Table 1: Mobility & Functional Assessment Tools Tool Berg Balance Scale Administration Description Strengths Limitat
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Table 1: Mobility & Functional Assessment Tools Tool Berg Balance Scale
Administration
Description
Strengths
Limitations
Access / Sources
Physiotherapist
14-item scale designed to assess balance and risk of falling of older people in the community
Easy measure administered in 15-20 minutes
Not practical in acute (needs equipment)
Access tool here:
Good community predictor of falls
20 minutes to administer, not practical in acute
#
Found to have high sensitivity for predicting falls Ability to identify risk for falling and used to identify change in risk following rehabilitation High inter-rater and intra-rater reliability Age-related normative values established Tested across community, acute, post-acute, residential care settings
de Morton Mobility Index (DEMMI) #
Physiotherapist
15 hierarchical mobility challenges
Simple, quick and easy to score and administer by clinician observation No special/expensive equipment required Can be administered at the patient’s bedside or in a community setting. Developed based on the Rasch model and therefore provides
Limited to balance Limited to specific patients, not generic
http://www.fallssa.co m.au/index.php http://www.fallssa.co m.au/cms/documents /hp/Berg_Balance_Sc ale.pdf
Does not include measure of gait Despite high intra-class correlation coefficient, absolute reliability showed change of 8 points is required to show change in function among older people who are dependent in activities of daily living (ADLs) New tool (published in August 2008) – limited interdisciplinary awareness A one-dimensional measure of ‘mobility’ so other tools required to measure other domains.
For details on how to access this tool refer to the resource review.
For further detail contact Dr. Natalie de Morton
interval level data
natalie.demorton@me d.monash.edu.au
Overcomes limitations of existing instruments such as ceiling and floor effects Extensive clinimetric evaluation – Rasch, reliability, validity, responsiveness to change and minimally clinically important difference (MCID)
Modified Elderly Mobility Scale (MEMS)
Physiotherapist
#
Timed Up & Go Test #
Physiotherapy; Once mobility level established, if at safe level can be administered by
7 item test of motor function of elderly patients with a spread of functional levels
Assessment of dynamic balance and mobility skills for older people
Quick and easy to administer Valid and reliable Experience of physiotherapist scoring patient does not greatly impact reliability of scoring Concurrent validity when compared to FIM (Functional Independence Measure)
Functional Reach component only practical in clinical setting Needs controlled environment and stairs No self-care component
Rural/regional areas may find difficult as do not have allied health staff seven days
Quick and easy to administer in less than 3 mins
Need a chair at the right height
Can be used across different settings
Difficult for patients with dementia, Parkinsons, visual impairments
Reliability and validity with
http://www.physiobob .com/forum/generalphysiotherapydiscussion/189functionalassessment-tools.html
Needs to be administered soon after admission
High inter-rater and test-retest reliability for each item and total score, regardless of experience of rater
Suits bedside
Access tool here:
Still reliable but less so for patients of a low functional level, but this may be due to video scoring method during trial
Only provides information on
Access tool here: http://www.saskatoon healthregion.ca/pdf/0 3_Timed%20Up%20a nd%20Go%20procedu re.pdf
a trained nurse or allied health assistant
community dwelling older adults
a few aspects of balance
Normative values established in Steffen et al. (2002) and Hill et al. (1999)
Scores do not have depth of information to discriminate between the various sources of impairment
High inter and intra-rater reliability and sensitivity and specificity
Tinetti Assessment Tool: Balance
Physiotherapist
Test measuring gait and balance
#
Unable to administer if person unable to transfer/mobilise without assistance
Simple and easily administered in 10-15 minutes
Not often used in clinical setting
Shorter than some other balance tests
No gait or self care components
Good inter-rater reliability
Requires therapist interpretation
Access tool here: http://www.bhps.org. uk/falls/documents/Ti nettiBalanceAssessme nt.pdf
Not sensitive enough to pick up some function changes Lengthy Validity not reported
Barthel Index #
Requires team of Physiotherapy, Occupational Therapist & Nursing
15 ADL items; Assesses selfcare and mobility activities of daily living
Widely used in geriatric settings Administered in 5-10 minutes Easy and quick to learn Multidisciplinary Good snap shot of inpatient function and covers personal care, mobility and self-care Reliability, validity and overall utility are rated as good to excellent Compares favourably with other ADL
Community rehabilitation / sub-acute setting focused Does not take cognition into account May give broad brush picture, as its ability to reflect change in function limited by a floor effect and lack of sensitivity to change
Access tool here: www.strokecenter.org /trials/scales/barthel. pdf
scales
Functional Independen ce Measure (FIM) and Functional Assessment Measure (FAM)
Requires trained clinician to administer; Team approach
#
Performance Orientated Mobility Assessment #
Physiotherapist
18 items Measures functional status of people in rehabilitation
Widely used in general rehabilitation settings
May not be translatable to acute
Administration by an trained assessor of any discipline
5 hour training required for administration with annual refresher training (costly)
Includes cognition, language, continence
Cost required for use/accreditation
Can be used as a benchmark
18 item mobility assessment, usually in the evaluation of fall risk or falls.
Quantitative assessment of balance and gait
Some items appear subjective
Can be performed at the bedside in about 5 minutes
Not well known
More reliable in detecting functional change in inpatient setting
http://www.birf.info/h ome/bitools/tests/fam.html
Users need to be certified
Reflects what person usually does rather than what he/she can do
Acceptable reliability for assessing ADLs for adults across a wide variety of settings, raters and patients
Access tool here:
Limited focus on physical health (skin integrity, nutrition, medical conditions, pain etc)
Mobility Assessment only, no functional assessment components Lengthy
Access tool here: http://www.hospitalm edicine.org/geriresour ce/toolbox/poma.htm