Elderly Mobility Scale

Original Editor - Lauren Lopez

Top Contributors - Lauren Lopez, Kim Jackson, Kapil Narale, Shaimaa Eldib, Lucinda hampton, Tolulope Adeniji and Mohit Chand  

Objective

The objective of this assessment is to measure the mobility function of older adults with frailty.    

The Elderly Mobility Scale (EMS) was developed in 1994 as part of an assessment package.  It is a relatively simple outcome measure and is quick to administer.  

Intended Population

This assessment is created for older adults having frailty. 

Method of Use

The following is from the Chartered Society of Physiotherapists and can be accessed here (this includes instructions, the assessment form for recording scores, and some simple interpretation of scores). 

Equipment: 

• Metre stick,
• Stopwatch,
• Bed and chair,
• Patient's usual walking aid, 
• Form to record scores

Physical spaces needed, space for:

• Bed,
• Chair,
• Free wall space,
• Assessing 6m walk 

See here for an online calculator for the EMS.  

Scoring and interpretation

The Elderly Mobility Scale (EMS) scoring system offers a structured method for assessing mobility in older adults by evaluating performance in seven key tasks, moving from:

• Laying to sitting,
• Sitting to laying,
• Sitting-to-standing,
• Standing balance,
• Walking,
• Functional reach, and
• timed walking over a 6-metre distance.

Each task is scored on a scale from 0 to 3, with higher scores reflecting better mobility. The total score ranges from 0 to 20, where a score below 10 indicates the need for substantial mobility assistance or supervision, while scores above 14 suggest greater independence and a higher likelihood of returning to independent living. This scoring framework supports clinical decision-making, allowing for personalised interventions and tracking of progress over time. Nonetheless, the tool’s utility is occasionally constrained by a ceiling effect, prompting adaptations such as increasing walking distances or incorporating additional tasks to improve its sensitivity.

Here is a video giving a depiction of each of the 7 items in the Elderly Mobility Scale:

Modifications

A correction was published by Smith because of an error in the functional reach measurement in the original publication . See above for correct scale. 

Evidence for two different modifications to the EMS was published in 2006: the Modified Elderly Mobility Scale (MEMS) and the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS).  

The MEMS has added a stair climbing task to the EMS and increased the walk distance from six metres to 10 metres to minimise the ceiling effect.  

The Swe M-EMS was translated into Swedish from its original English version, and research shows high inter-rater reliability and correlations with two other functional measures. Researchers found the EMS was limited in its sensitivity as a single measure to record improvement following an acute stroke.  

Evidence

Reliability

Inter-rater reliability:  High: two studies (n=19 and n=15) have shown no significant difference between scores 

Intra-rater reliability: No statistically significant differences in scoring by 15 physiotherapists.  

Validity

Content validity: The items of the test show a hierarchy of difficulty with "lay to sit" being the easiest task to perform and the functional reach being the most difficult task to perform. It has been proposed that the EMS measures two dimensions of mobility: bed mobility and functional mobility.   

Concurrent validity: EMS scores had highly significant correlations with both the Barthel and Functional Independence Measure (FIM) scores for 36 patients, age 70–93 years (Spearman's rho for Barthel: 0.962, FIM: 0.948).  A significant correlation between EMS and Barthel scores has been demonstrated in a second study (n=66, aged 66-69 years). A third study (n=32, aged >55 years) has demonstrated concurrent validity with the Modified Rivermead Mobility Index.  

Predictive validity: Is not conclusive. One study has shown that those discharged to home from hospital have higher EMS scores than those discharged to inpatient rehabilitation.  Another study has demonstrated the use of EMS scores to classify residential care placements. Although results were limited by the study design (cross-sectional rather than prospective), it appears that there may be some useful cut off scores which could associate the level of mobility with the type of residential care required. As the authors suggest, further research is required to confirm this. A third study found EMS scores showed no predictive validity for placement on discharge from hospital. 

Responsiveness

In one study of 83 patients with a mean age of 79 in a clinical day hospital, researchers found the EMS was significantly more likely (p<0.001) to detect an improvement in mobility following a course of physiotherapy, compared to two other functional measures. 

Limitations

The EMS has been shown to have a ceiling effect.  

Links

The Chartered Society of Physiotherapists provides an excellent manual for the use of the EMS, see here.