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RMD

Purpose

The DEMMI was designed to measure changes in mobility of the hospitalized elderly population across different settings, from acute to chronic, and from clinical to community.

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Instrument Details

Acronym DEMMI

Area of Assessment

Balance – Non-vestibular
Gait
Seating
Strength

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

CDE Status

NINDS CDE Notice of Copyright
de Morton Mobility Index (DEMMI)

Availability

This instrument is freely available: de Morton Mobility Index

Classification

Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)

Key Descriptions

  • Tasks range from bed/bedside to dynamic balance and increase in difficulty.
  • Items are scored in each category 0, 1, or 2.
  • Raw score maximum total is 19.
  • Converted score maximum total is 100.

Number of Items

15

Equipment Required

  • Hospital Bed of Plinth
  • Chair with 45cm seat height with arm rests
  • Pen (or other small object to pick up)

Time to Administer

9 minutes

It has been reported that the average time to administer is less than 9 minutes (Davenport and de Morton, 2011).

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Aduly

65 +

years

Instrument Reviewers

Andrew Bagley, Alexis Lacewell, Brendan Gates, Caleb Mere, Christine Streisel

ICF Domain

Activity
Participation

Measurement Domain

Motor

Considerations

  • Testing should be performed at bedside.
  • Testing should be performed when the person has adequate medication (e.g. at least half an hour after pain or Parkinson’s Disease medication).
  • Test should be administered in the sequence described.
  • Score persons based on first attempt.
  • Encouragement during test is acceptable but feedback should not be provided.
  • For patients who are short of breath, a 10 minute rest should be provided halfway through the testing (i.e. after completing the chair transfers section).
  • Bed Transfers
    • Patient cannot use an external device such as the monkey bar, bed rail, edge of bed or a bed pole.
    • Additional pillows can be provided for persons who are unable to lie flat in supine.
  • Balance
    • Shoes cannot be worn for balance testing.
    • Patient cannot use external support to successfully complete any balance items.
    • For sitting balance, neither the arm rests of the back of the chair can be used for external support.
  • Walking
    • Appropriate shoes can be worn for walking tests; same shoes must be worn for repeat testing.

Parkinson's Disease

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Minimally Clinically Important Difference (MCID)

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

  • MCID = 8.2 points

Normative Data

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)

Content Validity

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

Mobility Instrument

n

Spearman’s rho(95% CI)

6 meter walk test (speed, m/min)

101

0.57

Berg balance scale

99

0.84

Timed up and go

101

-0.57

R) Functional reach test

100

0.49

L) Functional reach test

99

0.59

Pastor’s test

100

-0.47

 

Convergent Validity of DEMMI with other mobility instruments

Mobility Instrument

n

Spearman’s rho(95% CI)

Mini Mental State Examination

79

0.22

Charlson Co-Morbidity Index

100

-0.12

Floor/Ceiling Effects

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

  • No ceiling or floor effect observed

Stroke

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Standard Error of Measurement (SEM)

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

Minimal Detectable Change (MDC)

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

Normative Data

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

Interrater/Intrarater Reliability

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)

Internal Consistency

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

Construct Validity

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)

Floor/Ceiling Effects

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.

Alzheimer's Disease and Progressive Dementia

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Minimal Detectable Change (MDC)

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

Cut-Off Scores

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.

Normative Data

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

  • Mean score 38 ± 21 (0 - 85)

Internal Consistency

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

Construct Validity

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

Measurement instrument

rho

95% CI

Hierarchical Assessment of Balance and Mobility, 0–26 points

0.95

0.93 to 0.96

Performance Oriented Mobility Assessment, 0–28 points

0.96

0.95 to 0.97

Functional Ambulation Categories, 0–5 points

0.92

0.89 to 0.94

Short Physical Performance Battery, 0–12 points

0.93

0.91 to 0.95

Timed Up and Go test (n = 72), sec

0.70

0.56 to 0.80

Barthel Index mobility subscale, 0–40 points

0.95

0.93 to 0.96

2-min walk test (n = 88), meter

0.70

0.58 to 0.79

4-m walk test (n = 85), m/s

0.68

0.55 to 0.78

Floor/Ceiling Effects

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

Mixed Populations

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Standard Error of Measurement (SEM)

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)

Minimal Detectable Change (MDC)

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

Minimally Clinically Important Difference (MCID)

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

Cut-Off Scores

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.

Normative Data

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)

 

Patient report Mean (n=261)

Physician report Mean (n=240)

Physical Therapist report Mean (n=257)

Total Population

7.1

7.6

7.5

Stroke

8.0

8.3

8.8

Other neurological

8.4

8.8

8.8

Orthopedic and other

6.3

6.8

6.6

Test/Retest Reliability

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

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

Interrater/Intrarater Reliability

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)

Internal Consistency

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

Construct Validity

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).

Floor/Ceiling Effects

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)

Responsiveness

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

Joint Pain and Fractures

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Minimally Clinically Important Difference (MCID)

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

Normative Data

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)

Construct Validity

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)

Floor/Ceiling Effects

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

Responsiveness

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)

Older Adults and Geriatric Care

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Minimal Detectable Change (MDC)

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

Minimally Clinically Important Difference (MCID)

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

Cut-Off Scores

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.

Normative Data

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

Construct Validity

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)

Floor/Ceiling Effects

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.

Osteoarthritis

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Standard Error of Measurement (SEM)

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

  • SEM for entire cohort (n=219): 2.9

Minimal Detectable Change (MDC)

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

Normative Data

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

  • Mean score: 71±18 (range, 30–100)

Interrater/Intrarater Reliability

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

Construct Validity

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

Measure

No. of Subjects

Correlation Coefficient (ρ)

TUG test

207

−.73

CRT

201

−.63

6MWT

208

.74

WOMAC* total score

171

.46

WOMAC physical functioning

174

.44

WOMAC pain

194

.32

WOMAC stiffness

197

.33

Floor/Ceiling Effects

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.

Bibliography

Johnston, M., de Morton, N., Harding, K., & Taylor, N. (2013). Measuring mobility in patients living in the community with Parkinson disease. NeuroRehabilitation, 32(4), 957-966.

Braun, Tobias, et al. (2019) Reliability and validity of the de Morton Mobility Index in individuals with sub-acute stroke; Disability and Rehabilitation, 41:13, 1561-1570, DOI: 10.1080/09638288.2018.1430176

Braun, Tobias et al. (2018) “Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index.” BMC geriatrics vol. 18,1 100. doi:10.1186/s12877-018-0780-9

New, Peter W. et al. (2017) The validity, reliability, responsiveness and minimal clinically important difference of the de Morton mobility index in rehabilitation; Disability and Rehabilitation, 39:10, 1039-1043. DOI: 10.1080/09638288.2016.1179800

Sommers, J., et al. (2016). "de Morton Mobility Index Is Feasible, Reliable, and Valid in Patients With Critical Illness." Physical Therapy 96(10): 1658-1666.

Braun T, Schulz RJ, Reinke J, et al. (2015). Reliability and validity of the German translation of the de Morton Mobility Index (DEMMI) performed by physiotherapists in patients admitted to a sub-acute inpatient geriatric rehabilitation hospital. BMC Geriatr. doi:10.1186/s12877-015-0035-y

de Morton NA, Harding KE, Taylor NF, Harrison G. Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation. Disabil Rehabil. 2013;35(4):325-333. doi:10.3109/09638288.2012.705220

de Morton, N. A., Meyer, C. , Moore, K. J., Dow, B. , Jones, C. and Hill, K. (2011), Validation of the de Morton Mobility Index (DEMMI) with older community care recipients. Australasian Journal on Ageing, 30: 220-225. doi:10.1111/j.1741-6612.2010.00497.

Jans, Marielle P. et al. Reproducibility and Validity of the Dutch Translation of the de Morton Mobility Index (DEMMI) Used by Physiotherapists in Older Patients With Knee or Hip Osteoarthritis; Archives of Physical Medicine and Rehabilitation, 92:11, 1892 - 1899. DOI: 10.1016/j.apmr.2011.05.011

de Morton NA, Brusco NK, Wood L, Lawler K, Taylor NF. The de Morton Mobility Index (DEMMI) provides a valid method for measuring and monitoring the mobility of patients making the transition from hospital to the community: an observational study. J Physiother. 2011;57(2):109-116. doi:10.1016/S1836-9553(11)70021-2

Davenport, S. J. and N. A. de Morton (2011). "Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults." Arch Phys Med Rehabil 92(1): 51-58.

de Morton, Natalie A et al. “The de Morton Mobility Index (DEMMI): an essential health index for an ageing world.” Health and quality of life outcomes Vol. 6 63. 19 Aug. 2008, doi:10.1186/1477-7525-6-63