Translation, construct validity and inter-rater reliability of the Dutch AM-PAC ‘6-clicks’ Basic Mobility short form to assess the mobility of hospitalized patients

Abstract

ABSTRACT Aim: A high proportion of hospitalized patients experience limitations in mobility. To identify a loss in mobility, it is important to use an objective, standardized and valid measurement tool. The Activity Measure for Post-Acute Care ‘6-clicks’ Basic Mobility (AM-PAC BM) is an easy-to-use, quick English measuring tool and has been found valid and reliable in a hospital population. Therefore, the study aims were: (1) to translate the AM-PAC BM to Dutch, and (2) to determine the construct validity and (3) inter-rater reliability in patients hospitalized in a Dutch medical center. Methods: First, the AM-PAC BM was translated from English to Dutch by using a backward-forward translation protocol. Secondly, to determine the validity physiotherapists assessed patients admitted to the internal medicine wards to test six hypotheses regarding the construct ‘mobility’. Thirdly, to determine the inter-rater reliability, pairs of physiotherapists independently scored hospitalized patients using the Dutch AM-PAC BM. Results: Five of the six hypotheses (83.33%) were confirmed. Better mobility scores as measured with the AM-PAC BM relate to less restrictive pre-admission living situations (p=0.011), less restrictive discharge locations (p=0.001), more independence in activities of daily living (p=0.001), and less physiotherapy visits (p=0.000). There is a correlation between a patient’s AM-PAC BM score and length of stay (r=-0.408, p=0.001), but not between the patient’s AM-PAC BM and age (r=-0.180, p=0.528). Three Intraclass Correlation Coefficients were found between 0.919 (95% CI: 0.862-0.953) to 0.920 (95% CI: 0.828 – 0.964). The Kappa Coefficients for the individual items ranged between 0.649 (walking stairs) to 0.841 (sit to stand). Conclusion: This study provides evidence for the construct validity of the Dutch AM-PAC BM when physiotherapists use it to assess the mobility of hospitalized patients, and also demonstrates a moderate to excellent inter-rater reliability. Clinical Relevance Not only does the newly translated AM-PAC BM offer the Dutch physiotherapist an easy way to measure the mobility more validly, it also offers the Dutch physiotherapists a way to improve the validity of their clinical recommendations regarding post-acute care and discharge planning.