Elderly Mobility Scale

Older Adult & Geriatric Care: (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)

• MDC₉₀ = 4.3 (95% CI 2.8-6.7)

Older Adult & Geriatric Care: (De Morton Et Al, 2008; N=15, 19,  28; Age= 78-93, 71-91, Not Provided)

• Estimated MCID = 2 Points
• MCID % of scale width = 10.0%

Older Adult & Geriatric Care: (De Morton Et Al, 2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)

• Using distribution-based method
  • MCID = 2.73
  • MCID % OF SCALE WIDTH = 13.7%
• Using criterion based approach
  • MCID = 6.97
  • MCID % OF SCALE WIDTH = 34.85%

Older Adult & Geriatric Care: (Smith, 1994; n=36; age= 70-93)

Discharge outcomes and EMS scores

• Score 14-20 = home (independent in basic ADLs)
• Score 11-13 = part iii accommodation (discharged home with high levels of care - community care package or relative)
• Score 0-6 = nursing home
• Score 5-13 = home with caretaker
• Score 1 = died

Level of independence and EMSscores

• Score > 14 = independent in basic ADLs
• Score 10-13 = borderline in terms of safe mobility and independence in ADLs (require some help with some mobility maneuvers)
• Score < 10 = dependent (require help with mobility and ADLs)

Older Adult & Geriatric Care: (Chiu et al, 2009, n=78, age= 65+)

Fall risk and EMS scores

• Non-fallers: score = 19 - 20
• Single-fallers: score = 19 - 20
• Multiple fallers: score < 15

Older Adult & Geriatric Care: (Spilg Et Al, 2001, N=76, Median Age = 80, Median Followup Time = 108 Days Post-Discharge)

Fall Risk And EMS Scores (If Barthel Index >=17 On Discharge)

• Score <20 On Discharge = Moderate Risk
• Score >= 20 On Discharge = Low Risk

Older Adult & Geriatric Care

• Inter-Rater Reliability
  • Excellent Inter-Rater Reliability (R = 0.88, P < 0.0001) (Prosser And Canby, 1997; N = 66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study)
  • Excellent Inter-Rater Reliability (Mann Whitney Test = 196, P = 0.75) (Smith, 1994; N=36; Age= 70-93)
  • Excellent Inter-Rater Reliability (R2 = 0.0051, P = 1.00) Based On The Influence Of Particular Therapists (Nolan Et Al, 2008; N =32; Mean Age = 76.6 (9.1))
  • Excellent Inter-Rater Reliability (R2 = 0.0058, P = 1.00) Based On Years Of Clinical Experience (Nolan Et Al, 2008; N=32; Mean Age = 76.6 (9.1))
  • Excellent Inter-Rater Reliability (R2 = 0.0048, P = 1.00) Based On Number Of EMS Assessments Previously Completed In Clinical Practice (Nolan Et Al, 2008; N=32; Mean Age = 76.6 (9.1))
  • Excellent Inter-Rater Reliability Showed By The EMS Score Of An Individual Being The Variable That Placed Them In A Cluster (R2 = 0.8263, P = 0.000) (Nolan Et Al, 2008; N=32; Mean Age = 76.6 (9.1))
• Intra-Rater Reliability
  • Good Intra-Rater Reliability (R2 = 0.0035, P= 0.72) (Nolan Et Al, 2008; N=32; Mean Age = 76.6 (9.1))

Older Adult & Geriatric Care:

Predictive Validity

• Poor Predictive Validity Of A Person Being Classified As A Single Faller Based On Performance In The EMS (P = 0.197) (Chiu Et Al, 2009, N=78, Age= 65+)
• Multiple Fallers Were Significantly Worse Than The Controls And The Single Fallers In Their Performance Even After Adjusting For Age, Gender And BMI (All With P < 0.001) (Chiu Et Al, 2009, N=78, Age= 65+)
• Group Differences In Discharge Destination Data And Significant Between Group Differences (P = 0.0005) Were Confirmed With A Chi Squared Test (Chi-Squared = 20.164) (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))
• Community Dwelling Older Persons With Multiple Falls In The Six Months Prior To The Study Scored Significantly Lower On The EMS Compared To Older Persons Who Had Experienced No Falls Or Only A Single Fall In The Six Months Prior To The Study (P

< 0.001) (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)

• • The Scale As A Whole Cannot Be Used To Predict Those At Risk Of Falling, As Those Who Fell During The Study Were Of A Wide Range Of EMS Scores; However, The Functional Reach Component May Be Of Value (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))
• Statistically Significant Relationship Between EMS Scores At Hospital Discharge And Risk Of >/= 2 Falls During 4 Month Follow-Up Period (Logistic Regression, P= 0.008) (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
• Statistically Significant Association Shown Betwee EMS On Discharge And Patient Having 2 Or More Falls Over Follow-Up Period (Spilg Et Al, 2001, N=76, Median Age = 80, Median Follow-up Time = 108 Days Post-Discharge)

Concurrent Validity

• Modified Rivermead Mobility Index (MRMI)
  • Excellent Correlation With MRMI Scores (R = 0.887, P < 0.05, 95% CI:779 To 0.944) (Nolan Et Al, 2008; N=32; Mean Age = 76.6 (9.1))
• Barthel Index (BI)
  • Excellent Correlation With BI Scores (R = 0.962) (Smith, 1994; N=36; Age= 70-93)
  • BI And EMS Scores Rendered A Lower Though Still Acceptable Level Of Correlation Than In The Original Study By Smith; However, The EMS And Barthel Are Not Measuring Exactly The Same Abilities (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))
• Functional Independence Measure (FIM)
  • Excellent Correlation With FIM Scores (R = 0.948) (Smith, 1994; N=36; Age= 70-93)

Older Adult & Geriatric Care:

Convergent Validity

• Barthel Index (BI)
  • Excellent Correlation Of BI And EMS Scores (R = 0.96) (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
• Excellent Correlation Of BI And EMS Scores (R = 0.787, P < 0.001) (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))
  • Functional Independence Measure (FIM)
    • Excellent Correlation Of FIM And EMS Scores (R = 0.95) (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
  • De Morton Mobility Index (DEMMI)
    • Excellent Correlation Of DEMMI And EMS Scores (R = 0.93 - 0.96, 95% CI, P = 0.00) (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)

Older Adult & Geriatric Care:

• The EMS Items And Response Options Are Worded Clearly And Simply And The Seven Items Can Be Classified As Measuring The Domain Of Mobility (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
• The Qualitative Methods Employed To Develop The EMS Items Were Not Clearly Reported By The Test Developer, But The Item Generation And Development Based On Expert Opinion And The Existing Literature Provides Evidence Of Content Validity (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
• EMS Is Appropriate And Has Content Validity In That Mobility Is Broken Down Into Comprehensive And Relevant Components As Perceived By Physiotherapists (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))

Older Adult & Geriatric Care:

• The Qualitative Methods Employed To Develop The EMS Items Were Not Clearly Reported By The Test Developer, But The Item Generation And Development Based On Expert Opinion And The Existing Literature Provides Evidence Of Face Validity (De Morton Et Al, 2008; N=15, 19,  28; Mean Age= 78-93, 71-91, Not Provided)
• EMS Has Face Validity For Application In The Acute Hospital Setting (Smith, 1994; N=36; Age= 70-93)
• EMS Is Appropriate And Has Face Validity In That Mobility Is Broken Down Into Comprehensive And Relevant Components As Perceived By Physiotherapists (Prosser And Canby, 1997; N=66, 19 (Inter-Rater Reliability Study); Age = 66-69, 71-95 (Inter-Rater Reliability Study))

Older Adult & Geriatric Care:

Ceiling Effects

• Poor ceiling effect of 50% identified for community-dwelling older adults who had experienced a single fall in the previous 6 months (7.5); Within 48 Hours Of Hospital Admission And Discharge)
• Adequate Ceiling Effect Of 15% Found For Persons At Hospital Discharge (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)
• Poor Ceiling Effect Of 35.3% Found Within The MDC Of The Highest Scale Score (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)
  • 20 Healthy 81-90-Year-Old Women All Scored The Maximum 20 Points On The Scale (Smith, 1994; N=36; Age= 70-93)

Floor effects

• Adequate floor effect of 20% found for persons at hospital admission (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)

Older Adult & Geriatric Care:

• 83% of patients expected to improve after falls rehabilitation program showed improved ems scores and
• A significant improvement in EMS scores was identified between assessments (p < 0.001) (de Morton et al, 2008; n=15, 19,  28; Mean Age= 78-93, 71-91, not provided)
• Effect Size Index (ESI) Point Estimate = 0.76 (0.60-0.93) (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)
• Guyatt’s Responsiveness Index Point Estimate = 1.68 (1.24 - 2.12) (De Morton Et Al,  2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)