A systematic review of mobility instruments and their measurement properties for older acute medical patients

Natalie A de Morton, David J Berlowitz, Jennifer L Keating, Natalie A de Morton, David J Berlowitz, Jennifer L Keating

Abstract

Background: Independent mobility is a key factor in determining readiness for discharge for older patients following acute hospitalisation and has also been identified as a predictor of many important outcomes for this patient group. This review aimed to identify a physical performance instrument that is not disease specific that has the properties required to accurately measure and monitor the mobility of older medical patients in the acute hospital setting.

Methods: Databases initially searched were Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials without language restriction or limits on year of publication until July 2005. After analysis of this yield, a second step was the systematic search of Medline, Cinahl and Embase until August 2005 for evidence of the clinical utility of each potentially suitable instrument. Reports were included in this review if instruments described had face validity for measuring from bed bound to independent levels of ambulation, the items were suitable for application in an acute hospital setting and the instrument required observation (rather than self-report) of physical performance. Evidence of the clinical utility of each potentially suitable instrument was considered if data on measurement properties were reported.

Results: Three instruments, the Elderly Mobility Scale (EMS), Hierarchical Assessment of Balance and Mobility (HABAM) and the Physical Performance Mobility Examination (PPME) were identified as potentially relevant. Clinimetric evaluation indicated that the HABAM has the most desirable properties of these three instruments. However, the HABAM has the limitation of a ceiling effect in an older acute medical patient population and reliability and minimally clinically important difference (MCID) estimates have not been reported for the Rasch refined HABAM. These limitations support the proposal that a new mobility instrument is required for older acute medical patients.

Conclusion: No existing instrument has the properties required to accurately measure and monitor mobility of older acute medical patients.

Figures

Figure 1
Figure 1
Flow diagram of process of outcome measure inclusion and exclusion.
Figure 2
Figure 2
Flow diagram of clinimetric paper inclusion and exclusion.

References

    1. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society. 2003;51:451–458. doi: 10.1046/j.1532-5415.2003.51152.x.
    1. Podsiadlo D, Richardson S. The Timed "Up & Go": a test of basic functional mobility for the frail elderly persons. Journal of the American Geriatrics Society. 1991;39:142–148.
    1. Holden MK, Gill K, Magliozzi MR. Gait assessment for the neurologically impaired patients. Physical Therapy. 1986;66:1530–1539.
    1. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Maryland State Medical Journal. 1965;14:61–65.
    1. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. International Disability Studies. 1988;10:61–63.
    1. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology. 1989;42:703–709. doi: 10.1016/0895-4356(89)90065-6.
    1. de Morton N, Jones C, Keating J, Berlowitz D, MacGregor L, Lim W, Jackson B, Brand C. The effect of exercise on outcomes for hospitalised older acute medical patients: An individual patient data meta-analysis. Age Ageing. 2007;36:219–222. doi: 10.1093/ageing/afl118.
    1. de Morton N, Keating J, Davidson M. Rasch analysis of the Barthel Index in the assessment of hospitalised older patients following admission for an acute medical condition. Archives of Physical Medicine & Rehabilitation. 2007;89:641–647. doi: 10.1016/j.apmr.2007.10.021.
    1. de Morton NA, Keating JL, Jeffs K. Exercise for acutely hospitalised older medical patients. Cochrane Database Systematic Reviews. 2007
    1. de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared to control or alternative treatments: a systematic review of randomised controlled trials. Clinical Rehabilitation. 2007;21:3–16. doi: 10.1177/0269215506071313.
    1. de Morton NA, Keating JL, Berlowitz DJ, Jackson B, Lim WK. Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial. Australian Journal of Physiotherapy. 2007;53:105–111.
    1. Rikli RE, Jones CJ. Assessing Physical Performance in independent older adults: Issues and guidelines. Journal of Aging and Physical Activity. 1997;5:244–261.
    1. Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clincial trials. Health Technology Assessment. 1998;2
    1. World Health Organisation . International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organisation; 2001.
    1. APTA . Interactive Guide to Physical Therapist Practice with Catalog of Tests and Measures (version 1.0) (Compact disc) Alexandria, VA: American Physical Therapy Association; 2001.
    1. The Chartered Society of Physiotherapy outcomemeasures database
    1. Hill K, Denisenko S, Miller K, Clements T, Batchelor F. Clinical outcome measurement in adult neurological physiotherapy. 3. Melbourne, Australia: Australian Physiotherapy Association; 2005.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimally clinically important difference. Controlled Clinical Trials. 1989;10:407–415. doi: 10.1016/0197-2456(89)90005-6.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes on health related quality of life. The remarkable universality of half a standard deviation. Medical Care. 2003;41:582–592. doi: 10.1097/00005650-200305000-00004.
    1. Low Choy N, Kuys S, Richards M, Isles R. Measurement of the functional ability following traumatic brain injury using the Clinical Outcomes Variable Scale: a reliability study. Australian Journal of Physiotherapy. 2002;48:35–39.
    1. Smith R. Validation and reliability of the Elderly Mobility Scale. Physiotherapy. 1994;80:744–747.
    1. Aberg A, Lindmark B, Lithell H. Development and reliability of the General Motor Function Assessment Scale (GMF)- a performance-based measure of function-related dependence, pain and insecurity. Disability and Rehabilitation. 2003;25:462–472. doi: 10.1080/0963828031000069762.
    1. Kiresuk TJ, Smith A, Cardillo JE. Goal Attainment Scaling: Applications, Theory and Measurement. Hillsdale, New Jersey, USA: Lawrence Erlbaum Associates; 1994.
    1. King GA, McDougall J, Palisano R, Grtizan J, Tucker MA. Goal attainment scaling: its use in evalutaing pediatric therapy programs. Physical and Occupational Therapy in Pediatrics. 1999;19:31–52. doi: 10.1300/J006v19n02_03.
    1. MacKnight C, Rockwood K. A Hierarchical Assessment of Balance and Mobility. Age and Ageing. 1995;24:126–130. doi: 10.1093/ageing/24.2.126.
    1. MacKnight C, Rockwood K. Rasch analysis of the hierarchical assessment of balance and mobility (HABAM) Journal of Clinical Epidemiology. 2000;53:1242–1247. doi: 10.1016/S0895-4356(00)00255-9.
    1. Gerety MB, Mulrow CD, Tuley MR, Hazuda HP, Lichtenstein MJ, Bohannon R, Kanten DN, O'Neil MB, Gorton A. Development and validation of the physical performance instrument for the functionally impaired elderly: The Physical Disability index. Journal of Gerontology. 1993;48:M33–M38.
    1. Winograd CH, Lemsky CM, Nevitt MC, Nordstrom TM, Stewart AL, Miller CJ, Bloch DA. Development of a physical performance and mobility examination. Journal of the American Geriatrics Society. 1994;42:743–749.
    1. Chiu AYY, Au-Yeung SSY, Lo SK. A comparison of four functional tests in discriminating fallers from non-fallers in older people. Disability and Rehabilitation. 2003;25:45–50. doi: 10.1080/713813432.
    1. Cuijpers CJ, Nelissen LH, Lenssen AF. Intra-rater and inter-rater reliability of the Dutch version of the Elderly Mobility Scale in the frail elderly. Nederlands Tijdschrift Voor Fysiotherapie. 2004;114:110–113.
    1. Prosser L, Canby A. Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people. Clinical Rehabilitation. 1997;11:338–343.
    1. Spilg EG, Martin BJ, Mitchell SL. Falls risk following discharge from a geriatric day hospital. Clinical Rehabilitation. 2003;17:334–340. doi: 10.1191/0269215503cr615oa.
    1. Lai J, Woo J, Hui E, Chan WM. Telerehabilitation- a new model for community-based stroke rehabilitation. Journal of Telemedicine and Telecare. 2004;10:199–205. doi: 10.1258/1357633041424340.
    1. Spilg EG, Martin BJ, Mitchell SL, Aitchison TC. A comparison of mobility assessments in a geriatric day hospital. Clinical Rehabilitation. 2001;15:296–300. doi: 10.1191/026921501675281708.
    1. Andrich D, Marais I. EDU435/635 Instrument design with Rasch IRT and data analysis 1 Unit Materials Semester 2, 2005. Perth, Western Australia: School of Education, Murdoch University; 2005.
    1. Streiner DL, Norman GR. Health Measurement Scales A practical guide to their development and use. Second. New York: Oxford University Press; 1995.
    1. Gordon JE, Powell C, Rockwood K. Goal attainment scaling as a measure of clinically important change in nursing-home patients. Age and Ageing. 1999;28:275–281. doi: 10.1093/ageing/28.3.275.
    1. Sherrington C, Lord S. Reliability of simple portable tests of physical performance in older people after hip fracture. Clinical Rehabilitation. 2005;19:496–504. doi: 10.1191/0269215505cr833oa.
    1. Winograd CH, Lindenberger EC, Chavez CM, Mauricio MP, Shi H, Bloch DA. Identifying hospitalized older patients at varying risk for physical performance decline: a new approach. Journal of the American Geriatrics Society. 1997;45:604–609.
    1. MacKnight C, Sibley A, Rockwood K. The sensibility of bedside tests of balance and mobility. Geriatrics Today: Journal of the Canadian Geriatrics Society. 2002;5:140–144.
    1. MacKnight C, Rockwood K. Mobility and balance in the elderly: a guide to bedside assessment. Postgraduate Medicine. 1996;99:269–271.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다