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Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties



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.


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.


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.


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.

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Fig. 1
Fig. 2



Six-minute walk test


Activities of daily living


Consensus-based standards for selection of health status measurement instruments


Chelsea critical care physiotherapy assessment tool


Functional status score for the intensive care


Intra-class correlation coefficient


International Classification of Functioning


Intensive care unit


Intensive care unit acquired weakness


Intensive care unit mobility scale


Length of stay


Manual muscle strength testing


Medical Research Council sum-score


Physical function in intensive care test scored


Preferred reporting for systematic reviews and meta-analyses


Short Form-36


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Conflicts of interest

This research has been undertaken by Ms Parry (primary author) as part of her doctoral qualification with the support of a National Health and Medical Research Council Dora Lush Scholarship (#103923) and previously the Stella Mary Langford scholarship. Pat Cosh grant funding enabled this research to be undertaken. R.K. is currently in receipt of a CR Roper Fellowship and S.B. is a recipient of a National Health and Medical Research Council Fellowship. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Correspondence to Selina M. Parry.

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Take home message : 33 different measures were identified, and only 20 have published clinimetric properties.

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Parry, S.M., Granger, C.L., Berney, S. et al. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med 41, 744–762 (2015).

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  • Muscle strength
  • Physical function
  • Critical care
  • Intensive care
  • Outcome measurement
  • Muscle mass