de Morton Mobility Index

Parkinson’s: (Johnston, M. et al, 2013; n=102; mean age (SD) =72.4 (8.3) years)

• MCID = 8.2 points

Parkinson’s: (Johnston, M. et al, 2013; n=102; mean age (SD) =72.4 (8.3) years, physiotherapy outpatients)

• Mean score at admission (n=101): 66.2 (16.4)
• Mean score at discharge (n=83): 73.8 (15.9)
• Mean score gait aid (n=68): 72.15 (14.31)
• Mean score no gait aid (n=31): 51.90 (10.60)
• Mean score Hoehn-Yahr ≤2 (n=26): 75.15 (14.34)
• Mean score Hoehn-Yahr >2 (n=62): 62.83 (16.16)

Parkinson’s: (Johnston, M. et al, 2013; n=102; mean age (SD) = 72.4 (8.3) years)

Convergent Validity of DEMMI with other mobility instruments

Convergent Validity of DEMMI with other mobility instruments

Parkinson’s: (Johnston, M. et al, 2013; n=102; mean age (SD) =72.4 (8.3) years)

• No ceiling or floor effect observed

Sub-Acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ±15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40))

• SEM for entire group (n = 109) = 5.4 points

Sub-acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ±15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40))

• MDC90 =12.5 and MDC95 =15.0 points

Sub-Acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ±15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40))

• Mean score: 57 ± 28

Sub-acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ± 15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40))

• Excellent reliability: (ICC = .95)

Sub-acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ± 15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40)

• Excellent: Cronbach's alpha = 0.94

Sub-acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ± 15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40)

• Excellent correlation with Rivermead Mobility index (ρ=0.93)
• Excellent correlation with Functional Ambulation Categories (ρ=0.93)
• Excellent correlation with Berg Balance Scale (ρ=0.96)
• Excellent correlation with Performance-Oriented Mobility Assessment (ρ=0.95)
• Excellent correlation with Timed Up and Go Test (ρ=-0.82)
• Excellent correlation with 10-meter walk test (ρ=0.78)
• Excellent correlation with 6-minute walk test (ρ=0.91)
• Excellent correlation with Functional Independence Measure (FIM) Mobility (ρ=0.87)
• Excellent correlation with FIM Total (ρ=0.85)
• Adequate  correlation with National Institutes of Health Stroke Scale (ρ=-0.76)

Sub-acute Stroke: (Braun et al., 2019; n=109; mean age = 66 ± 15 (18–90); mean disease duration = 7 ± 13 (0–63) days, gender M/F (%) = M: 65 (60), F: 44 (40)

• No floor or ceiling effects were evident.

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

• MDC: 7 points [38 ± 21 (0 - 85)]
• MDC for entire group (n = 153): 7 points

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

DEMMI has 15 hierarchical mobility items that is rated with 2 or 3 response options. The ordinal raw score is 0 - 19 points, and the interval-level score is 0 - 100 points. In general, higher scores indicate better mobility, but there are no specific cut off score for this particular population of older adults with cognitive impairments (dementia, delirium, other). Additionally, Braun et al. noted that participants with more severe cognitive impairment tended to have lower DEMMI mean scores.

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

• Mean score 38 ± 21 (0 - 85)

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

• Excellent internal consistency Cronbach’s Alpha = 0.92

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

Construct validity of the de Morton Mobility Index (n = 153) including the hypotheses on construct validity and the constructs of the comparison measurement instruments

Mild to Moderate Cognitive Impairment: (Braun et al., 2018; n = 153, mean age: 82 ± 7, geriatric hospital patients)

• Floor Ranges: 0 - 7 DEMMI Score Ceiling Ranges: 93 - 100 DEMMI Score
• Floor Effect: 10 participants (7%) scored 0, which translates to an adequate floor effect because it is < 20%
• Ceiling Effects: No participants scored 100 (0%), which translates to excellent because there are no ceiling effects

Rehabilitation hospital inpatients: (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German Translation, rehabilitation hospital inpatients)

• SEM for entire group (n = 140): 3.8

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

• Time of admission to ICU
  • SEM: 2.89 (n=115)
• Time of discharge
  • SEM: 3.54 (n=86)

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• MDC for inter rater reliability (n = 35): 8.9

Rehabilitation hospital inpatients (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German translation)

• MDC for entire group (n = 140): 8.8 points

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

• Admission MDC: 6.73
• Discharge MDC: 8.23

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• Criterion based method MCID = 9.43 (5.9 to 12.9)
• Distribution based method MCID = 10.5

Patients transitioning from hospital to community: (de Morton 2011,age: 82(9))

• Criterion based: 12 points(10-13) 95% confidence (n=265)
• Distribution based: 10 points, 95% confidence (n=678)

Inpatient Adult: (New PW, et al. 2016; n = 367; Stroke, n = 110; Other neuro, n = 102; Ortho/other, n= 25)

• Total Cohort MCID: 2.5
• Stroke Patient MCID: 2.9
• Other Neuro MCID: 2.8
• Orthopedic conditions/Other MCID: 2.1

Rehabilitation hospital inpatients (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German translation)

• DEMMI has 15 hierarchical mobility items that is rated with 2 or 3 response options. The ordinal raw score is 0 - 19 points, and the interval-level score is 0 - 100 points. In general, higher scores indicate better mobility, but there are no specific cut off score for this particular population.

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• Mean score: 57.19 (sd = 17.07)

Patients transitioning from hospital to community: (de Morton 2011,age: 82(9))

• High level residential care: 33 (19) n=185
• Low level residential care: 59 (13) n=65

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

• Median score: 30 (24-33) 

Inpatient Adult: (New PW, et al. 2016; n = 367; Stroke, n = 110; Other neuro, n = 102; Ortho/other, n= 25)

Rehabilitation hospital inpatients (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German translation)

• Excellent test-retest reliability: (ICC = .94)

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• Excellent interrater reliability (Pearson's r = 0.94, 95% CI 0.86 to 0.98)

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

• Excellent Interrater reliability: ICC=.93 (.91, .95)
• Adequate Intrarater reliability: ICC=.68 (.46, .82)

Critical Illness at discharge: (van der Schaaf, 2016; n=86)

• Excellent Interrater reliability: ICC=.097 (.96, .98)

Rehabilitation hospital inpatients (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German translation)

• Excellent internal consistency: Cronbach's alpha = 0.83

Inpatient Adult: (New PW, et al. 2016; n = 367)

• Excellent, Cronbach’s Alpha value = 0.904

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

Convergent:

• HABAM: 0.91 (0.87 to 0.94), p = 0.00
• Barthel Index: 0.68 (0.56 to 0.77), p = 0.00

Discriminant

• MMSE0.24 (0.05 to 0.41), p = 0.02
• APACHE II 0.07 (-0.12 to 0.26), p = 0.49
• Charlson -0.04 (-0.23 to 0.15), p = 0.68

Rehabilitation hospital inpatients (Braun et al., 2015; n=140; mean age = 79.5 ± 7.3, German translation)

• Excellent validity with Performance Oriented Mobility Assessment: rho = 0.89
• Excellent validity with Functional Ambulation Categories: rho = 0.70;
• Excellent validity with six-minute walk test: rho = 0.73
• Excellent validity with gait speed: rho = 0.67

Excellent validity with Falls Efficacy Scale International: rho = −0.68)

Patients transitioning from hospital to community: (de Morton 2011,age: 82(9))

• Excellent convergent Validity of DEMMI with Modified barthel index: ρ=.75 (.71-.78) n=655
• Discriminant Validity of DEMMI with Charleston Index: -.11 (-.18--.04) n=678

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

Convergent Validity:

At admission:

• Adequate validity with Barthel index: ρ=.56 (.42, .67)
• Adequate validity with Katz ADL: ρ=–0.45(–0.59,–0.29)
• Adequate validity with MMT (MRC-SS): ρ=0.57(0.43, 0.69)

At discharge (n=86):

• Adequate validity with Barthel index: 0.75(0.63, 0.83) n=86
• Adequate validity with Katz ADL: –0.76(–0.84,–0.65)
• Adequate validity with MMT (MRC-SS): 0.63(0.48, 0.75)

Divergent Validity: At admission (n=97):

• Poor validity with APACHE II: –0.18(–0.36, 0.01)

Inpatient Adult: (New PW, et al. 2016; n = 367; Stroke, n = 110; Other neuro, n = 102; Ortho/other, n= 25)

Convergent Validity: Inpatient Adult:

• Adequate correlation with motor subscale of Functional Independence Measure (FIM) (ρ=0.76, p < 0.001)
• Adequate correlation with FIM – Transfer from bed/chair(ρ= 0.76, p < 0.001)
• Adequate correlation with FIM – Transfer toilet (ρ=0.75, p < 0.001)
• Adequate correlation with FIM – Transfer bath/shower (ρ=0.75, p < 0.001)
• Adequate correlation with FIM – Locomotion: Walk/Wheelchair (ρ=0.67, p < 0.001)
• Poor  correlation with FIM – Locomotion: Stairs (ρ=0.46, p < 0.001)

Discriminant Validity: Inpatient Adult:

• Shown by identification of a low and nonsignificant correlation with the Charleston comorbidity index (rho= 0.08, p = 0.15, n =355) and a low correlation with the cognitions sub scale of the FIM (rho= 0.21, p<0.001, n=362).

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• Floor effects: <1%
• Ceiling effects: 3.8%

Patients transitioning from hospital to community: (de Morton 2011,age: 82(9))

Patients at admission

• 46 participants (7%) scored 0 and 3 participants (0.4%) scored 100. n=678

At discharge

• 35 participants (7%) scored 0 and 6 participants (1%) scored 100. n=502

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

• Critical Illness floor effect:  At admission: 2.6% (in 3 patients)
• At discharge: no floor effect (0 patients)

Critical illness ceiling effect:

• At admission: no ceiling effect (0 patients) At discharge: 2.6% (3 patients)

Inpatient Adult: (New PW, et al. 2016; n = 367; Stroke, n = 110)

• Total Cohort: No floor or ceiling effect
• Stroke patients at discharge: slight ceiling effect (19% of patients reported highest score possible)

Hospital Inpatients: (De Morton 2008, age: 81.2 (7.3), hospital inpatients)

• Responsiveness to change# Effect Size Index 0.39 (0.28 to 0.50)
• Guyatt's Responsiveness Index (Patient) DEMMI: 0.92 (0.66 to 1.17)*
• Guyatt's Responsiveness Index  (Therapist) DEMMI:1.73 (1.37 to 2.09)*

Patients transitioning from hospital to community: (de Morton 2011,age: 82(9))

• Guyatt Responsiveness to change: 1.58 (1.39-1.77) n=265 Effect Size: .34 (.25-.42) n=501

Critical illness: (Sommers, J., et al. 2016, n=115, age: 61(16.1), inpatients in ICU and M-ICU)

Effect sizes

• At admission: 0.21(P≤.001) n=115 At discharge: 0.20(P≤.001) n=86

Inpatient Adult: (New PW, et al. 2016; n = 367; Stroke, n = 110)

• Large changes in the ESI (1.22) and SRM (1.30) of the DEMMI indicated that the DEMMI was highly responsive to change

Hip Fracture: (de Morton et al, 2013; n = 109; median time between surgery and rehabilitation admission = 10 days; median length of rehab stay = 26 days)

• MCID = 6 points

Hip Fracture: (de Morton et al, 2013; n = 109; median time between surgery and rehabilitation admission = 10 days; median length of rehab stay = 26 days)

• Admission Mean (SD): 29.6 (11.9)
• Discharge Mean (SD) (n=102): 48.7 (8.9)

Hip Fracture: (de Morton et al, 2013; n = 109; median time between surgery and rehabilitation admission = 10 days; median length of rehab stay = 26 days)

Convergent Validity:

• DEMMI with
  • 6 minute walk test n = 62  Spearman’s rho = .76 (.63-.85)
  • 6 meter walk test velocity  n = 90  Spearman’s rho = .62 (.46-.71)
  • Barthel Index   n = 108   Spearman’s rho = .60 (.46-.71)

Discriminant Validity

• DEMMI with Mini Mental State Examination: n= 71  Spearman’s rho = 0.15 (−0.09 to 0.37)

Hip Fracture: (de Morton et al, 2013; n = 109; median time between surgery and rehabilitation admission = 10 days; median length of rehab stay = 26 days)

• No floor or ceiling effect at hospital admission or discharge

Hip Fracture: (de Morton et al, 2013; n = 109; median time between surgery and rehabilitation admission = 10 days; median length of rehab stay = 26 days)

• DEMMI reported to be highly responsive to change. n = 102; ESI = 1.60 (1.42 to 1.77)

Healthy Community-Dwelling Older Adults_(Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

• MDC for entire group (n = 61) = 13 points, 90% CI

Healthy Community-Dwelling Older Adults (Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

• MCID = 7 points

This MCID is lower than the MCID value reported in the acute medical population of older adults, which has been noted to be 10 points.

Older Community Care Recipients: (de Morton et al. 2011; n = 35; mean age = 75.2 (9.2) years; average of 5 health problems (2-9))

• MCID = 11 points

Healthy Community-Dwelling Older Adults (Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

• Davenport and de Morton noted that participants with more gait aids tended to have lower DEMMI mean scores than participants with no gait aids.

Older Community Care Recipients: (de Morton et al. 2011; n = 35; mean age = 75.2 (9.2) years; average of 5 health problems (2-9))

• Mean score of 63.7 (SD: 21.5, 95% CI 56.58-70.81).

Healthy Community-Dwelling Older Adults (Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

• Mean score: 76.9±14.1

Healthy Community-Dwelling Older Adults (Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

Convergent:

• Adequate Correlation for the DEMMI with the Lower Extremity Functional Scale (LEFS) in the population of healthy community-dwelling older adults (r = 0.69)

 Discriminant:

• Poor correlation for the DEMMI with the Quality of Life Scale (QOLS) in the population of healthy community-dwelling older adults (r = 0.28)

Older Community Care Recipients: (de Morton et al. 2011; n = 35; mean age = 75.2 (9.2) years; average of 5 health problems (2-9))

Convergent Validity:

• Barthel Index Scores: (rho = 0.60, 95%CI 0.33– 0.78, P < 0.001, n = 35)

• SF-36 physical component total scores (rho = 0.50, 95%CI 0.18–0.72, P < 0.001, n = 35)

Discriminant Validity:

• AQoL scores (rho = -0.38, 95%CI -0.50 to -0.63, P < 0.05, n = 35)
• SF-36 mental component total scores (rho = 0.17, 95%CI -0.19 to 0.48, P > 0.05, n = 33)

Healthy Community-Dwelling Older Adults (Davenport, de Morton, 2011; n = 61; mean age = 76.5 ± 5.5 years (65 - 87 year range); DEMMI score mean = 76.8 ± 14.1 points (44 -100 point range)

• Floor Ranges: 0 - 7 DEMMI Score Ceiling Ranges: 93 - 100 DEMMI Score
• In this study floor and ceiling effects were defined as 15% or more of participants scored the highest or lowest possible score on the DEMMI.
• Floor Effect: No participants scored 0 (0%), which translates to excellent because there are no floor effects.
• Ceiling Effects: 8 participants (13.1%) scored 100, which translates to an adequate floor effect because it is both < 15% as the study identifies and < 20% as the rehabilitation measures database identifies.

Older Community Care Recipients: (de Morton et al. 2011; n = 35; mean age = 75.2 (9.2) years; average of 5 health problems (2-9))

• Neither a floor nor ceiling effect was identified.

Knee/Hip Osteoarthritis (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

• SEM for entire cohort (n=219): 2.9

Knee/Hip Osteoarthritis: (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

• MDC for entire group (n =219): 6.7
  • 5.6-11.5 on 95% CI

Knee/Hip Osteoarthritis (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

• Mean score: 71±18 (range, 30–100)

Knee/Hip OA: (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

• Excellent interrater reliability: ICC=0.85
  • .71-.93 on 95% CI

Knee/Hip OA: (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

Spearman Correlation Coefficients (ρ) of DEMMI Scores With Scores of Other Performance-Based and Self-report Measures of Mobility in a Population of Patients Waiting for Total Hip or Total Knee Arthroplasty

Knee/Hip OA: (Jans MP, et al. 2011; n= 219; age: 65+, pre-surgical intervention)

• In this population, the DEMMI showed no floor and ceiling effects because no patient obtained the lowest score and less than 15% of patients obtained the highest score.