Rivermead Mobility Index: Difference between revisions

(Updated objective, intended population and method)
(Updated evidence)
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== Intended Population  ==
== Intended Population  ==


Those with a diagnosis of [[Stroke]], [[Overview of Traumatic Brain Injury|Acquired Brain Injury]], Lower Limb [[Amputations|Amputation]] or [[Multiple Sclerosis (MS)|Multiple Sclerosis]]<ref>Sabrina Figueiredo. Rivermead Mobility Index (RMI). Available from: https://strokengine.ca/en/assessments/rivermead-mobility-index-rmi/ (Accessed 23/06/2022)</ref><ref name=":1" />. It can be used for a wide range of functional ability levels.   
Those with a diagnosis of [[Stroke]], [[Overview of Traumatic Brain Injury|Acquired Brain Injury]], Lower Limb [[Amputations|Amputation]] or [[Multiple Sclerosis (MS)|Multiple Sclerosis]]<ref>Sabrina Figueiredo. Rivermead Mobility Index (RMI). Available from: https://strokengine.ca/en/assessments/rivermead-mobility-index-rmi/ (Accessed 23/06/2022)</ref><ref name=":1">Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153</ref>. It can be used for a wide range of functional ability levels.   


== Method of Use  ==
== Method of Use  ==
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=== Reliability  ===
=== Reliability  ===
<u>Test-retest reliability</u> 


<u>Test-retest Reliability:</u>  
Excellent for chronic stroke and lower limb amputees<ref>Chen, H. M., Hsieh, C. L., et al. "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 2007 21(4): 347-352</ref><ref name=":1" />.


''Chronic Stroke:''
<u>Interrater reliability</u>
 
(Chen et al, 2007; Green, Foster &amp; Young, 2001; n = 22; 1 year post-stroke, assessed twice, with one week between assessments)&nbsp;<ref>Chen, H. M., Hsieh, C. L., et al. "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 2007 21(4): 347-352</ref>
 
*Excellent overall test-retest reliability (ICC = 0.96)
*Excellent test-retest reliability for the following subcategories:
 
Kappa for turning in bed = 1.0<br>Kappa for walking inside without aid = 0.89<br>Kappa for walking outside on uneven ground = 0.83<br>Kappa for bathing = 0.81<br>Kappa for picking objects off the floor = 0.79
 
*Adequate test-retest reliability for the following subcategories:
 
Kappa for stairs = 0.68<br>Kappa for lying to sitting = 0.64<br>Kappa for sitting balance = 0.64<br>Kappa for transfers = 0.64<br>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)&nbsp;<ref name=":1">Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153</ref>
 
*Excellent test-retest reliability (ICC = 0.99)
 
<br>
 
<u>Interrater/Intrarater Reliability:</u>  
 
''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)&nbsp;<ref>Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745</ref>
 
*Excellent interrater reliability for total score (ICC = 0.92)
*Poor to excellent interrater reliability for individual subcategories (Weighted Kappa = 0.37 - 0.94)


Excellent for acute stroke<ref>Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745</ref>.
=== Validity  ===
=== Validity  ===


<u>Criterion Validity:</u>  
<u>Criterion Validity:</u>
 
''Acute Stroke:''
 
(Hsieh et al, 2000; n = 38 inpatients; Sommerfeld &amp; vo Arbin, 2001; n = 115 inpatients aged &gt; 65; Hsueh et al, 2003)&nbsp;<ref>Hsieh, C. L., Hsueh, I. P., et al. "Validity and responsiveness of the rivermead mobility index in stroke patients." Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142</ref>
 
*Excellent predictive validity with Barthel Index 24 days post stroke (r = 0.77)
*RMI scores of &gt; 4 best predictor of early discharge home


''Lower Limb Amputees'':  
Found in acute stroke to have excellent predictive validity with [[Barthel Index]] and scores above 4 to be the best predictor of early discharge home<ref>Hsieh, C. L., Hsueh, I. P., et al. "Validity and responsiveness of the rivermead mobility index in stroke patients." Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142</ref>.


(Ryall et al, 2003)&nbsp;<ref>Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153</ref>  
Adequate concurrent validity with the timed walk test for lower limb amputees <ref>Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153</ref>.
 
*Adequate concurrent validity with TWT (r = -0.58)
*Only one value is outside the 95% limits of agreement


<u>Construct Validity:&nbsp;</u>  
<u>Construct Validity:&nbsp;</u>  


''Acute Stroke: ''(Hsueh et al, 2003)&nbsp;<ref>Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745</ref>  
Excellent correlation with Barthel Index at 14, 30, 90 and 180 days post stroke&nbsp;<ref>Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745</ref>.


*Excellent correlation with BI at 14 days post stroke (r = 0.72)
Excellent correlation with motFIM and Timed Walk Test at the end of prosthetic training for lower limb amputees<ref>Franchignoni, F., Brunelli, S., et al. "Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study." J Rehabil Med 2003 35(3): 141-144</ref>.
*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)&nbsp;<ref>Franchignoni, F., Brunelli, S., et al. "Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study." J Rehabil Med 2003 35(3): 141-144</ref>  
 
· Excellent correlation with motFIM at beginning of prosthetic training (r = 0.83)<br>· Excellent correlation with motFIM at end of prosthetic training (r = 0.69)<br>· Excellent correlation of the change scores for the RMI with changes in motFIM (r = 0.75)<br>· Excellent correlation with TWT (timed walking test) at end of prosthetic training (r = -0.70)


<u>Content Validity:</u>  
<u>Content Validity:</u>  


''Acute Stroke: ''(Hsieh et al, 2000)&nbsp;<ref name="Hsieh et al">Hsieh, C. L., Hsueh, I. P., et al. "Validity and responsiveness of the rivermead mobility index in stroke patients." Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142</ref>  
The Rivermead Mobility Index was found to be valid and sensitive to change over time, and achieved reproducibility and scalability &nbsp;<ref name="Hsieh et al">Hsieh, C. L., Hsueh, I. P., et al. [https://pubmed.ncbi.nlm.nih.gov/11028799/ Validity and responsiveness of the rivermead mobility index in stroke patients]. Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142</ref>. It was significantly correlated with physical function variables in stroke  patients. <ref>Park GT, Kim M. [https://pubmed.ncbi.nlm.nih.gov/27630440/ Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients]. J Phys Ther Sci. 2016 Aug;28(8):2389-92. </ref>. Moreover, it is also recommended for assessing ambulation levels in chronic stroke patients during rehabilitation.<ref>Lim JY, An SH, Park DS. [https://pubmed.ncbi.nlm.nih.gov/31889763/ Walking velocity and modified rivermead mobility index as discriminatory measures for functional ambulation classification of chronic stroke patients]. Hong Kong Physiother J. 2019 Dec;39(2):125-132</ref>
 
*Critical values for two indices, coefficient of reproducibility (&gt; 0.9) and coefficient of scalability (&gt; 0.7), were all exceeded
 
''Lower limb amputees:'' (Franchignoni et al, 2003a)&nbsp;<ref name="Franchignoni et al">Franchignoni, F., Brunelli, S., et al. "Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study." J Rehabil Med 2003 35(3): 141-144</ref>  
 
*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)&nbsp;<ref name="Ryall et al">Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153</ref>  
 
*Coefficient of reproducibility was exceeded and ranged from 0.91-0.94
 
=== Responsiveness  ===
=== Responsiveness  ===


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| Days Post Stoke  
| Days Post Stoke  
| ''n''  
| ''n''  
| RMI
| Rivermead Mobility Index
| MRMI
| Modified Rivermead Mobility Index
| STREAM
| Mobility Subscale of the Stroke Rehabilitation Assessment of Movement
| BI
| Barthel Index
|-
|-
| 14-30  
| 14-30  
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Values reported as SRM (Standardized Response Mean)  
Values reported as SRM (Standardized Response Mean)  
RMI = Rivermead Mobility Index<br>MRMI = Modified Rivermead Mobility Index<br>STREAM = Mobility Subscale of the Stroke Rehabilitation Assessment of Movement<br>BI = Barthel Index


== Links  ==
== Links  ==

Revision as of 14:06, 23 June 2022

 

Original Editor - Sinead Greenan

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

Objective[edit | edit source]

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[1].

Intended Population[edit | edit source]

Those with a diagnosis of Stroke, Acquired Brain Injury, Lower Limb Amputation or Multiple Sclerosis[2][3]. It can be used for a wide range of functional ability levels.

Method of Use[edit | edit source]

The Rivermead Mobility Index consists of 15 items (14 self reported items and 1 direct observation)[1]. 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[4].

The items are[5]:

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[edit | edit source]

Reliability[edit | edit source]

Test-retest reliability

Excellent for chronic stroke and lower limb amputees[6][3].

Interrater reliability

Excellent for acute stroke[7].

Validity[edit | edit source]

Criterion Validity:

Found in acute stroke to have excellent predictive validity with Barthel Index and scores above 4 to be the best predictor of early discharge home[8].

Adequate concurrent validity with the timed walk test for lower limb amputees [9].

Construct Validity: 

Excellent correlation with Barthel Index at 14, 30, 90 and 180 days post stroke [10].

Excellent correlation with motFIM and Timed Walk Test at the end of prosthetic training for lower limb amputees[11].

Content Validity:

The Rivermead Mobility Index was found to be valid and sensitive to change over time, and achieved reproducibility and scalability  [12]. It was significantly correlated with physical function variables in stroke patients. [13]. Moreover, it is also recommended for assessing ambulation levels in chronic stroke patients during rehabilitation.[14]

Responsiveness[edit | edit source]

Acute Stroke: (Hsueh et al, 2003) [15]

Days Post Stoke n Rivermead Mobility Index Modified Rivermead Mobility Index Mobility Subscale of the Stroke Rehabilitation Assessment of Movement Barthel Index
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)

Links[edit | edit source]

Rivermead Mobility Index

References[edit | edit source]

  1. ↑ 1.0 1.1 Collen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud. 1991;13(2):50-4
  2. ↑ Sabrina Figueiredo. Rivermead Mobility Index (RMI). Available from: https://strokengine.ca/en/assessments/rivermead-mobility-index-rmi/ (Accessed 23/06/2022)
  3. ↑ 3.0 3.1 Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153
  4. ↑ Shirley Ryan Ability Lab. Rivermead Mobility Index. Available from: https://www.sralab.org/rehabilitation-measures/rivermead-mobility-index (Accessed 23/06/2022)
  5. ↑ Donato S, Halliday Pulaski K, Gillen G. Chapter 19 - Overview of Balance Impairments: Functional Implications. In: Gillen G. Stroke Rehabilitation (Fourth Edition) Mosby, 2016. p394-415.
  6. ↑ Chen, H. M., Hsieh, C. L., et al. "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 2007 21(4): 347-352
  7. ↑ Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745
  8. ↑ Hsieh, C. L., Hsueh, I. P., et al. "Validity and responsiveness of the rivermead mobility index in stroke patients." Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142
  9. ↑ Ryall, N. H., Eyres, S. B., et al. "Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?" Disabil Rehabil 2003 25(3): 143-153
  10. ↑ Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745
  11. ↑ Franchignoni, F., Brunelli, S., et al. "Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study." J Rehabil Med 2003 35(3): 141-144
  12. ↑ Hsieh, C. L., Hsueh, I. P., et al. Validity and responsiveness of the rivermead mobility index in stroke patients. Scandinavian Journal of Rehabilitation Medicine 2000 32(3): 140-142
  13. ↑ Park GT, Kim M. Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients. J Phys Ther Sci. 2016 Aug;28(8):2389-92.
  14. ↑ Lim JY, An SH, Park DS. Walking velocity and modified rivermead mobility index as discriminatory measures for functional ambulation classification of chronic stroke patients. Hong Kong Physiother J. 2019 Dec;39(2):125-132
  15. ↑ Hsueh, I. P., Wang, C. H., et al. "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 2003 34(7): 1741-1745


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