Inter-rater reliability of activity measure for post-acute care '6-Clicks' inpatient mobility short form in the intensive care unit.
Stephanie Hiser, Amy Toonstra, Lisa A Friedman and 2 others
PMID 32449231WHAT IT FOUND
Physical therapists in the ICU showed excellent agreement when scoring patient mobility using the AM-PAC IMSF after just one hour of training.
This means changes in scores over time likely reflect real patient progress, not differences in how therapists rate them.
Key findings
01Inter-rater reliability for the overall AM-PAC IMSF score was excellent, with an intra-class correlation coefficient of 0.957 across medical, surgical, and neurological ICUs.
02Agreement on individual mobility items ranged from good to very good, with weighted kappa values between 0.737 and 0.869.
03There was no systematic bias in scoring between clinical therapists and reference raters, as the mean difference in scores was 0.0.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was conducted at a single large academic hospital, so results may not apply to other settings. All therapists had received a specific one-hour training session; reliability might be lower in teams without this standardized training. Reference raters only observed the clinical therapists' assessment; they did not perform a separate hands-on evaluation, which could have influenced agreement levels. The sample size was relatively small, with 76 patients and 8 therapists.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not assume this high reliability applies to all ICU therapists or settings. The excellent agreement depended on a standardized one-hour training session and a single academic hospital context. Without similar training, inter-rater reliability may be lower.