Background
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identify potentially relevant instruments for measuring mobility in older acute medical patients.
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summarise and compare the relevant clinimetric properties of the included instruments.
Methods
Phase One: instrument search
Inclusion and exclusion criteria
Instrument identification and selection
Phase Two: clinimetric search
Instrument evaluation
Instrument characteristics
Internal structure and dimensionality
Reliability
Validity
Minimally clinically important difference
Responsiveness to change
Acceptability and feasibility
Results
Phase one: instrument search
Phase two: clinimetric search
Instrument | Reason for exclusion |
---|---|
Goal Attainment Scale
| Requires a minimum of 1 year of clinical experience and 7 hours of training to administer [17]. |
The Clinical Outcomes Variable Scale
| Approximately 30 minutes to administer [17]. |
The General Motor Function Assessment Scale
| Average time to administer of 18 mins (range 5 to 40 mins) [23]. |
Physical Disability Index
| Average time to administer of 60+/-21 minutes (range 46 – 83) [28]. |
Elderly Mobility Scale
Characteristics
EMS | HABAM | PPME | |
---|---|---|---|
Versions
| 1. Original [22]. | 1. Original [26,42] 2. Rasch refined [27] | 1. Original [29] |
Number of items
| Seven | 1. 27 in the original version 2. 22 in the modified version | 1. Six items |
Content
| Lying to sitting, sitting to lying, sit to stand, stand, gait, timed walk (6 meters), functional reach. | MOBILITY: bedfast, chairfast, 2 person assist +/- aid, 1 person hands on +/- aid, 1 person standby +/- aid, with aid 8–50 m, with aid > 50 m, unlimited with aid, limited 8–50 m, limited > 50 m, unlimited. TRANSFERS: total lift, 2 person assist, 1 person assist, 1 person pivot, 1 person hands-on, 1 person standby, independent with aid, independent. BALANCE: impaired static sitting, stable static sitting, stable dynamic sitting, stable static standing, stable dynamic standing, stable transfer, stable with aid, stable ambulation. | Bed mobility, transfer skills, multiple stands from chair, standing balance, step-up and ambulation. |
Time to complete
| "No more than 5 minutes" [32] | Average of 2.6 (+/- 1) minutes [41]. | Approximately 10 minutes [29] 8.6 minutes (SD = 3.6 minutes) [41] |
Equipment requirements
| A bed, chair, stop watch, walking aid if necessary, a space for a standardised 6 meter walk and a functional reach test. | A bed, chair and walking aid if required. | A bed, chair, stop watch, standardised step and gait aid if required. |
Scaling method
| One response is selected by the clinician administering the test for the 7 mobility tasks. Two items are scored from 0 – 2, four items are scored from 0 – 3 and one item from 0 – 4. | The original version of the HABAM is an ordinal measure. Interval level data is provided by the Rasch converted version of the HABAM. | The PPME has two scaling methods. The pass-fail PPME provides 2 response options (pass or fail) and the 3 level PPME provides 3 response options for each item (high pass, low pass or fail). Each response option is clearly defined [29]. |
Scoring
| Each item score is summed to provide a total possible score from 0 to the maximum score of 20 which represents independent mobility. Scores under 10 are considered to represent "dependence in mobility manoeuvres", 10 – 13 to indicate "borderline in terms of safe mobility" and 14 or more to be "likely to be independent in mobility" [22]. | The original version of the HABAM has a total score range of 0 – 24. One point is scored for each increment in ability. Higher scores indicate higher levels of mobility. The Rasch converted HABAM has a broader interval score range of 0 to 26. A score is listed next to each item on the HABAM. Harder items have higher scores. The highest score obtained across the 3 sections of the HABAM represents the HABAM interval score. Higher scores indicate higher levels of mobility. | The pass-fail PPME provides a dichotomous scoring system for the 6 PPME items. Zero is scored for a fail. One point is scored for successfully completing each item. Items sum to obtain a maximum score of 6. In the 3 level PPME scoring system, zero is scored for a fail, one point for a low pass and two points for a high pass. The total score range is 0 – 12. |
Floor and ceiling effects
| A ceiling effect was identified for community dwelling older adults who had experienced a single fall in the previous 6 months, "approximately 50% of single fallers scored 19 – 20" [30]. Twenty healthy 81 to 90 year old women all scored the highest possible score of 20 on the EMS [22]. | A ceiling effect was identified in an older acute medical patient population. Approximately 25% of patients scored the maximum possible score at hospital admission [27]. | An absence of floor and ceiling effects has been reported for the 3 level scoring system [29]. |
Internal structure and dimensionality
Reliability
Author | Population and test procedures | Reliability data provided |
---|---|---|
Inter-rater reliability
| ||
Smith [22] | 15 inpatients or day hospital patients, 78 to 93 years were independently assessed by two assessors. | Inadequate data provided to estimate reliability. |
Prosser et al. [32] | 19 older acute medical patients aged 71 to 91 years, independently assessed by two assessors. Assessors were blinded to the other assessor scores. | Spearman's correlation coefficient between assessor scores, r = 0.88, p < 0.0001. |
Cuijpers et al. [31] | A video recorded assessment of 28 hospitalised frail older patients rated by two independent assessors (Dutch version of the EMS). Patient age was not provided in the English abstract. | Inter-rater reliability ICC 0.95 – 0.97 (p value not provided in the published abstract).* Bland and Altman limit of agreement of 3 points. |
Intra-rater reliability
| ||
Cuijpers et al. [31] | A video recorded assessment of 28 hospitalised frail older patients rated by two independent assessors (Dutch version of the EMS). Patient age was not provided in the English abstract. | Intra-rater reliability ICC 0.97 (p value not provided in the published abstract).* Bland and Altman limit of agreement = 3 points. |
Validity
Minimally clinically important difference
Responsiveness
Acceptability and feasibility
Hierarchical Assessment of Balance and Mobility
Characteristics
Internal structure and dimensionality
Reliability
Validity
Minimally clinically important difference
Responsiveness
Acceptability and feasibility
Physical Performance and Mobility Examination
Characteristics
Internal structure and dimensionality
Reliability
Author | Population and test procedures | Scoring System | ICC (95%CI) | Standard deviation (SD) | SEM | MDC90 |
---|---|---|---|---|---|---|
Intra-rater reliability
| ||||||
Winograd et al. [29] | 50 hospitalised patients, mean age 74.8 (SD = 7.9). Tested 48 hours apart. If the patient reported or the chart indicated a change in condition, the patient was excluded. This study included 33 patients. | Pass-fail scoring system. | 0.99* | Pooled SD not provided. Baseline SD 2.1 for sample 1 (n = 146) and 1.7 for sample 2 (n = 352). Weighted average SD = 1.8. | 0.18 | 0.42 |
Winograd et al. [29] | As above. | 3 level scoring system. | 0.98# | Pooled SD not provided. Baseline SD 2.8 for sample 1 (n = 146) and 3.1 for sample 2 (n = 352). Weighted average SD = 3.0. | 0.42 | 0.97 |
Sherrington and Lord [39] | Test retest of 30 older people, mean age 81.1 years (SD = 7.5) following hip fracture (16 rehabilitation hospital inpatients and 14 community dwelling). Two assessments one day apart. | 3 level scoring system. | 0.96# (0.92 -0.98) | Test 1 SD = 2.4 and test 2 SD = 2.2. Weighted average SD = 2.3. | 0.46 | 1.07 |
Inter-rater reliability
| ||||||
Winograd et al. [29] | 31 patients, mean age 75 (SD = 6.43), selected from (1) acute medical unit inpatients that had impaired mobility and (2) acute medical and surgical inpatients aged ≥ 65 years. Two assessors independently rated each patient's performance on the PPME. | Pass-fail scoring system. | 0.99 | Pooled SD not provided. Baseline SD 2.1 for sample 1 (n = 146) and 1.7 for sample 2 (n = 352). Weighted average SD = 1.8. | 0.18 | 0.42 |
Winograd et al. [29] | As above. | 3 level scoring system. | 0.99 | Pooled SD not provided. Baseline SD 2.8 for sample 1 (n = 146) and 3.1 for sample 2 (n = 352). Weighted average SD = 3.0. | 0.3 | 0.7 |
Validity
Author | Patient population (≥ 65 years) |
n
| 2 level scoring system | 3 level scoring system |
---|---|---|---|---|
Convergent validity
|
Total PPME score correlation with:
|
Total PPME scores correlate highly with:
| ||
Winograd et al. [29] | Older patients hospitalised with mobility impairment | 88 | Self reported physical functioning and mobility scores, r = 0.61, p < 0.001. | Self reported physical functioning and mobility scores, r = 0.73, p < 0.001. |
Winograd et al. [29] | Hospitalised older medical and surgical patients | 154 | Self reported physical functioning and mobility scores, r = 0.71, p < 0.001. | Self reported physical functioning and mobility scores, r = 0.77, p < 0.001. |
Hospitalised older medical and surgical patients | 154 | ADL scores, r = 0.70, p < 0.001. | ADL scores, r = 0.68, p < 0.001. | |
Discriminant validity
|
Total PPME score correlation with:
|
Total scores have low correlation with:
| ||
Winograd et al. [29] | Older patients hospitalised with mobility impairment | 97 | MMSE scores, r = 0.36, p < 0.001. | MMSE scores, r = 0.38, p < 0.001. |
Winograd et al. [29] | Hospitalised older medical and surgical patients | 154 | MMSE scores, r = 0.36, p < 0.001. | MMSE scores, r = 0.38, p < 0.001. |
Hospitalised older medical and surgical patients | 86 | Geriatric depression scores, r = 0.23, p < 0.001. | Geriatric depression scores, r = 0.28, p < 0.001. |
Minimally clinically important difference
Responsiveness
Acceptability and feasibility
Comparison of error estimates and clinically important change
MDC90 | MDC90 % of scale width | MCID | MCID % of scale width | |
---|---|---|---|---|
EMS (0 – 20)
| 3* | 15.0% | 2 | 10.0% |
HABAM** (0 – 24)
| 5.1 | 21.3% | 4.5 | 18.8% |
PPME (0 – 6)
| 0.42 | 7% | 0.9 | 15.0% |
PPME (0 – 12)
| 0.7 – 1.07 | 5.8% – 8.9% | 1.15 – 2.15 | 9.6% – 17.9% |