Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability
Schanke, Charlotte Marie; Brekka, Anne Kristine; Rimehaug, Stein Arne; Klokkerud, Mari; Andersen, Tiina Maarit
Peer reviewed, Journal article
Published version
Date
2023Metadata
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Abstract
Background: Assessment of physical and respiratory function in the intensive care unit
(ICU) is useful for developing an individualized treatment plan and evaluating patient progress.
There is a need for measurement tools that are culturally adapted, reliable and easy to use. The
Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong
psychometric properties for the intensive care population. This study aims to translate, adapt and
test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use
in critically ill adult patients receiving prolonged mechanical ventilation. Method: CPAx-NOR was
forward backward translated, culturally adapted and tested by experts and patients for face validity.
Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. Results: The
experts and pilot testers reached consensus on the translation and face validity. Patients were tested
at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at “A” was 0.990
(0.983–0.994) and at “B” 0.994 (0.990–0.997). Based on A+B combined and adjusted, the ICC was 0.990
(95% CI 0.996–0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable
change (MDC) was 1.89. The Bland–Altman plot showed low bias and no sign of heteroscedasticity.
CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of
physiotherapy and low ceiling effects at discharge. Conclusion: CPAx-NOR demonstrated good face
validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function
in critically ill adults receiving prolonged mechanical ventilation in Norway.