Teste da ponte no leito: propriedades clinimétricas de um novo teste funcional para uso em pacientes hospitalizados

Abstract

Background: Conventional functional capacity tests, such as the 6-minute walk test, are often not applicable to bedridden patients, just as functional scales can determine a ceiling effect in patients with greater functional independence. In this sense, the proposal to develop a physical test that requires little equipment, minimal training and simple execution in bed, expands the opportunity to evaluate and define rehabilitation strategies for a wide variety of hospitalized patients, from the most restricted to bed even the most functionally independent. Aim: To investigate the feasibility, safety and the clinimetric properties of a new functional test, the bed bridge test (BBT) and its versions: bed bridge test 5 repetitions (BBT5R) and 10 repetitions (BBT10R), bed bridge test 30 seconds (BBT30sec) and 60 seconds (BBT60sec), admitted to the ward of a tertiary university hospital. Methods: Ninety-two clinical and surgical patients eligible for the study performed on day 1 the BBT5R, BBT10R, BBT30sec, and BBT60sec in randomized order. Feasibility was tested by the number of patients included who were able to perform one of the BBT versions. The adverse events monitored were: major pain complaints, major changes in blood pressure, dyspnea or intolerable fatigue, and any major clinical changes. Validity was examined using the Functional Status Score scale (FSS), the sit-to-stand test (STS), and the Short Physical Performance Battery test (SPPB). On day 2 (24-48 hours later), BBT was performed randomly to exam the reproducibility using intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Interpretability by the ceiling and floor effect was also examined. Results: The participants (50.9 ± 17.2 years, 60% women) included in the study were 66% with a clinical condition and 34% surgical. These showed good functional status according to the FSS [35 (10 to 35) points] and moderate physical capacity according to the SPPB [9 (1 to 12) points]. All participants completed all versions of the BBT.No adverse events were observed. In fact, ICC (95%) between test-retest was good to excellent, being for the BBT5R and BBT10R [0.89.84-0.93) and 0.92 (0.88-0.95), and BBT30sec and BBT60sec [0.87 (0.80-0.91) and 0.88 (0.83-0.92)], respectively. The observed agreement for the BBT were SEM: 13 and MDC: 3.6 for the BBT5R; SEM: 10 and MDC: 5.5 for BBT10R, SEM: 11 and MDC: 4.7 for BBT30sec; and SEM: 10 and MDC: 8.2 for BBT60sec. Appropriate ceiling (≤ 10%) and floor (≤ 11%) effects were observed. The content validity was observed by the weak association between the performance in the BBT versions and the FSS (rs= -0.27 to -0.37 and 0.36, p<0.05 for all). The construct validity was observed by the moderate association between the four versions of the BBT and the SPPB (rs= -0.63 to -0.58 and 0.47 to 0.53, p<0.05 for all), and the criteria validity was observed by the moderate association between the performance of the BBT versions and the performance in the STS (rs= -0.48 to -0.59 and 0.64, p<0.05 for all). Conclusion: All BBT versions proved feasible and safe, with good reproducibility and validity clinimetric properties, without ceiling and floor effects. Although more studies are needed, BBT versions can be a good alternative for the functional assessment of hospitalized patients.