Rivermead Mobility Index

 

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Chloe Waller, Kim Jackson, WikiSysop, Evan Thomas, Oyemi Sillo, Amrita Patro, Scott Buxton and Naomi O'Reilly

Objective

The Rivermead Mobility Index assesses functional mobility in gait, balance and transfers. It was developed in 1991 to be used after stroke or head injury.

Intended Population

Those with a diagnosis of Stroke, Acquired Brain Injury, Lower Limb Amputation or Multiple Sclerosis. It can be used for a wide range of functional ability levels.

Method of Use

The Rivermead Mobility Index consists of 15 items (14 self reported items and 1 direct observation). The items are scored 0 if the patient is is not able to complete the task or 1 if they are able to complete it. The points are then added together, to score a maximum of 15, with higher scores stipulating better functional mobility.

The items are:

1. Turning over in bed: Do you turn over from your back to your side without help?

2. Lying to sitting: From lying in bed, do you get up to sit on the edge of the bed on your own?

3. Sitting balance: Do you sit on the edge of the bed without holding on for 10 seconds?

4. Sitting to standing: Do you stand up from any chair in less than 15 seconds and stand there for 15 seconds, using hands and/or an aid, if necessary?

5. Standing unsupported: Ask client to stand without aid and observe standing for 10 seconds without any aid.

6. Transfer: Do you manage to move from bed to chair and back without any help?

7. Walking inside (with an aid if necessary): Do you walk 10 meters, with an aid if necessary, but with no standby help?

8. Stairs: Do you manage a flight of stairs without help?

9. Walking outside (even ground): Do you walk around outside, on pavements, without help?

10. Walking inside, with no aid: Do you walk 10 meters inside, with no caliper, splint, or other aid (including furniture or walls) without help?

11. Picking up off floor: Do you manage to walk 5 meters, pick something up from the floor, and then walk back without help?

12. Walking outside (uneven ground): Do you walk over uneven ground (grass, gravel, snow, ice, etc.) without help?

13. Bathing: Do you get into/out of a bath or shower to wash yourself unsupervised and without help?

14. Up and down four steps: Do you manage to go up and down four steps with no rail but using an aid if necessary?

15. Running: Do you run 10 meters without limping in 4 seconds (fast walk, not limping, is acceptable)?

This video gives a demonstration of using the Rivermead Mobility Index

Evidence

Reliability

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

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)

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)

Validity

Criterion Validity:

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

Lower Limb Amputees:

(Ryall et al, 2003) 

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

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)

Lower Limb Amputees: (Franchignoni et al, 2003a, n = 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:

Acute Stroke: (Hsieh et al, 2000) 

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

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

Responsiveness

Acute Stroke: (Hsueh et al, 2003) 

Days Post Stoke	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

Links

Rivermead Mobility Index