Identifying Clinically Relevant Functional Strata to Direct Mobility Preservation Among Patients Hospitalized With Medical Conditions.
Elizabeth Marfeo, Pengsheng Ni, Chun Wang and 2 others
PMID 34146535WHAT IT FOUND
Experts established four mobility levels and one cognition flag for the FAMCAT tool to guide hospital triage.
The calibration sample was mostly high-functioning, with no patients scoring in the lowest mobility strata. These cut-points help direct mobility preservation programs.
Key findings
01The consensus process established four functional strata for Basic Mobility and Daily Activities, and a single cut-point for Applied Cognition to flag safety risks.
02In the calibration sample, no patients scored in the lowest (Red) functional level for either Basic Mobility or Daily Activities.
03FAMCAT classifications agreed with nurse or occupational therapist ratings for 69% of patients on mobility, 59.6% on daily activities, and 71.8% on applied cognition.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The calibration sample was primarily drawn from internal medicine and cardiopulmonary units, so results may not generalize to neurological or orthopedic patients. No patients in the sample scored in the lowest (Red) functional strata for Basic Mobility or Daily Activities, meaning the cut-points for the most severely impaired patients are based on expert opinion rather than observed data. Selection bias may exist because patients unable to provide informed consent due to medical complications or cognitive status were excluded. The study validates the consensus process for creating strata, not the clinical effectiveness of using these strata to improve patient outcomes.
Declared interests
The study was supported by the National Institutes of Health (N.I.H., Extramural). No other specific conflicts of interest or commercial funding sources are declared in the provided text.
The easy way to misread this
Do not assume the FAMCAT is validated for patients with severe functional impairment or those who cannot consent. The study found no patients in the lowest functional strata, so the cut-points for severe disability are theoretical and untested in this sample.