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. 2023 Jul 31;12(15):5033.
doi: 10.3390/jcm12155033.

Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability

Charlotte Marie Schanke  1 , Anne Kristine Brekka  2   3 , Stein Arne Rimehaug  1 , Mari Klokkerud  1   4 , Tiina Maarit Andersen  3   5
Affiliations

Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability

Charlotte Marie Schanke et al. J Clin Med. .

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.

Keywords: CPAx; critical care; critical illness; early rehabilitation; measurement tool; physical function; physiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Stage I. The translation process.
Figure 2
Figure 2
Flow chart showing patient inclusion in the 5 different hospitals (H1-H5) during the study.
Figure 3
Figure 3
Modified Bland–Altman plot of data adjusted for repeated measurements. Limits of agreement were defined as d±1.96×SDdiff where d  = mean difference between raters and SDdiff = the standard deviation of the differences. The mean CPAx-NOR score is indicated with a solid line and the upper and lower limits are indicated with dotted lines.
Figure 4
Figure 4
Bland–Altman plot of data from 57 assessments of critically ill patients at time point A and 53 assessments at time point B. The mean is indicated with a solid line and the upper and lower limits are indicated with dotted lines.
See this image and copyright information in PMC

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