Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review

Abstract

Objectives: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning.

Design and data sources: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018.

Study selection: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument.

Data extraction: Hospital-acquired deconditioning assessment items.

Results: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity.

Conclusion: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.

Keywords: HAD; acute hospital admission; assessment; discharge planning; frailty; functional decline; hospital-acquired deconditioning; inter-professional practice; older people; psychometric properties; quality care; systematic evidence scan; utility.