High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture.
OBJECTIVE
To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture.


METHODS
An intertester reliability study.


METHODS
An acute 20-bed orthopaedic hip fracture unit.


METHODS
Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years.


METHODS
The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability - was assessed by two independent physiotherapists at postoperative median day 3. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent of human assistance). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent ambulation.


METHODS
Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD).


RESULTS
The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were >or=0.92, <or=0.20 and <or=0.55 CAS points, respectively.


CONCLUSIONS
The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.
Kristensen
Morten Tange
MT
Department of Health Sciences, Division of Physiotherapy, Lund University, Sweden. mortentange@hotmail.com
Andersen
Lene
L
Bech-Jensen
Rie
R
Moos
Malene
M
Hovmand
Bente
B
Ekdahl
Charlotte
C
Kehlet
Henrik
H
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index