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Norwegian version of the Cumulated Ambulation Score (CAS, 0-6 points).

Authors:
Vegar Hjermundrud at Akershus universitetssykehus
Vegar Hjermundrud
Morten Tange Kristensen at Bispebjerg and Frederiksberg Hospital - University of Copenhagen
Morten Tange Kristensen
  • Bispebjerg and Frederiksberg Hospital - University of Copenhagen
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Abstract

Beskrivelse og bruk: CAS [1, 2] er en skår som kan brukes til daglig vurdering av basismobilitet inntil selvstendig mobilitet er oppnådd. Basismobiliteten er definert som: • Ut av/opp i seng • Reise/sette seg i stol med armlener • Gange innendørs Hver av de tre aktiviteter skåres fra 0-2, og skal resultere i en daglig skår fra 0-6 poeng (endags CAS) [3-6]. CAS er dokumentert som et redskap som gir tidlig indikasjon på rehabiliterings-og innleggelsesforløpet etter hoftebrudd. Til bruk for dette adderes skåren fra de tre første postoperative dager til en CAS fra 0-18 poeng (tredagers CAS) [1, 2]. En CAS > 9 poeng for disse dagene har vist seg å forutsi • utskriving fra akuttsykehus innen 14 dager • utskriving til egen bolig • fravaer av større medisinske komplikasjoner • status som levende etter 30 dager. Skåringsnøkkel for CAS, som publisert i artikkelen fra 2009 [3].
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Norsk versjon af Kathrine A. Lyngstad, Sørlandet Sykehus Arendal, 2011 og Vegar Hjermundrud, OsloMet, 2019 efter dansk versjon af
Morten Tange Kristensen, H:S Hvidovre Hospital, Christina Weirum Andersen, KAS Glostrup, Anders Vinther, KAS Herlev og Carsten
Juhl, KAS Gentofte, juni 2006, revideret november 2006. Kontaktperson, Vegar Hjermundrud, E-mail: vegarh@oslomet.no
Skåringsnøkkel for Cumulated Ambulation Score (CAS) – Norsk versjon
Beskrivelse og bruk
CAS [1, 2] er en skår som kan brukes til daglig vurdering av basismobilitet inntil selvstendig mobilitet er
oppnådd. Basismobiliteten er definert som:
• Ut av/opp i seng
• Reise/sette seg i stol med armlener
• Gange innendørs
Hver av de tre aktiviteter skåres fra 0-2, og skal resultere i en daglig skår fra 0-6 poeng (endags CAS) [3-6]
CAS er dokumentert som et redskap som gir tidlig indikasjon på rehabiliterings- og innleggelsesforløpet
etter hoftebrudd. Til bruk for dette adderes skåren fra de tre første postoperative dager til en CAS fra 0-18
poeng (tredagers CAS) [1, 2]. En CAS > 9 poeng for disse dagene har vist seg å forutsi
• utskriving fra akuttsykehus innen 14 dager
• utskriving til egen bolig
• fravær av større medisinske komplikasjoner
• status som levende etter 30 dager
Skåringsnøkkel for CAS, som publisert i artikkelen fra 2009 [3]:
1. Ut av og opp i seng
Pasienten kommer fra liggende til stående eller over til stol, og tilbake til liggende i seng.
Det skåres 2 når funksjonen klares selvstendig. Med selvstendig forstås at det ikke er nødvendig
med verken muntlig veiledning eller personstøtte, heller ikke av sikkerhetsmessige hensyn. Alle
ganghjelpemidler kan brukes.
Det skåres 1 ved behov for personstøtte. Personstøtte kan være alt fra muntlig veiledning til
massiv hjelp fra en eller flere personer, inklusive hjelpemidler.
Det skåres 0 for pasienter som ikke er i stand til å komme ut av senga. Med dette forstås at
pasienter som til tross for massiv hjelp fra en eller flere personer, inklusive hjelpemidler, ikke kan
komme opp og stå, eller komme opp for å sitte i en stol.
2. Reise seg og sette seg i stol
Pasienten kommer fra sittende i stol med armlener til stående, og tilbake til sittende i stol.
Det skåres 2 når funksjonen klares selvstendig. Med selvstendig forstås at det ikke er nødvendig
med verken muntlig veiledning eller personstøtte, heller ikke av sikkerhetsmessige hensyn.
Det skåres 1 ved behov for personstøtte. Personstøtte kan være alt fra muntlig veiledning til
massiv hjelp fra en eller flere personer, inklusive hjelpemidler.
Det skåres 0 for pasienter som ikke er i stand til å komme opp for å sitte i en stol. Med dette
forstås at pasienter som til tross for massiv hjelp fra en eller flere personer, inklusive hjelpemidler,
ikke kan komme opp for å sitte i en stol.
Norsk versjon af Kathrine A. Lyngstad, Sørlandet Sykehus Arendal, 2011 og Vegar Hjermundrud, OsloMet, 2019 efter dansk versjon af
Morten Tange Kristensen, H:S Hvidovre Hospital, Christina Weirum Andersen, KAS Glostrup, Anders Vinther, KAS Herlev og Carsten
Juhl, KAS Gentofte, juni 2006, revideret november 2006. Kontaktperson, Vegar Hjermundrud, E-mail: vegarh@oslomet.no
3. Gange innendørs
Det skåres 2 når funksjonen klares selvstendig. Ved selvstendig gange forstås at det ikke er
nødvendig med verken muntlig veiledning eller personstøtte, heller ikke av sikkerhetsmessige
hensyn. Alle ganghjelpemidler kan brukes.
Det skåres 1 ved behov for personstøtte. Personstøtte kan være alt fra muntlig veiledning til
massiv hjelp fra en eller flere personer, inklusive ganghjelpemiddel.
Det skåres 0 for pasienter som ikke er i stand til å gå. Med dette forstås at pasienter som til tross
for massiv hjelp fra en eller flere personer, inklusive ganghjelpemiddel, ikke er i stand til å gå.
Referanser (utvalgte):
1. Kristensen MT, Foss NB, Kehlet H. CAS – en postoperativ score til hoftefrakturpatienter. Fysioterapeuten
2005; 5: 22-26.
2. Foss NB, Kristensen MT, Kehlet H. Prediction of postoperative morbidity, mortality and rehabilitation in
hip fracture patients: the cumulated ambulation score. Clin Rehabil 2006; 20: 701-708.
3. Kristensen MT, Andersen L, Bech-Jensen R, Hovmand B, Ekdahl C, Kehlet H. High intertester reliability of
the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture. Clin
Rehabil 2009; 23: 1116-23
4. Kristensen MT, Jakobsen TL, Nielsen JW, Jørgensen LM, Nienhuis RJ, Jønsson LR. Cumulated Ambulation
Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture. Dan Med J 2012;
59(7): A4464
5. Kristensen MT, Kehlet H. Most patients regain prefracture basic mobility after hip fracture surgery in a
fast-track programme. Dan.Med.J. 2012; 59: A4447.
6. Ferriero G, Kristensen MT, Invernizzi M, Salgovic L, Bravini E, Sartorio F, Vercelli S. Psychometric
properties of the Cumulated Ambulation Score: a systematic review. Eur J Phys Rehabil Med. 2018
Oct;54(5):766-771
Norsk versjon af Bente Kjeang, OUS, 2010, Kathrine A. Lyngstad, Sørlandet Sykehus Arendal, 2011 og Vegar Hjermundrud, OsloMet, 2019
efter dansk versjon af Morten Tange Kristensen, Fysioterapien og Ortopædkirurgisk Afdeling og Nikolaj Bang Foss, Anæstesiologisk Afdeling,
H:S Hvidovre Hospital, 2002. Kontaktperson, Vegar Hjermundrud, E-mail: vegarh@oslomet.no
Navn
Årsak til innleggelse:
FCF (S72.0) PTFF (S72.1) STFF (S72.2)
Annet:
Opr. Dato:
Skåringsskjema for Cumulated Ambulation Score (CAS) – Norsk versjon
CAS skåringsnøkkel (0-2 poeng) - se skåringsnøkkel for nærmere beskrivelse.
(2 poeng) Kan selvstendig, uten personstøtte eller veiledning
(1 poeng) Kan med personstøtte og/eller muntlig veiledning fra en eller flere personer
(0 poeng) Kan ikke, til tross for personstøtte og muntlig veiledning (f.eks. kan ikke komme ut av sengen)
Nivå før
det
aktuelle
Postopr. dag /
Dato
/
/
/
/
/
/
Nivå
ved
utreise
Ut av/opp i seng
Reise/sette seg i
stol med
armlener
Gange innendørs:
Høy rullator/
prekestol
Gangbukk/
gåstativ
Rullator
Krykke(r)
Stokk(er)
Uten
hjelpemidler
Daglig CAS-skår
(0-6 poeng)
Trappegange
Daglig CAS-skår (0-6 poeng) for basismobilitet er den samlede skår for de tre aktiviteter:
• Ut av/opp i seng (0-2 poeng)
• Reise/sette seg i stol med armlener (0-2 poeng)
• Gange innendørs med hjelpemiddel (om nødvendig) (0-2 poeng)
Trappegange kan også vurderes med 0-2 poeng, men inngår ikke i daglig CAS-skår da aktiviteten ikke
omfattes av definisjonen av basismobilitet.
Tre-dagers CAS-skår (0-18 poeng) = Postoperativ dag 1 + 2 + 3 =__________________

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Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture
Article
Full-text available
  • Jul 2012
Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark. A total of 101 consecutive patients (with a mean age of 84.9 (standard deviation 7.2) years) were evaluated with the CAS upon admission and at discharge from a geriatric ward, while data concerning the use of the CAS after hip fracture were collected from national Danish reports. All geriatric patients could be evaluated with the CAS. A total of 41% were independent in terms of basic mobility at admission and 83% of patients at discharge from the ward (p < 0.001). Patients who were not independent in basic mobility upon admission died more often during admission or were more often not discharged to their own home than patients who were independent in basic mobility. National data from the year 2010 showed that the CAS was reported by 21 (78%) of the 27 hospitals and used in 92% of the hospitals that will be treating patients with hip fracture in the future. In geriatric wards, the CAS is a feasible tool for evaluating all patients' basic mobility, and we recommend that it be used in other settings and at all hospitals treating patients with hip fracture.
View
Most patients regain prefracture basic mobility after hip fracture surgery in a fast-track programme
Article
Full-text available
  • Jun 2012
Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity of the preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery. The study comprised a total of 213 consecutive patients with a median age of 82 years who were admitted from their own home to a special hip fracture unit. Outcome variables were the regain of independency in basic mobility as evaluated by the Cumulated Ambulation Score, and discharge destination in the community. Multiple logistic regression analysis revealed that patients with a low prefracture NMS and/or an intertrochanteric fracture were 6.5 and four times more likely to not regain independency in basic mobility during admittance than patients with a high prefracture NMS level and a cervical fracture, respectively. In addition, the odds of not regaining independent mobility increased with age by 5% per year. The same three variables significantly increased the odds of patients not being discharged to their own home. Prefracture NMS, age and fracture type were confirmed as independent predictors of in-hospital outcome in patients with hip fracture who followed a multimodal rehabilitation concept.
View
High intertester reliability of the Cumulated Ambulation Score for the evaluation of basic mobility in patients with hip fracture
Article
Full-text available
  • Nov 2009
Objective: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. Design: An intertester reliability study. Setting: An acute 20-bed orthopaedic hip fracture unit. Subjects: Fifty consecutive patients with a median age of 83 (25—75% quartile, 68—86) years. Interventions: The CAS, which describes the patient’s independency in three activities — (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability — was assessed by two independent physiotherapists at postoperative median day 3. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent of human assistance). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent ambulation. Main measures: Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). Results: The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were ≥0.92, ≤0.20 and ≤0.55 CAS points, respectively. Conclusions: The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.
View
Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score
Article
Full-text available
  • Aug 2006
Objective: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. Design: Prospective, descriptive study. Setting: An orthopaedic hip fracture unit in a university hospital. Patients: Four hundred and twenty-six consecutive hip fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. Main outcome measure: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to18 (fully mobile). The three assessments were correlated to short-term outcome parameters. Results: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P < 0.001 for all). The cumulated ambulation score was superior in its association with all postoperative outcome parameters to both the New Mobility Score and the mental score. A cumulated ambulation score of ±10 correlated with a 99% survival at one month and 93% discharge to own home. Conclusion: The cumulated ambulation score is a potentially valuable score for early prediction of short-term postoperative outcome after hip fracture surgery.
View
Psychometric properties of the Cumulated Ambulation Score: A systematic review
Article
  • Mar 2018
  • Eur J Phys Rehabil Med
Introduction: In the geriatric population, independent mobility is a key factor in determining readiness for discharge following acute hospitalization. The Cumulated Ambulation Score (CAS) is a potentially valuable score that allows day-to-day measurements of basic mobility. The CAS was developed and validated in older patients with hip fracture as an early postoperative predictor of short-term outcome, but it is also used to assess geriatric in-patients with acute medical illness. Despite the fast- accumulating literature on the CAS, to date no systematic review synthesizing its psychometric properties has been published. Therefore, we aimed to provide a comprehensive review of the psychometric properties of the CAS, summarizing the present evidence on this measure as a basis for further research to investigate its applicability across a wider range of functional abilities and care settings. Evidence acquisition: A literature search was conducted on research articles published between 2006 and June 2016 in journals indexed by MEDLINE and Scopus databases using as search item: "Cumulated Ambulation Score"[All Fields], and selecting studies that presented a psychometric analysis of the scale. Of 49 studies identified, 17 examined the psychometric properties of the CAS. Evidence synthesis: Most papers dealt with patients after hip fracture surgery, and only 4 studies assessed the CAS psychometric characteristics also in geriatric in-patients with acute medical illness. Two versions of CAS (CAS1 and the more detailed CAS2 version) and two different methods to calculate the total score (1-day and 3-day CAS score) were used in the selected papers. Most of the papers assessed reliability and validity, using different statistics, and only one showed evidence of sensitivity to change of the score. Conclusions: This systematic review shows international interest of researchers in the CAS, despite the short time frame since its first publication in 2006. The results support the reliability, validity, and sensitivity to change of the tool. Since different versions of CAS are available and two scores are commonly used, we suggest that clinicians and researchers in the future choose the more detailed CAS2 version, already used by the large majority of studies, and report whether they used the 1- or 3-day score.
View
CAS -en postoperativ score til hoftefrakturpatienter
  • Jan 2005
  • 22-26
  • M T Kristensen
  • N B Foss
  • H Kehlet
Kristensen MT, Foss NB, Kehlet H. CAS -en postoperativ score til hoftefrakturpatienter. Fysioterapeuten 2005; 5: 22-26.