6-Clicks: A Case Study

Introduction

Screening tools were developed for different reasons like identifying/assessing problems, preventing negative impact, or predicting an outcome. They must be free of bias and distortion that is why their reliability and validity must be assessed. Reliability is when the screening tool yield the same result and validity is the degree of the tool to measure what is intended to measure (Roach, 2006). In this paper, I will discuss about the reliability and validity of two screening tools, “6-Clicks” and gait speed, which I utilize in my practice at an acute care hospital setting.

“6-Clicks”

Acute care hospital-based physical therapists and occupational therapists primary focus is to evaluate patient’s mobility and self-care abilities to determine the need for skilled care, which

influences discharge planning (Jette et al., 2014a). An adequate discharge planning improves the efficiency of care and reduces costs by transitioning patients, in a timely manner, to the next appropriate level of care (Jette et al., 2014a). According to Jette et al. (2014a), to reduce delays in discharge from the expensive

acute care setting, complete and relevant assessments of patients for the purposes of discharge planning should be performed early in the course of hospitalization. An efficient and effective discharge planning reduces hospital readmissions that is why the physical therapists and occupational therapists should attempt to accurately project the discharge needs using the data gathered at hospital admission and their initial visit to the patient (Jette et al., 2014a). Jette et al. found that there was a lower incidence of hospital readmissions for patients discharged to settings recommended by physical therapist compared to those that were not in agreement with the physical therapist recommendations.
The Cleveland Clinic Health System hospitals have recently piloted the use of a new standardized instruments, allowing physical and occupational therapists in acute care setting to measure that basic mobility and daily activity functions of the patients (Jette et al., 2014b). These tools are called “6-Clicks”, which are the short forms created from the Activity Measure for Post-Acute Care (AM-PAC) instruments, which measures three functional domains: basic mobility, daily activities, and applied cognition. (Jette et al., 2014b). The physical therapists complete the basic mobility short form while the occupational therapists complete the daily activity short form by determining scores for each item either by observing the performance of the patient or by using their clinical judgement (Jette et al., 2014b). The items on the forms, were functional activities that the physical therapist and occupational therapists in an acute care setting usually assess, is scored on 1 of 4 levels based on the patient’s difficulty or how much assistance is needed in completing the task (Jette et al., 2014b).
Jette et al. (2014b) found that the internal consistency reliability for both basic mobility and daily activities forms were high moreover, the validity of both forms was supported by the ceiling and floor effects below 20% at the initial and last visits. “6-Clicks” provided fair to good accuracy for predicting discharge destination at the first visit with the cutoff scores of 42.9 for basic mobility and 39.4 for daily activity (Jette et al., 2014a).
From my understanding of the results of the study, the “6-Clicks” tools are reliable, valid and accurate therefore, it is a good tool to use to predict discharge destination. The “6-Clicks” tools were first introduced to us in our hospital about a year or two ago. It is included in our documentation and we are required to fill it up in every physical therapy session of the patient. I like using the tool because it is simple, quick and as its name implies, it only takes six clicks to complete it. No additional set up is required. You answer the questions by either observing the patient’s performance or by using your clinical judgement. Lower scores correlate to greater degree of limitation (Jette et al., 2014b).
Gait Speed
Walking is part of our everyday living.

A number of poor health outcomes including hospitalization, falls, nursing home placement, mobility disability and mortality are associated with a declined gait speed (Graham, Ostic, Fisher, & Ottenbacher, 2008). There is considerable variation in gait speed testing procedures including pace, protocol and distance however, all versions of these short, distance-based walk tests have high (>0.90) test-retest and inter-rater reliabilities (Graham et al., 2008). Kim, Park, Lee, and Lee (2016) reported that the validity of gait speed with normal pace was higher compared with maximal pace against physical function. Lower extremity function is reflected in short, distance-based assessments while longer, time-based walks (e.g. the 6-minute walk) are measures of fitness rather than functional performance (Graham et al.,

2008).
I like to incorporate the gait speed test in my treatment session because it is easy and not time consuming. All you need is a stopwatch and a marked distance. It is measurable and can be included as a goal for the patient. “Gait speed has been described as a reliable and valid measurement for seniors’ walking performance and is regarded as a pivotal factor associated with the quality of life (Kim et al., 2016, p. 46).

Conclusion
In our daily physical therapy practice, we use different screening tools to help us identify/assess problems, prevent negative impact, or predict an outcome. “6-Clicks” and gait speed are two screening tools that I utilize as an acute care hospital physical therapist. “6-Clicks” are tools that help predict the discharge destination of a patient on the other hand, gait speed measures fitness or functional performance. Both tools are reliable and valid. Whatever screening tools you use in your practice, try to assess the reliability and validity of those tools to make sure that they are free of bias and distortion.