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Standardization of the Continuing Care Activity Measure: A Multicenter Study to Assess Reliability, Validity, and Ability to Measure Change

M.P.J. Huijbregts, PT, PhD, is Director, Quality, Risk, & Patient Safety, Baycrest Centre for Geriatric Care, Poslun's Building, Room 414B, 3560 Bathurst St, Toronto, Ontario, Canada M6A 2E1, and Assistant Professor, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
G.F. Teare, DVM, PhD, is Director, Quality Measurement and Analysis, Health Quality Council, Saskatoon, Saskatchewan, Canada.
C. McCullough, PT, MEd, is Senior Physiotherapist, Baycrest Centre for Geriatric Care.
T.M. Kay, PT, MHSc, is Chief of Health Disciplines, Sunnybrook Health Sciences Centre, Toronto.
D. Streiner, PhD, is Director, Kunin Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care.
S.K.C. Wong, PT, MHS, is Professional Practice Leader, Physiotherapy, Baycrest Centre for Geriatric Care.
S.E. McEwen, PT, MSc, is Doctoral Candidate, Graduate Department of Rehabilitation Science, University of Toronto.
I. Otten, PT, BSc, is Physiotherapist, Specialized Geriatric Services, Sunnybrook Health Sciences Centre.

mhuijbregts{at}baycrest.org

Background: There is a lack of standardized mobility measures specific to the long-term care (LTC) population. Therefore, the Continuing Care Activity Measure (CCAM) was developed.

Objective: This study determined levels of reliability, validity for clinical utilization, and sensitivity to change of this measure.

Design: This was a prospective longitudinal cohort study among elderly people with primarily physical or medical impairments who were residing in LTC institutions that provide nursing home and more-complex care, with access to physical therapy services.

Method: The CCAM, the Clinical Outcome Variables Scale (COVS), the Social Engagement Scale (SES) of the Resident Assessment Instrument—Minimum Data Set (RAI-MDS) 2.0 instrument, and the Resource Utilization Groups, version 3, (RUG-III) were administered by clinical and research physical therapists, with timing dictated by the study purpose.

Results: The participants were 136 residents of LTC institutions and 21 physical therapists. The CCAM interrater reliability (intraclass correlation coefficient [ICC]) was .97 (95% confidence interval=.91–1.00), and test-retest reliability (ICC) over a period of 1 week was .99 (95% confidence interval=.93–1.00). Over 6 months, the absolute change in total score was 5.88 for the CCAM and 4.26 for the COVS; the CCAM was 28% more responsive across all participants (n=105) and 68% more responsive for those scoring in the lower half (n=49). The minimal detectable difference of the CCAM was 8.6 across all participants. The CCAM correlated with the COVS, nursing care hours inferred from the RUG-III, and the SES.

Limitations: Some participants were lost to follow-up.

Conclusions: The CCAM is a reliable and valid tool to measure gross motor function and physical mobility for elderly people in LTC institutions. It discriminates among functional levels, measures individual functional change, and can contribute to clinical decision making.

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