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Physical Function Intensive Care Unit Test

Original Editor - Alicia Fernandes Top Contributors - Alicia Fernandes

Introduction

The Physical Function ICU Test (PFIT) is a clinical tool developed to assess physical function in critically ill patients within the ICU. Its objective is to evaluate patients’ strength, endurance, and mobility to guide physical rehabilitation and predict functional outcomes post-ICU.[1]

The PFIT-s is accessible, takes approximately 10 to 15 minutes to administer,3 requires minimal equipment (a chair and stopwatch)[2] Here

Objective

PFIT's primary goal is to assess early functional mobility in ICU patients, providing a standardized way to measure baseline function, monitor progress, and predict long-term physical outcomes. It helps clinicians make informed decisions regarding individualized rehabilitation needs and discharge planning.[3]

Population

PFIT is specifically designed for critically ill patients who have been in the ICU, especially those who may have developed ICU-acquired weakness (ICUAW) or experienced a prolonged ICU stay. This test applies to patients with sufficient consciousness and the physical capacity to attempt simple functional movements.[4]

Method

PFIT evaluates physical function across four key domains:

  1. Sit-to-stand performance: This assesses lower limb strength and functional independence by measuring a patient's ability to stand up from a seated position. Patients are scored on their level of assistance, with a higher score indicating a better functional outcome.
  2. Marching on the spot: This evaluates endurance and coordination, as patients are required to march in place for a set period. The duration and speed of the marching, along with the number of steps, help determine endurance levels.
  3. Shoulder strength: Shoulder strength is tested as an indicator of overall upper body strength, typically measured using the Oxford Muscle Scale. This measurement helps gauge the patient's capacity for self-support during activities like sitting up or transferring.
  4. Assistance for transfers: This measure notes the level of assistance needed by the patient to perform basic transfers (e.g., from bed to chair). This aspect is essential in gauging mobility and independence.[2]

Scoring and Interpretation of PFIT

Each component of PFIT is scored on a scale, with higher scores reflecting better physical function. Patients are assessed based on their level of assistance required, endurance in performing tasks, and the number of repetitions or time completed for each activity. The cumulative PFIT score helps categorize patients into different recovery trajectories, which assists clinicians in making informed decisions about rehabilitation intensity and discharge planning.[2]

Reliability and Validity

Studies have shown PFIT to be highly reliable in ICU settings, with consistent scoring across various assessors. This reliability makes it a dependable choice for clinicians tracking physical function changes over time in a critically ill patient population. The consistency of PFIT scores among assessors reinforces its credibility as a standardized tool in ICU rehabilitation settingsIT has demonstrated strong validity, as its scores correlate well with other measures of physical function and long-term outcomes, such as patient mobility and independence post-ICU. Its validity is particularly high in reflecting improvements or declines in ICU patients' functional status, which is essential for evaluating rehabilitation effectiveness[5][6][7] [8][9]

References

  1. ↑ Denehy L, de Morton NA, Skinner EH, Edbrooke L, Haines K, Warrillow S, Berney S. A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Physical therapy. 2013 Dec 1;93(12):1636-45.
  2. ↑ 2.0 2.1 2.2 Parry SM, Baldwin CE. Clinimetrics: The Physical Function in ICU test-scored. Journal of Physiotherapy. 2022 Jan;68(1):73.
  3. ↑ Agarwal BM, Aglawe D, Sawant B. Physical function assessment tools in the intensive care unit: a narrative review. Critical Reviews™ in Physical and Rehabilitation Medicine. 2022;34(1).
  4. ↑ Amy Nordon-Craft, Margaret Schenkman, Lara Edbrooke, Daniel J. Malone, Marc Moss, Linda Denehy, The Physical Function Intensive Care Test: Implementation in Survivors of Critical Illness, Physical Therapy, Volume 94, Issue 10, 1 October 2014, Pages 1499–1507
  5. ↑ Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU–what should we be using?-an observational study. Critical Care. 2015 Dec;19:1-9.
  6. ↑ Donovan MA, Drasgow F, Munson LJ. The Perceptions of Fair Interpersonal Treatment scale: Development and validation of a measure of interpersonal treatment in the workplace. Journal of Applied psychology. 1998 Oct;83(5):683.
  7. ↑ Peterson ML, Lukens K, Fulk G. Psychometric properties of physical function measures used in the intensive care unit: a systematic review. Journal of Acute Care Physical Therapy. 2018 Apr 1;9(2):78-90.
  8. ↑ Skinner EH, Berney S, Warrillow S, Denehy L. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc. 2009 Jun;11(2):110-5. PMID: 19485874.
  9. ↑ Heels-Ansdell D, Kelly L, O'Grady HK, Farley C, Reid JC, Berney S, Pastva AM, Burns KE, D'Aragon F, Herridge MS, Seely A. Early In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial. JMIR Research Protocols. 2024 Oct 28;13(1):e54451.
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