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  2. Elderly Mobility Scale

Elderly Mobility Scale

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Purpose

The Elderly Mobility Scale (EMS) is a 7-item objective measure designed to assess mobility and function in elderly adults.

Acronym EMS

Area of Assessment

Activities of Daily Living
Aerobic Capacity
Balance – Vestibular
Balance – Non-vestibular
Coordination
Functional Mobility
Gait
Life Participation
Range of Motion
Seating
Strength
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Older Adults and Geriatric Care

Key Descriptions

  • Number of items in the instrument: 7 (lying to sitting, sitting to lying, sitting to standing, standing, gait, timed walk, functional reach)
  • ● Minimum score = 0, maximum score = 20
  • Description of item scoring: determined by the ability to perform the assessed activity and level of assistance needed
  • Administration instructions: static and dynamic activities are completed by the patient with the appropriate level of assistance and a score is given based off of performance. Item scores are summed.

Number of Items

7

Equipment Required

  • Meter stick
  • Stopwatch
  • Bed
  • Chair
  • Walking aid (if typically needed by patient)
  • Wall
  • Space for 6m walk
  • Form to record scores

Time to Administer

5-10 minutes

Required Training

No Training

Required Training Description

No training required but familiarization with tool beforehand is recommended

Age Ranges

Elderly Adult

+

years

Instrument Reviewers

Sabrina Burri, SPT at Duke University School Of Medicine

Laura Guy, SPT at Duke University School Of Medicine

Michelle Hinkey, SPT at Duke University School Of Medicine

Tyler Ray, SPT at Duke University School Of Medicine

Mike Walsh, SPT at Duke University School Of Medicine

Kristiana Warth, SPT at Duke University School Of Medicine

Zayd Hayani at Rush Medical Center

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Motor

Considerations

EMS was specifically designed for application in the hospital setting and is commonly applied in the acute hospital environment (reliable and valid for hospital patients over 55)

The accuracy of the ems is comparable to other known clinical instruments on the functional independence measure

EMS is significantly more likely to detect improvement in mobility than either the barthel index or functional ambulation category and the magnitude of detected improvement is significantly greater using the ems

EMS score was significantly associated with an individual having had 2 or more falls

Potential ceiling effect for more able patients

Not sensitive for patients with issues of poor confidence

Older Adults and Geriatric Care

back to Populations

Minimal Detectable Change (MDC)

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)

Minimally Clinically Important Difference (MCID)

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%

Cut-Off Scores

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

 

Interrater/Intrarater Reliability

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))

 

Criterion Validity (Predictive/Concurrent)

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)

 

Construct Validity

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)

 

Content Validity

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))

Face Validity

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))

 

Floor/Ceiling Effects

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)

Responsiveness

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)

 

Bibliography

Chiu, A. Y. Y., Au-Yeung, S. S. Y., Lo, S. K. (2009). “A Comparison Of Four Functional Tests In Discriminating Fallers From Non-Fallers In Older People.” Disabil Rehabil 25(1): 45-50. Find It On Pubmed

De Morton, N. A., Berlowitz, D. J., Keating, J. L. (2008). “A Systematic Review Of Mobility Instruments And Their Measurement Properties For Older Acute Medical Patients.” Health Qual Life Outcomes 6(44). Find It On Pubmed

De Morton, N. A., Nolan, J. S., O'Brien M. J., Thomas, S. K., Govier, A. V., Sherwell, K., Harris, B. N., Markham, N. O. (2015). “A Head-To-Head Comparison Of The De Morton Mobility Index (DEMMI) And Elderly Mobility Scale (EMS) In An Older Acute Medical Population.” Disabil Rehabil 37(20): 1881-1887. Find It On Pubmed

De Morton, N. A., Nolan, J. S. (2011). “Unidimensionality Of The Elderly Mobility Scale In Older Acute Medical Patients: Different Methods, Different Answers.” J Clin Epidemiol 64(6): 667-674. Find It On Pubmed

Nolan, J. S., Remilton, L. E., Green, M. M. (2008). “The Reliability And Validity Of The Elderly Mobility Scale In The Acute Hospital Setting.” The Internet Journal Of Allied Health Sciences And Practice 6(4). Find It On Nsuworks

Prosser, L. A., Canby, A. (1997). “Further Validation Of The Elderly Mobility Scale For Measurement Of Mobility Of Hospitalized Elderly People.” Clin Rehabil 11(4): 338-343. Find It On Pubmed

Smith, R. (1994). “Validation And Reliability Of The Elderly Mobility Scale.” Physiotherapy 80(11): 744-747. Find It On Sciencedirect

Spilg, E. G., Martin, B. J., Mitchell, S. L., & Aitchison, T. C. (2003). Falls Risk Following Discharge From A Geriatric Day Hospital. Clinical Rehabilitation, 17(3), 334–340. Find it on PubMed.

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