Table 1: Mobility & Functional Assessment Tools

Tool
Berg Balance Scale
Administration Physiotherapist

Description
14-item scale designed to assess balance and risk of falling of older people in the community

Strengths
Easy measure administered in 15-20 minutes Good community predictor of falls 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

Limitations
Not practical in acute (needs equipment) 20 minutes to administer, not practical in acute Limited to balance Limited to specific patients, not generic 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.

Access / Sources
Access tool here: http://www.fallssa.co m.au/index.php http://www.fallssa.co m.au/cms/documents /hp/Berg_Balance_Sc ale.pdf

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 patients bedside or in a community setting. Developed based on the Rasch model and therefore provides

For details on how to access this tool refer to the resource review.

For further detail contact Dr. Natalie de Morton

interval level data 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)

natalie.demorton@me d.monash.edu.au

Modified Elderly Mobility Scale (MEMS)

Physiotherapist

7 item test of motor function of elderly patients with a spread of functional levels

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) High inter-rater and test-retest reliability for each item and total score, regardless of experience of rater

Functional Reach component only practical in clinical setting Needs controlled environment and stairs No self-care component Needs to be administered soon after admission Rural/regional areas may find difficult as do not have allied health staff seven days Still reliable but less so for patients of a low functional level, but this may be due to video scoring method during trial Need a chair at the right height Difficult for patients with dementia, Parkinsons, visual impairments Only provides information on

Access tool here: http://www.physiobob .com/forum/generalphysiotherapydiscussion/189functionalassessment-tools.html

Timed Up & Go Test

Physiotherapy; Once mobility level established, if at safe level can be administered by

Assessment of dynamic balance and mobility skills for older people

Quick and easy to administer in less than 3 mins Can be used across different settings Suits bedside Reliability and validity with

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 Normative values established in Steffen et al. (2002) and Hill et al. (1999) High inter and intra-rater reliability and sensitivity and specificity

a few aspects of balance Scores do not have depth of information to discriminate between the various sources of impairment Unable to administer if person unable to transfer/mobilise without assistance Not often used in clinical setting No gait or self care components Requires therapist interpretation Not sensitive enough to pick up some function changes Lengthy Validity not reported Access tool here: http://www.bhps.org. uk/falls/documents/Ti nettiBalanceAssessme nt.pdf

Tinetti Assessment Tool: Balance

Physiotherapist

Test measuring gait and balance

Simple and easily administered in 10-15 minutes Shorter than some other balance tests Good inter-rater reliability

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

18 items Measures functional status of people in rehabilitation Reflects what person usually does rather than what he/she can do

Widely used in general rehabilitation settings Administration by an trained assessor of any discipline Includes cognition, language, continence Can be used as a benchmark Acceptable reliability for assessing ADLs for adults across a wide variety of settings, raters and patients More reliable in detecting functional change in inpatient setting Quantitative assessment of balance and gait Can be performed at the bedside in about 5 minutes

May not be translatable to acute 5 hour training required for administration with annual refresher training (costly) Users need to be certified Cost required for use/accreditation Limited focus on physical health (skin integrity, nutrition, medical conditions, pain etc) Some items appear subjective Not well known Mobility Assessment only, no functional assessment components Lengthy

Access tool here: http://www.birf.info/h ome/bitools/tests/fam.html

Performance Orientated Mobility Assessment

Physiotherapist

18 item mobility assessment, usually in the evaluation of fall risk or falls.

Access tool here: http://www.hospitalm edicine.org/geriresour ce/toolbox/poma.htm