title: Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties.
abstract: OBJECTIVE
  To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified.
  
  
  METHODS
  A systematic review of articles was carried out using the databases Medline (1950-2014), CINAHL (1982-2014), EMBASE (1980-2014), Cochrane Library (2014) and Scopus (1960-2014). Additional studies were identified by searching personal files. Eligibility criteria for selection: Search 1: studies which assessed muscle mass, strength or function using objective non-laboratory measures; Search 2: studies which evaluated a clinimetric property (reliability, measurement error, validity or responsiveness) for one of the measures identified in search one. Two independent reviewers assessed articles for inclusion and assessed risk of bias using the consensus-based standards for selection of health status measurement instruments checklist.
  
  
  RESULTS
  Thirty-three measures were identified; however, only 20 had established clinimetric properties. Ultrasonography, dynamometry, physical function in intensive care test scored and the Chelsea critical care physical assessment tool performed the strongest for the measurement of impairment of body systems (muscle mass and strength) and activity limitations (physical function), respectively.
  
  
  CONCLUSIONS
  There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness. Future work should identify a core set of standardized measures, which can be utilized across the continuum of critical illness recovery embedded within the International Classification of Functioning framework. This will enable improved comparisons between future studies, which in turn will assist in identifying the most effective treatment strategies to ameliorate the devastating longer-term outcomes of a critical illness.
authors: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia, selina.parry@unimelb.edu.au.
authors: Selina M
authors: SM
authors: Parry
authors: Catherine L
authors: CL
authors: Granger
authors: Sue
authors: S
authors: Berney
authors: Jennifer
authors: J
authors: Jones
authors: Lisa
authors: L
authors: Beach
authors: Doa
authors: D
authors: El-Ansary
authors: René
authors: R
authors: Koopman
authors: Linda
authors: L
authors: Denehy
mesh_terms: D000203:Activities of Daily Living; D016638:Critical Illness; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D053580:Muscle Strength; D005082:Physical Exertion; D011594:Psychometrics; D015203:Reproducibility of Results; D012720:Severity of Illness Index
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