Supplementary Digital Content – A cross-sectional study of the clinical metrics of functional status tools in pediatric critical illness
Supplementary Table S1. STROBE checklist for cross-sectional studies (1)
Item
No Recommendation
Page Title and abstract 1 (a) Indicate the study’s design with a commonly used term in
the title or the abstract
1
(b) Provide in the abstract an informative and balanced summary of what was done and what was found
2
Introduction
Background/rationale 2 Explain the scientific background and rationale for the investigation being reported
4
Objectives 3 State specific objectives, including any prespecified hypotheses
4-5
Methods
Study design 4 Present key elements of study design early in the paper 5 Setting 5 Describe the setting, locations, and relevant dates, including
periods of recruitment, exposure, follow-up, and data collection
5
Participants 6 (a) Give the eligibility criteria, and the sources and methods of selection of participants
5
Variables 7 Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable
5-6
Data sources/
measurement
8* For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe
comparability of assessment methods if there is more than one group
5-6
Bias 9 Describe any efforts to address potential sources of bias NA
Study size 10 Explain how the study size was arrived at NA
Quantitative variables
11 Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why
7
Statistical methods 12 (a) Describe all statistical methods, including those used to control for confounding
6-7
(b) Describe any methods used to examine subgroups and interactions
6
(c) Explain how missing data were addressed 6 (d) If applicable, describe analytical methods taking account
of sampling strategy
NA
(e) Describe any sensitivity analyses NA
Results
Participants 13* (a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analysed
7
(b) Give reasons for non-participation at each stage NA
(c) Consider use of a flow diagram NA
Descriptive data 14* (a) Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and potential confounders
7
(b) Indicate number of participants with missing data for each variable of interest
NA
Outcome data 15* Report numbers of outcome events or summary measures Main results 16 (a) Give unadjusted estimates and, if applicable, confounder-
adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included
7-8
(b) Report category boundaries when continuous variables were categorized
(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period
NA
Other analyses 17 Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses
NA
Discussion
Key results 18 Summarise key results with reference to study objectives 8
Generalisability 21 Discuss the generalisability (external validity) of the study results
10
Other information
Funding 22 Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based
1
*Give information separately for exposed and unexposed groups.
Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at
http://www.plosmedicine.org/, Annals of Internal Medicine at http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe-statement.org.
Supplementary Table S2. Assessments and time-points explored in our original study
*Assessments PICU admission
(baseline)
PICU stay
PICU discharge
Hospital discharge
Post- discharge
Ultrasound ✓ a ✓ ✓ ✓ ✓
FSS ✓ b - ✓ ✓ ✓
PEDI-CAT ✓ b - - - ✓
PedsQL ✓ b - - ✓ ✓
SF-36 - - - ✓ ✓
a Within 48 hours of admission; b based on pre-admission function.
FSS, functional status scale; PEDI-CAT, pediatric evaluation of disability inventory – computer adaptive test; PedsQL, pediatric quality of life inventory; PICU, pediatric intensive care unit; SF- 36, short-form 36 questionnaire.
Supplementary Table S3. Description of functional assessment tools Name of
tool
Description Domains Validity assessments
in critically ill children PedsQL A health-related quality of life
questionnaire that has been used in critical illness, which has been used to elucidate information on physical and psychosocial function.
Physical and psychosocial subscores
Responsiveness and construct validity of the PedsQL has been demonstrated in pediatric intensive care unit survivors (2).
FSS A global tool measuring 6 areas of biological function – mental, sensory, communication, motor, feeding and respiratory function – each ranked on a 1 to 5 scale by an appropriate health care
professional, with higher scores indicating worse function.
Mental, sensory, communication, feeding, respiratory and motor
Reliability, construct validity, concurrent validity has been
demonstrated in critically ill children (3)
PEDI- CAT
A computer adaptive test that assesses functional performance, ability and participation in daily activities.
Daily activities, Mobility,
Social/Cognitive and Responsibility
Not reported
FSS Functional status scale; PEDI-CAT Pediatric evaluation of disability inventory – computer adaptive
Supplementary Table S4. Description of techniques for muscle and strength measurement.
Tool Measurement technique Hand grip
strength
To measure muscle strength, hand grip strength tests were conducted in children ≥6 years using a Jamar Hand Dynamometer (TEC, Clifton, New Jersey) on their dominant hand according to published protocols (4). Briefly, children sat upright in a chair with their dominant arm supported, the elbow flexed at 90 degrees and wrist in neutral position. The average of 3 readings were obtained, and raw values (in kg) were converted to z-scores using age and gender-specific published normative values (5).
Supplemental Table S5. Floor and ceiling effects of functional measures
Functional measures Healthy Children PICU survivors
Floor (%) Ceiling (%) Floor (%) Ceiling (%)
FSS total NA NA 0 69.2
PedsQL Total 0 1.9 0 0
PedsQL Physical 0 13.5 0 15.4
PedsQL Psychosocial 0 7.7 0 2.6
PEDI-CAT Daily activities scaled scores 0 0 0 0
PEDI-CAT Mobility scaled scores 0 0 0 0
PEDI-CAT Social scaled scores 0 0 0 0
PEDI-CAT Responsibility scaled scores 0 0 0 0
FSS Functional status scale; PEDI-CAT Pediatric evaluation of disability inventory – computer adaptive test; PedsQL Pediatric quality of life inventory; PICU pediatric intensive care unit.
References
1. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, et al: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Annals of internal medicine 2007; 147(8):W163-194
2. Aspesberro F, Fesinmeyer MD, Zhou C, Zimmerman JJ, et al: Construct Validity and Responsiveness of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales and Infant Scales in the PICU.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2016; 17(6):e272-279
3. Pollack MM, Holubkov R, Glass P, Dean JM, et al: Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124(1):e18-28
4. Hamilton GF, McDonald C, Chenier TC: Measurement of grip strength: validity and reliability of the sphygmomanometer and jamar grip dynamometer. The Journal of orthopaedic and sports physical therapy 1992; 16(5):215-219
5. Mathiowetz V, Wiemer DM, Federman SM: Grip and pinch strength: norms for 6- to 19-year-olds. The American journal of occupational therapy : official publication of the American Occupational Therapy Association 1986; 40(10):705-711
