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RehabMeasures Instrument

Rivermead Mobility Index

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Purpose

The RMI assesses functional mobility following stroke (e.g., gait, balance, and transfers).

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Instrument Details

Acronym RMI

Area of Assessment

Balance – Non-vestibular
Functional Mobility
Gait

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury
  • Spinal Cord Injury
  • Stroke Recovery

Key Descriptions

  • The RMI is an extension of the Rivermead Motor Assessment Gross Function Scale.
  • Appropriate for a range of disabilities that include anything from being bedridden to being unable to run.
  • 15 items:
    14 self-reported items
    1 direct observation item
  • Items progress in difficulty.
  • Items are coded as either 0 or 1, depending on whether the patient can complete the task according to specific instructions.
  • Items receive a score of 0 for a "No" response and 1 for a "Yes" response.
  • Total scores are determined by summing the points for all items.
  • A maximum of 15 points is possible; higher scores indicate better mobility performance.
  • A score of "0" indicates an inability to perform any of the activities on the measure.

Number of Items

15

Time to Administer

3-4 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references for the lower limb amputee population by Noelle Fillmore, SPT and Valerie Kramer, SPT in 2011; Updated by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 2012

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

TBI EDGE

NR

LS

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

R

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

Yes

Yes

Yes

No

TBI EDGE

No

No

No

Not reported

Considerations

  • The RMI does not assess mobility gained through environmental modifications such as the use of assistive devices.
  • The RMI utilizes a Guttman type scaling method.  However research suggests that assumptions for this scaling method might not hold on the first three items in the assessment as some patients are able to complete item 3 while not being able to perform items 1 or 2.  Therefore, caution should be used when interpreting results, particularly at the low end of the scale (Franchignoni et al, 2003).
  • The RMI is not appropriate for all amputees and its psychometric properties have a number of limitations. Its use is not recommended for lower limb amputees (Ryall et al, 2003). The RMI used for lower limb amputees seems more useful for epidemiological studies than for clinical decision-making in single patients when knowledge of precise changes due to interventions are necessary (Franchignoni et al, 2003a). 
  • The RMI does not meet the Guttman scaling criteria coefficient of scalability, even if item columns have been rearranged. Therefore, the RMI cannot be considered in lower limb amputees as a hierarchical scale in which any particular item subsumes the items below it (Franchignoni et al, 2003a). 

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Stroke

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Standard Error of Measurement (SEM)

Chronic Stroke: (Chen et al. 2007; n = 50; mean age = 60.9 (12.8) years; time since onset = 15.9 (5.3) months; Taiwanese sample)

  • SEM = 0.8 points

Minimal Detectable Change (MDC)

Chronic Stroke: (Chen et al, 2007)

  • SEM = 2.2 points

Normative Data

Acute Stroke: (Antonucci et al, 2002; n = 302*; mean age = 62.79 (11.94) years; mean number of days between stroke and admission = 52.48 (36.22) days)

 

Measure

Sample 1*

Sample 2*

Age

63.79 (10.99)

60.93 (11.56)

RMI admission score

3.16 (3.82)

5.21 (4.73)

RMI discharge score

8 (4.57)

9.75 (4.44)

CNS admission score

6.38 (3.51)

6.53 (2.39)

CNS discharge score

7.35 (2.55)

7.73 (2.36)

BI admission score

37.25 (27.00)

49.95 (29.15)

BI discharge score

67.80 (26.62)

78.10 (23.73)

RMI = Rivermead Mobility Index

CNS = Canadian Neurological Scale

BI = Barthel Index

Test/Retest Reliability

Chronic Stroke: (Chen et al, 2007; Green, Foster & Young, 2001; n = 22; 1 year post-stroke, assessed twice, with one week between assessments)

  • Excellent overall test-retest reliability (ICC = 0.96)
  • Excellent test-retest reliability for the following subcategories:
    • Kappa for turning in bed = 1.0
    • Kappa for walking inside without aid = 0.89 
    • Kappa for walking outside on uneven ground = 0.83
    • Kappa for bathing = 0.81
    • Kappa for picking objects off the floor = 0.79
  • Adequate test-retest reliability for the following subcategories:
    • Kappa for stairs = 0.68
    • Kappa for lying to sitting = 0.64
    • Kappa for sitting balance = 0.64
    • Kappa for transfers = 0.64
    • Kappa for walking up and down 4 steps = 0.67

 

Interrater/Intrarater Reliability

Acute Stroke: (Hsueh et al, 2003; n = 57; mean age of 64.2 (11.5) years; assessed at 14, 30, 90, and 180 days post stroke; Taiwanese sample)

  • Excellent interrater reliability for total score (ICC = 0.92)
  • Poor to excellent interrater reliability for individual subcategories (Weighted Kappa = 0.37 - 0.94)

Internal Consistency

Acute Stroke: (Franchignoni et al, 2003b; n = 73; inpatients undergoing rehabilitation; assessed at rehab admission and 5 weeks)

  • Excellent internal consistency (Cronbach's alpha = 0.92)

  • Excellent internal consistency for Brazilian sample (Cronbach’s alpha= 0.99) 

Chronic and Acute Stroke: (Roorda et al, 2008; n = 620 mixed Dutch and English sample; onset ranged from 3 weeks to > 1 year)

  • Excellent (assessed with coefficient ρ) 

    • English speaking sample (ρ = 0.96)

    • Dutch speaking sample (ρ = 0.97)

    • Reliability coefficient ρ range 0–1; ρ ≥ 0.90 is recommended for decisions regarding individual patients

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Hsueh et al, 2003)

  • Excellent concurrent validity with:
    • Modified Rivermead Mobility Index:
      • Day 14:  (r = 0.78)
      • Day 30:  (r = 0.90)
      • Day 90:  (r = 0.90)
      • Day 180:  (r = 0.93)
    • STREAM
      • Day 14:  (r = 0.69)
      • Day 30:  (r = 0.87)
      • Day 90:  (r = 0.82)
      • Day 180:  (r = 0.85)

 

Acute Stroke: (Hsieh et al, 2000; n = 38 inpatients; Sommerfeld & vo Arbin, 2001; n = 115 inpatients aged > 65; Hsueh et al, 2003)

  • Excellent predictive validity with Barthel Index 24 days post stroke (r = 0.77)
  • RMI scores of > 4 best predictor of early discharge home

Construct Validity

Acute Stroke: (Hsueh et al, 2003)

  • Excellent correlation with BI at 14 days post stroke (r = 0.72)
  • Excellent correlation with BI at 30 days post stroke (r = 0.88)
  • Excellent correlation with BI at 90 days post stroke (r = 0.86)
  • Excellent correlation with BI at 180 days post stroke (r = 0.88)

Content Validity

Acute Stroke: (Hsieh et al, 2000) 

  • Critical values for two indicess, coefficient of reproducibility (> 0.9) and coefficient of scalability (> 0.7), were all exceeded

Floor/Ceiling Effects

Acute Stroke: (Hsueh et al, 2003)

 

Floor and Ceiling Effects

 

 

Time after stroke (d)

RMI, n%, floor

RMI, n%, ceiling

14 (n=57)

23(40.4) Poor

0 (0) Excellent

30 (n=54)

6(11.1) Adequate

2(3.7) Adequate

90 (n=44)

1(2.3) Adequate

3(6.8) Adequate

180 (n=43)

0 (0) Excellent

2(4.7) Adequate

Responsiveness

Acute Stroke: (Hsueh et al, 2003)

Days Post Stroke

n

RMI

MRMI

STREAM

BI

14–30

51

1.14

1.31

1.17

1.51

30–90

43

0.86

0.83

0.95

1.07

90–180

43

0.24

0.20

0.40

0.35

14–90

43

1.67

1.56

1.61

2.09

14–180

43

1.94

1.53

1.65

2.01

Values reported as SRM (Standardized Response Mean)

 

 

 

 

 

RMI = Rivermead Mobility Index

MRMI = Modified Rivermead Mobility Index

STREAM = Mobility Subscale of the Stroke Rehabilitation Assessment of Movement

BI = Barthel Index

 

 

 

 

 

Limb Loss and Amputation

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Test/Retest Reliability

Lower Limb Amputees: (Ryall et al, 2003; n = 62; mean age = 56.8 (18.8) years; mean time post amputation: 4.9 (14.7) years)

  • Excellent test-retest reliability (ICC = 0.99)

Criterion Validity (Predictive/Concurrent)

Lower Limb Amputees: (Ryall et al, 2003)

  • concurrent validity with TWT (= -0.58)
  • Only one value is outside the 95% limits of agreement

Construct Validity

Convergent validity in lower limb amputees: (Franchignoni et al, 2003a, = 140; mean age = 57 (18) years)

  • Excellent correlation with motFIM at beginning of prosthetic training (r = 0.83)
  • Excellent correlation with motFIM at end of prosthetic training (r = 0.69)
  • Excellent correlation of the change scores for the RMI with changes in motFIM (r = 0.75)
  • Excellent correlation with TWT (timed walking test) at end of prosthetic training (r = -0.70)

Content Validity

Lower limb amputees: (Franchignoni et al, 2003a) 

  • Coefficient of reproducibility was exceeded and ranged from 0.71-1.0 
  • Coefficient of scalability was not exceeded and ranged from 0.38-0.62 

 

Lower limb amputees: (Ryall et al, 2003) 

  • Coefficient of reproducibility was exceeded and ranged from 0.91-0.94

Floor/Ceiling Effects

Lower limb amputees: (Ryall et al, 2003)

  • 35% of patients in study affirmed all 15 items, resulting in a poor ceiling effect

Bibliography

Antonucci, G., Aprile, T., et al. (2002). "Rasch analysis of the Rivermead Mobility Index: a study using mobility measures of first-stroke inpatients." Arch Phys Med Rehabil 83: 1442-1449. Find it on PubMed

Chen, H. M., Hsieh, C. L., et al. (2007). "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 21(4): 347-352. Find it on PubMed

Franchignoni, F., Brunelli, S., et al. (2003). "Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study." J Rehabil Med 35(3): 141-144. Find it on PubMed

Franchignoni, F., Tesio, L., et al. (2003). "Psychometric properties of the Rivermead Mobility Index in Italian stroke rehabilitation inpatients." Clinical Rehabilitation 17(3): 273-282. Find it on PubMed

Green, J., Forster, A., et al. (2001). "A test-retest reliability study of the Barthel Index, the Rivermead Mobility Index, the Nottingham Extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients." Disability and Rehabilitation 23(15): 670-676. Find it on PubMed

Hsieh, C. L., Hsueh, I. P., et al. (2000). "Validity and responsiveness of the rivermead mobility index in stroke patients." Scandinavian Journal of Rehabilitation Medicine 32(3): 140-142. Find it on PubMed

Hsueh, I. P., Wang, C. H., et al. (2003). "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 34(7): 1741-1745. Find it on PubMed

Roorda, L. D., Green, J., et al. (2008). "Excellent cross-cultural validity, intra-test reliability and construct validity of the Dutch Rivermead Mobility Index in patients after stroke undergoing rehabilitation." J Rehabil Med 40(9): 727-732. Find it on PubMed

Ryall, N. H., Eyres, S. B., et al. (2003). "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 25(3): 143-153. Find it on PubMed

Sommerfeld, D. K. and von Arbin, M. H. (2001). "Disability test 10 days after acute stroke to predict early discharge home in patients 65 years and older." Clinical Rehabilitation 15(5): 528-534. Find it on PubMed

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