and to explore the value of Chinese version CPAx scale in the diagnosis of ICU-AW and ascertain its threshold.Results:The Chinese version CPAx scale included 10 items which are respiratory function,cough,moving within the bed(e.g.rolling),supine to sitting on the edge of the bed,dynamic sitting(i.e.when sitting on the edge of the bed / unsupported sitting),standing balance,sit to stand(starting position:? 90 degrees hip flexion),transferring from bed to chair,stepping and grip strength.Each item is rated from 0 to 5,and the total score is 0-50.For all items,the hit ratio of the options was distributed between 0% and 69%,the range of the discriminant index value and CR value was 2.66-134.92(P<0.05);the discriminant validity calculated by the confirmatory factor analysis(CFA)model was 0.79,and the Chinese version CPAx scale had a good discriminant degree.There are only one common factor was extracted(KMO = 0.926),and the cumulative variance contribution rate was 67.42%,which was calculated by Exploratory Factor Analysis(EFA)and the EFA verified that the model had good dominance.The EFA results showed that the standardized factor loading of each items between 0.54 to 0.91,CR value is 0.94 > 0.7,AVE = 0.63 > 0.5.Therefore,the Chinese version CPAx scale has the very good R-squared,combination reliability and convergent validity.Taking the MRC-Score as the standard to verify the criterion-related validity(CRV),rho=0.758(P<0.001);The Cronbach 's ?=0.939,the correlation coefficient between two assessor of each itemswas between 0.668-0.992(P<0.001),the correlation coefficient between the scale sum score was 0.902,(P < 0.001).The Chinese version CPAx scale has good item discrimination,validity and reliability.Taking the MRC-Score?48as the standard and Combined with the ROC curve cutting value,the Chinese version CPAx scale?31 points is the threshold for diagnosis ICU-AW.In addition,The Chinese version CPAx scale has high sensitivity(0.889-0.932)and specificity(0.788-0.986)in the diagnosis of ICU-AW in ICU mechanical ventilation patients.Conclusion:The Chinese version CPAx scale not only has good item discrimination,structure validity,content validity,CRV,and good intrinsic consistency?Inter-rater reliability,but also has comprehensive assessment content and the assessment method is simple and feasible.The Chinese version CPAx scale?31 score is the critical value for diagnosis ICU-AW. |
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