Measurement properties of the Chelsea Critical Care Physical Assessment tool (CPAx): a systematic review and meta-analysis

IF 9.4 1区医学 Q1 ORTHOPEDICS

Journal of Physiotherapy Pub Date : 2026-07-01 Epub Date: 2026-06-29 DOI:10.1016/j.jphys.2026.06.009

Sabrina Eggmann, Camilo Caceres-Parra, Ashlea Hills, Carol L Hodgson, Michelle Paton

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引用次数: 0

Abstract

Question

What are the measurement properties of the Chelsea Critical Care Physical Assessment tool (CPAx) for evaluating physical function and activity for rehabilitation of patients who are critically ill?

Methods

A systematic search was conducted in five databases to 12 January 2026. Two reviewers independently screened studies, extracted data and assessed quality for each measurement property (COSMIN Risk of Bias checklist); quality of each available measurement property was independently evaluated by any two reviewers who judged the quality as very good, adequate, doubtful or inadequate. Data were synthesised according to COSMIN guidelines, with random-effects meta-analyses for intraclass correlation coefficients (ICCs). Pooled results were rated and the evidence graded as very low, low, moderate or high quality.

Results

27 studies investigated 71 measurement properties (inadequate to very good). The CPAx was feasible, with small floor and ceiling effects across the trajectory of recovery. Content validity was high (pooled index 0.94; high-quality evidence). The CPAx demonstrated excellent inter-rater reliability (pooled ICC 0.99, 95% CI 0.98 to 1.00, six studies, high-quality evidence), intra-rater reliability (ICC 0.95, 95% CI 0.82 to 0.97, one study, low-quality evidence) and acceptable standard error of measurement (pooled SEM 1.36, five studies) corresponding to a smallest detectable change of 3.76 (sufficient rating, high-quality evidence). Construct validity was supported with 26 out of 34 predefined hypotheses accepted (76%, sufficient, 10 studies, moderate-quality evidence) and responsiveness with five out of six predefined hypotheses accepted (83%, sufficient, five studies, very low-quality evidence).

Conclusion

Moderate- to high-quality evidence indicates that the CPAx is a valid and reliable instrument for evaluating physical function and activity of critically ill patients. Further research is needed to evaluate responsiveness.

Registration

PROSPERO CRD420250655518.

查看原文本刊更多论文

切尔西重症监护体格评估工具（CPAx）的测量特性：一项系统回顾和荟萃分析。

问题：切尔西重症监护身体评估工具（CPAx）用于评估危重患者康复的身体功能和活动的测量特性是什么？方法：系统检索5个数据库至2026年1月12日。两名审稿人独立筛选研究，提取数据并评估每个测量属性的质量（COSMIN偏倚风险检查表）；每个可用测量属性的质量由任意两名评论者独立评估，他们判断质量为非常好、适当、可疑或不充分。根据COSMIN指南对数据进行综合，并对类内相关系数（ICCs）进行随机效应荟萃分析。对合并结果进行评级，并将证据分为极低、低、中等或高质量。结果：27项研究调查了71项测量特性（从不足到非常好）。CPAx是可行的，在整个恢复过程中具有较小的下限和上限效应。内容效度高（综合指数0.94，证据质量高）。CPAx表现出优异的评分间信度（合并ICC 0.99, 95% CI 0.98至1.00,6项研究，高质量证据）、评分内信度（合并ICC 0.95, 95% CI 0.82至0.97,1项研究，低质量证据）和可接受的测量标准误差（合并SEM 1.36, 5项研究），对应于最小的可检测变化3.76（足够评分，高质量证据）。34个预定义假设中有26个被接受（76%，充分，10个研究，中等质量的证据），结构效度得到支持，6个预定义假设中有5个被接受（83%，充分，5个研究，非常低质量的证据）。结论：中度至高质量的证据表明，CPAx是评估危重患者身体功能和活动的有效和可靠的工具。需要进一步的研究来评估反应性。报名：普洛斯彼罗CRD420250655518。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Physiotherapy ORTHOPEDICS-REHABILITATION

CiteScore

11.40

自引率

7.40%

发文量

审稿时长

72 days

期刊介绍： The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.