ORIGINAL RESEARCH
Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

https://doi.org/10.1016/j.apmr.2021.08.006Get rights and content

Highlights

  • The coronavirus disease 2019 (COVID-19) pandemic has presented a substantial challenge to our health care system.

  • Greater knowledge of the factors that are associated with the need for posthospital care or longer length of stay may help facilitate discharge planning for people with COVID-19.

  • Activity Measure for Post-Acute Care (AM-PAC) “6-Click” mobility and activity scores provide important prognostic information about discharge destination and length of stay for individuals hospitalized with COVID-19.

  • Consistent use of AM-PAC “6-Click” assessments may help guide discharge planning in this and future pandemics.

Abstract

Objective

To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19).

Design

Retrospective cohort study.

Setting

An academic health system in the United States consisting of 5 inpatient hospitals.

Participants

Adult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment.

Interventions

Not applicable.

Main Outcome Measures

Discharge destination, hospital length of stay, in-hospital mortality, and readmission.

Results

A total of 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (odds ratio, 0.867 and 0.833, respectively) and activity scores (odds ratio, 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (area under the curve [AUC]=0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, whereas specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (odds ratio, 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged length of stay (odds ratio, 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC=0.659-0.679). AM-PAC scores did not predict rehospitalization.

Conclusions

Functional status as measured by the AM-PAC “6-Clicks” mobility and activity scores are independent predictors of key clinical outcomes individual hospitalized with COVID-19.

Keywords

Length of stay
Morbidity
Mortality
Prognosis
Rehabilitation

List of abbreviations

AM-PAC
Activity Measure for Post-Acute Care
AUC
area under the curve
CI
confidence interval
COVID-19
coronavirus disease 2019
ICU
intensive care unit
LOS
length of stay
ROC
receiver operating characteristic
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
UPHS
University of Pennsylvania Health System

Cited by (0)

Michael A. Tevald's contribution is supported, in part, by the Foundation for Physical Therapy Research (Acute Care Research Grant 2019), which had no role in the design, conduct, analysis, or interpretation of this study.

Disclosures: none

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