Objectives: To develop valid and reliable
hospital discharge criteria and a scoring system that would be used to
assess when a patient should be discharged from perioperative physical
therapy (PT) care.
Design: We developed the
postoperative physiotherapy discharge scoring tool (POP-DST), a tool
composed of objective criteria and a scoring system that would be used
to determine when a patient should be discharged from perioperative PT.
It is a composite score of the following five subcategories: mobility;
breath sounds; secretion clearance; oxygen saturation; and respiratory
rate. The score for the POP-DST ranges from 6 to 15, with a
score of > 13 indicating readiness for discharge. We examined the
content validity of the the POP-DST using focus groups and a mailed
survey. To determine interrater reliability, two therapists, who were
blinded to each other’s scores, assessed postsurgical patients.
Validity was examined by comparing the decision to discharge based on
the score on the POP-DST to the decision to discharge according to the
therapist’s judgment. In addition, subjects who were discharged from
PT were followed-up 7 to 10 days later to determine whether they had
developed any subsequent respiratory problems.
Patients: One hundred four surgical patients were assessed
to determine the reliability and validity of the POP-DST. For the
ability of the test to detect postoperative complications following
discharge from PT, 204 surgical patients were followed-up after
discharge from PT.
Results: Interrater reliability was
moderately high (intraclass correlation coefficient = 0.76;
r = 0.77). There was strong agreement between the
decision to discharge the patient from PT based on the tool criteria
compared to the therapist’s judgment (κ range, 0.91 to 0.96). The
ability of the POP-DST to predict those patients who would not develop
complications postoperatively was 94%.
The results indicate that the POP-DST would facilitate clinical
decision making related to PT discharge planning in postsurgical
populations. The instrument demonstrated strong content validity and
predictive validity, as well as high levels of interobserver agreement.
This tool should be considered as a work in progress until it is more