Purpose
ICU-specific tool used to measure mobility status of patients with decreased functional mobility frequently present during a critical illness.
Link to Instrument
Acronym
PERME
Primary Image
Perme ICU Mobility Score
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Populations
Key Descriptions
- Measurement of a patient’s mobility status starting with the ability to follow commands and culminating in the distance walked in 2 minutes
- Scores range from 0 to 32
- The score is derived from 15 items grouped in 7 categories
- Item scores are summed
- Max score of 32
- (Perme C et al., 2014; n=35; mean age: 67)
● Scoring system for:
● Item 1- 8: based on yes/no answers
● Item 9 -14: a score of “0” is assigned to a patient who needed total assistance (< 25% of effort) or when the activity did not occur. A score of “3” was assigned for patients who needed minimal assistance (> 75% of effort) or when the activity occurred with supervision.
● Item 15: scored from “0” to “3” based on the distance walked in 2 minutes.
Number of Items
The score is derived from 15 items grouped in 7 categories:
○ Mental Status
○ Potential mobility barriers
○ Functional strength
○ Bed mobility
○ Transfers
○ Gait
○ Endurance
Equipment Required
- Hospital bed
- Chair
- Wheelchair
- Bedside commode
- Recliner (patient dependent)
- Assistive devices (patient dependent)
- Tape measure for distance walked in 2 minutes
- Stopwatch
Time to Administer
15-60 minutes
Evaluating Physical Functioning in ICU: (Parry SM, 2017; study critique) Time required to physically undertake initial or final testing is between 15-60 minutes per patient dependent on severity and ability to complete assessment.
Type of assessment was defined into two categories: 1) “simple” involving observation of patient’s current ability (time to complete: <5 min); and 2) “Comprehensive” providing greater understanding of the impairments in physical functioning (time to complete: 10–15 min)
ICU Mobility (translation to Spanish): (WilchesLuna EC, 2018; n = 150; mean age: 58 (+/- 17) years; translation/validation study): The approximate time for the application of the Perme score was less than five minutes.
ICU Mobility (cardiovascular): (Kawaguchi YM, 2016; n = 103; 52 (+/- 18) years): The mean completion time for the scoring was two minutes for the Perme Score.
Required Training
No TrainingRequired Training Description
No training package or video currently available. The scoring criteria and detailed instructions are available in the manuscript.Age Ranges
Adult
18 - 64
yearsElderly Adult
65 +
yearsInstrument Reviewers
Anna Dankewich SPT
Jill Le SPT
Dr. Alaina Bell
ICF Domain
Body FunctionActivity
Participation
Measurement Domain
MotorCognition
Activities of Daily Living
Professional Association Recommendation
Perme ICU Rehab Seminars:
https://www.permeicuseminars.com
Considerations
The above categories were designed to reflect the impaired mobility of patients in the ICU, which can arise from a variety of factors.
ICU Mobility Tool: (Perme C et al., 2014; n=35; mean age: 67): A high score indicates few potential mobility barriers and decreased assistance whereas a low score indicates more potential barriers to mobility and more assistance needed for mobility.
Mixed Populations
back to PopulationsNormative Data
ICU Mobility (liver transplant): (Pereira CS, 2018; n = 30; mean age = 58.4 (+/- 9.9) years; prospective, observational study): A comparison of the Perme scale score at the different time in points (ICU admission and discharge), indicating significantly better results at hospital discharge (p < 0.001) compared with the initial evaluation
Mean scores of PERME between initial and final evaluations (p<0.001)
- Inpatient unit admission: 28.2±5.0
- Hospital discharge: 31.7 ±0.7
Comparison between the initial and final evaluations
|
|
Inpatient unit admission |
Hospital discharge |
P value |
|
Perme |
28.2±5.0 |
31.7±0.7 |
<0.001 |
Association between Perme mobility scale score and demographic and clinical variables
|
Variables |
Perme at ICU discharge |
|
Perme in the inpatient unit |
|
|
|
r |
P value |
r |
P value |
|
Length of ICU stay (days |
|
0.535 |
|
0.420 |
|
Length of hospital stay (days) |
|
0.551 |
|
0.141 |
|
Time on mechanical ventilation |
-0.374 |
0.042* |
|
0.450 |
*Significant association between the time on mechanical ventilation and the Perme score at discharge from the intensive care unit
ICU Patients starting PT:
(Perme, C, 2020; n = 250; mean age = 63.2 years; prospective, observational study)
- The mean Perme Score for all patients was 23.56 (SD 7.09).
ICU Mobility (cardiovascular): (Nawa RK et al., 2014; n = 20; mean age: 64.5; prospective observational study)
The mean Perme Score for all patients was 21.475 (SD 6.71)
Interrater/Intrarater Reliability
ICU Mobility (cardiovascular): (Kawaguchi YM, 2016; n = 103; 52 (+/- 18) years)
- Excellent interrater per-term reliability: 𝜅 = 0.78-0.99
ICU Mobility (cardiovascular): (Nawa RK et al., 2014; n = 20; mean age: 64.5; prospective observational study)
- Excellent Interrater reliability (ICC = 0.98). Narrow confidence interval of 0.97743 to 0.99859 further supports interrater reliability
ICU Mobility (translation to Spanish): (WilchesLuna EC, 2018; n = 150; mean age: 58 (+/- 17) year; translation/validation study)
- Good Interrater reliability (ICC = 0.98801).
ICU Mobility Tool: (Perme C et al., 2014; n=35; mean age: 67)
- Excellent The total interrater reliability agreement between the raters had a median of 94.29% (68.57%- 100%).
Inter-rater agreement *Kappa values lower than 0.60
Number of ratings (n=35)
|
Item |
Agreement |
Non-Agreement |
% Agreement |
Kappa |
|
1 |
31 |
4 |
88.57% |
0.2784* |
|
2 |
34 |
1 |
97.14% |
0.000* |
|
3 |
34 |
1 |
97.14% |
0.9057 |
|
4 |
32 |
3 |
88.57% |
0.7727 |
|
5 |
33 |
2 |
94.29% |
0.4776* |
|
6 |
34 |
1 |
97.14% |
0.9398 |
|
7 |
33 |
2 |
94.29% |
0.7941 |
|
8 |
34 |
1 |
97.14% |
0.8759 |
|
9 |
27 |
8 |
77.14% |
0.6631 |
|
10 |
26 |
9 |
74.29% |
0.4224 |
|
11 |
27 |
8 |
77.14% |
0.6721 |
|
12 |
24 |
11 |
68.57% |
0.5534 |
|
13 |
26 |
9 |
74.29% |
0.5987* |
|
14 |
34 |
1 |
97.14% |
0.9474 |
|
15 |
35 |
0 |
100% |
1.000 |
Internal Consistency
ICU Mobility (cardiovascular): (Kawaguchi YM, 2016; n = 103; 52 (+/- 18) years)
- Excellent per-term internal consistency 𝛼 = 0.88-1.00
Criterion Validity (Predictive/Concurrent)
ICU Patients starting PT:
(Perme, C, 2020; n = 250; mean age = 63.2 years; prospective, observational study) A higher Perme Score indicated a higher likelihood of discharging to home rather than those discharged to rehab, skilled nursing facilities, long-term acute care, and other.
Mean PERME ICU Mobility Score by Discharge Location
- Home: 26.05(5.417)
- Long-term Acute Care: 18.65(8.43)
- Skilled Nursing Facility: 17.38(7.72)
- Rehab: 20.33(7.48)
- Other: 18(5.8)
Construct Validity
ICU Mobility (cardiovascular): (Kawaguchi YM, 2016; n = 103; mean age = 52 (+/- 18) years)
- Strong positive correlation between the Perme and ICU Mobility Scale (r = 0.941; p < 0.001)
ICU Mobility (liver transplant): (Pereira CS, 2018; n = 30; mean age = 58.4 (+/- 9.9) years; prospective, observational study)
- A significant inverse association was observed between the number of physical therapy treatments and the Perme score in the ICU (r = -0.578; p = 0.001) specifically, the lower the Perme score was, the greater the number of physical therapy treatments performed.
ICU Patients starting PT:
(Perme, C, 2020; n = 250; mean age = 63.2 years; prospective, observational study)
- A moderate correlation was found between the Medical Research Council Sum Score (MRC-SS) and the Perme ICU score (r = 0.66; P < .001)
ICU Mobility (translation to Spanish): (WilchesLuna EC, 2018; n = 150; mean age: 58 (+/- 17) years; translation/validation study)
- Excellent agreement was found during admission to ICU (r=0.967; P < .005)
- Excellent agreement was found during discharge from ICU (r=0.985; P< .005)
Floor/Ceiling Effects
ICU Mobility (cardiovascular): (Kawaguchi YM, 2016; n = 103; 52 (+/- 18) years)
- Adequate Ceiling effects: 3%
- Poor Floor effects: 20%
(Floor effects were expected to be higher than normal, given the high incidence of sedated or unconscious patients in ICUs.)
Bibliography
Kawaguchi YM, Nawa RK, Figueiredo TB, Martins L, Pires-Neto RC. Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil. J Bras Pneumol. 2016;42(6):429-434. doi:10.1590/S1806-37562015000000301
Parry SM, Huang M, Needham DM. Evaluating physical functioning in critical care: considerations for clinical practice and research. Crit Care. 2017;21(1):249.
Pereira CS, Carvalho AT, Bosco AD, Forgiarini Júnior LA. The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation. Escala Perme como preditor de funcionalidade e complicações após a alta da unidade de terapia intensiva em pacientes submetidos a transplante hepático. Rev Bras Ter Intensiva. 2019;31(1):57-62. doi:10.5935/0103-507X.20190016
Perme C, Schwing T, deGuzman K, et al. Relationship of the perme ICU mobility score and medical research council sum score with discharge destination for patients in 5 different intensive care units. Journal of Acute Care Physical Therapy. 2020. doi: 10.1097/JAT.0000000000000132.
Wilches Luna EC, Hernández NL, Siriani de Oliveira A, Kenji Nawa R, Perme C, Gastaldi AC. Perme ICU Mobility Score (Perme Score) and the ICU Mobility Scale (IMS): translation and cultural adaptation for the Spanish language. Colomb Med (Cali). 2018;49(4):265-272. Published 2018 Dec 30. doi:10.25100/cm.v49i3.4042