Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2008

Open Access 01-12-2008 | Research

The de Morton Mobility Index (DEMMI): An essential health index for an ageing world

Authors: Natalie A de Morton, Megan Davidson, Jennifer L Keating

Published in: Health and Quality of Life Outcomes | Issue 1/2008

Login to get access

Abstract

Background

Existing instruments for measuring mobility are inadequate for accurately assessing older people across the broad spectrum of abilities. Like other indices that monitor critical aspects of health such as blood pressure tests, a mobility test for all older acute medical patients provides essential health data. We have developed and validated an instrument that captures essential information about the mobility status of older acute medical patients.

Methods

Items suitable for a new mobility instrument were generated from existing scales, patient interviews and focus groups with experts. 51 items were pilot tested on older acute medical inpatients. An interval-level unidimensional mobility measure was constructed using Rasch analysis. The final item set required minimal equipment and was quick and simple to administer. The de Morton Mobility Index (DEMMI) was validated on an independent sample of older acute medical inpatients and its clinimetric properties confirmed.

Results

The DEMMI is a 15 item unidimensional measure of mobility. Reliability (MDC90), validity and the minimally clinically important difference (MCID) of the DEMMI were consistent across independent samples. The MDC90 and MCID were 9 and 10 points respectively (on the 100 point Rasch converted interval DEMMI scale).

Conclusion

The DEMMI provides clinicians and researchers with a valid interval-level method for accurately measuring and monitoring mobility levels of older acute medical patients. DEMMI validation studies are underway in other clinical settings and in the community. Given the ageing population and the importance of mobility for health and community participation, there has never been a greater need for this instrument.
Appendix
Available only for authorised users
Literature
1.
go back to reference Mazzeo R, Cavanagh P, Evans W, Fiatarone M, Hagberg J, McAuley E, Startzell J: ACSM Position Stand: Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise 1998, 30: 992–1008. 10.1097/00005768-199806000-00033CrossRef Mazzeo R, Cavanagh P, Evans W, Fiatarone M, Hagberg J, McAuley E, Startzell J: ACSM Position Stand: Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise 1998, 30: 992–1008. 10.1097/00005768-199806000-00033CrossRef
2.
go back to reference Morris ME, Schoo Ae: Optimizing Exercise and Physical Activity in Older People. London, UK: Butterworth Heinemann; 2004. Morris ME, Schoo Ae: Optimizing Exercise and Physical Activity in Older People. London, UK: Butterworth Heinemann; 2004.
3.
go back to reference de Morton N, Berlowitz D, Keating J: A systematic review of mobility instruments and their measurement properties for older acute medical patients. BMC Health and Quality of Life Outcomes 2008, 6: 44. 10.1186/1477-7525-6-44CrossRef de Morton N, Berlowitz D, Keating J: A systematic review of mobility instruments and their measurement properties for older acute medical patients. BMC Health and Quality of Life Outcomes 2008, 6: 44. 10.1186/1477-7525-6-44CrossRef
4.
go back to reference Smith R: Validation and reliability of the Elderly Mobility Scale. Physiotherapy 1994, 80: 744–747.CrossRef Smith R: Validation and reliability of the Elderly Mobility Scale. Physiotherapy 1994, 80: 744–747.CrossRef
5.
go back to reference MacKnight C, Rockwood K: Rasch analysis of the hierarchical assessment of balance and mobility (HABAM). Journal of Clinical Epidemiology 2000, 53: 1242–1247. 10.1016/S0895-4356(00)00255-9CrossRefPubMed MacKnight C, Rockwood K: Rasch analysis of the hierarchical assessment of balance and mobility (HABAM). Journal of Clinical Epidemiology 2000, 53: 1242–1247. 10.1016/S0895-4356(00)00255-9CrossRefPubMed
6.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
7.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
8.
go back to reference Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Medical Journal 1965, 14: 61–65.PubMed Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Medical Journal 1965, 14: 61–65.PubMed
9.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
10.
go back to reference 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. 10.1093/ageing/afl118CrossRefPubMed 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. 10.1093/ageing/afl118CrossRefPubMed
11.
go back to reference de Morton NA, Keating JL, Jeffs K: Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2007, 24(1):CD005955. de Morton NA, Keating JL, Jeffs K: Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2007, 24(1):CD005955.
12.
go back to reference 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. 10.1177/0269215506071313CrossRefPubMed 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. 10.1177/0269215506071313CrossRefPubMed
13.
go back to reference 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 2008, 89: 641–647. 10.1016/j.apmr.2007.10.021CrossRef 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 2008, 89: 641–647. 10.1016/j.apmr.2007.10.021CrossRef
14.
go back to reference World Health Organisation: International Classification of Functioning, Disability and Health. Geneva, Switzerland; 2001. World Health Organisation: International Classification of Functioning, Disability and Health. Geneva, Switzerland; 2001.
15.
go back to reference Rikli RE, Jones CJ: Assessing Physical Performance in independent older adults: Issues and guidelines. Journal of Aging and Physical Activity 1997, 5: 244–261. Rikli RE, Jones CJ: Assessing Physical Performance in independent older adults: Issues and guidelines. Journal of Aging and Physical Activity 1997, 5: 244–261.
16.
go back to reference Chodzko-Zajko WJ: Assessing physical performance in older adult populations. Journal of Aging and Physical Activity 1994, 2: 103–104. Chodzko-Zajko WJ: Assessing physical performance in older adult populations. Journal of Aging and Physical Activity 1994, 2: 103–104.
17.
go back to reference Guralnik J, Simonsick E, Ferrucci L, Glynn R, Berkman L, Blazer D, Scherr P, Wallace R: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49(2):M85-M94.CrossRefPubMed Guralnik J, Simonsick E, Ferrucci L, Glynn R, Berkman L, Blazer D, Scherr P, Wallace R: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49(2):M85-M94.CrossRefPubMed
18.
go back to reference Folstein MF, Folstein SE, McHugh PR: "Mini-Mental State." A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Reserve 1975, 12: 189–198. 10.1016/0022-3956(75)90026-6CrossRef Folstein MF, Folstein SE, McHugh PR: "Mini-Mental State." A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Reserve 1975, 12: 189–198. 10.1016/0022-3956(75)90026-6CrossRef
19.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease 1987, 40: 373–383. 10.1016/0021-9681(87)90171-8CrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease 1987, 40: 373–383. 10.1016/0021-9681(87)90171-8CrossRef
20.
go back to reference Knaus W, Draper E, Wagner DP, Zimmerman JE: APACHE 11: A severity of disease classification system. Critical Care Medicine 1985, 13: 818–829. 10.1097/00003246-198510000-00009CrossRefPubMed Knaus W, Draper E, Wagner DP, Zimmerman JE: APACHE 11: A severity of disease classification system. Critical Care Medicine 1985, 13: 818–829. 10.1097/00003246-198510000-00009CrossRefPubMed
21.
go back to reference Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology 1989, 42: 703–709. 10.1016/0895-4356(89)90065-6CrossRefPubMed Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology 1989, 42: 703–709. 10.1016/0895-4356(89)90065-6CrossRefPubMed
22.
go back to reference SPSS for Windows [computer program] Chicago: SPSS Inc; 2003. SPSS for Windows [computer program] Chicago: SPSS Inc; 2003.
23.
go back to reference Andrich D, Sheridan BS, Luo G: RUMM2020 [computer program]. Western Australia: RUMM Laboratory; Andrich D, Sheridan BS, Luo G: RUMM2020 [computer program]. Western Australia: RUMM Laboratory;
24.
go back to reference Smith E: Detecting and evaluating the impact of multidimensionality using item fit statistics and principal components analysis of residuals. Journal of Applied Measurement 2002, 3: 205–231.PubMed Smith E: Detecting and evaluating the impact of multidimensionality using item fit statistics and principal components analysis of residuals. Journal of Applied Measurement 2002, 3: 205–231.PubMed
25.
go back to reference Smith R: Fit analysis in latent trait measurement models. J Appl Meas 2000, 1(2):199–218.PubMed Smith R: Fit analysis in latent trait measurement models. J Appl Meas 2000, 1(2):199–218.PubMed
26.
go back to reference Linacre JM: Sample size and item calibration stability. Rasch Measurement Transactions 1994, 7: 328. Linacre JM: Sample size and item calibration stability. Rasch Measurement Transactions 1994, 7: 328.
27.
go back to reference Wright BD: Rack and stack: time 1 vs time 2. Rasch Measurement Transactions 2003, 17: 905–906. Wright BD: Rack and stack: time 1 vs time 2. Rasch Measurement Transactions 2003, 17: 905–906.
28.
go back to reference Chang W, Chan C: Rasch analysis for outcome measures: some methodological considerations. Archives of Physical Medicine and Rehabilitation 1995, 76: 934–939. 10.1016/S0003-9993(95)80070-0CrossRefPubMed Chang W, Chan C: Rasch analysis for outcome measures: some methodological considerations. Archives of Physical Medicine and Rehabilitation 1995, 76: 934–939. 10.1016/S0003-9993(95)80070-0CrossRefPubMed
29.
go back to reference Walter SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Statistics in Medicine 1998, 17: 101–110. 10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-ECrossRefPubMed Walter SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Statistics in Medicine 1998, 17: 101–110. 10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-ECrossRefPubMed
30.
go back to reference Stratford PW, Binkley JM, Riddle DL: Health status measures: strategies and analytic methods for assessing change scores. Physical Therapy 1996, 76: 1109–1123.PubMed Stratford PW, Binkley JM, Riddle DL: Health status measures: strategies and analytic methods for assessing change scores. Physical Therapy 1996, 76: 1109–1123.PubMed
31.
go back to reference 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. 10.1097/00005650-200305000-00004PubMed 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. 10.1097/00005650-200305000-00004PubMed
32.
go back to reference Tryon W: Evaluating statistical difference, equivalence, and indeterminacy using inferential confidence intervals: an integrated alternative method of conducting null hypothesis statistical tests. Psychological Methods 2001, 6: 371–386.CrossRefPubMed Tryon W: Evaluating statistical difference, equivalence, and indeterminacy using inferential confidence intervals: an integrated alternative method of conducting null hypothesis statistical tests. Psychological Methods 2001, 6: 371–386.CrossRefPubMed
33.
go back to reference Tennant A, Pallant J: Unidimensionality matters! (A tale of two Smiths?). Rasch Measurement Transactions 2006, 20: 1048–1051. Tennant A, Pallant J: Unidimensionality matters! (A tale of two Smiths?). Rasch Measurement Transactions 2006, 20: 1048–1051.
34.
go back to reference Katz S, Ford A, Moskowitz R, Jackson B, Jaffe M: Studies of illness in the aged. Journal of the Amercian Medical Association 1963, 185: 94–99. Katz S, Ford A, Moskowitz R, Jackson B, Jaffe M: Studies of illness in the aged. Journal of the Amercian Medical Association 1963, 185: 94–99.
Metadata
Title
The de Morton Mobility Index (DEMMI): An essential health index for an ageing world
Authors
Natalie A de Morton
Megan Davidson
Jennifer L Keating
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2008
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-6-63

Other articles of this Issue 1/2008

Health and Quality of Life Outcomes 1/2008 Go to the issue