ICU Mobility Scale

Original Editor - Redisha Jakibanjar Top Contributors - Redisha Jakibanjar and Kim Jackson

Objective

  • To record the patient's highest level of mobility in the Intensive Care Unit (ICU)[1][2]

Intended Population

  • The patient's admitted in ICU [2]

Method of Use

Health professionals working in the ICU setting can easily use the outcome tool in the patient to check the highest mobility level of the patient.[1]

There is a total of 11 categories on this scale and the maximum score obtained is 10. The scoring is done based on the mobility achieved by the patient. the classified mobility stages are, nothing (lying on the bed), sitting in bed and exercising in bed, passively moved to the chair (no standing), sitting over the edge of the bed, standing, transferring bed to chair, marching on the spot at bedside.walking with the assistance of 2 or more person, walking with the assistance of 1 person, walking independently with gait aid, walking independently without gait aid. If the patient is unable to move and lying in bed, it is scored as 0 and when the patient is able to walk independently without gait aid, it is scored as 10.

Evidence

Reliability

  • Intraclass correlation: 0.80 (0.75-0.84)[1]
  • Interrater reliability with kappa score: 0.84 for senior and junior physiotherapists, 0.77 for senior physiotherapists and nurses and 0.90 for junior physiotherapists and nurses[1].

Validity

Construct validity

  • The convergent validity was assessed by finding the correlation between ICU mobility scale and muscle strength and was found to be moderate(r=0.64, P<0.001)[3]
  • The divergent validity was assessed by finding the correlation between weight and gender of the patient and no correlation was found.[3]

Predictive validity

  • The mobility score was associated with survival of patient to 90 days with OR, 1.38; 95% CI, 1.14–1.66[3]
  • The mobility score was associated with a discharge home (OR, 1.16; 95% CI, 1.02–1.32). Patients who score high in the ICU mobility scale were discharged directly at home rather than in any rehabilitation center or other centers.[3]
  • The mobility score wasn't associated with return to work at 6months. [3]

Responsiveness

  • The effect size for the change in score from admission to discharge from ICU to 6 months follow up was large i.e, 0.8 between each time point
  • Around 86% of survivors had improved in the ICU score between the start and discharge from ICU and 92% had shown improvement between discharge and 6 months follow up.[3]

Floor and ceiling effect

  • It was calculated by assessing the number and percentage of participants scoring the lowest value (0) and the highest value (10) initially and at ICU discharge. If the value was less than 15%, it was considered acceptable.
  • ICU mobility scale has acceptable floor and ceiling effect. 14% of patient scored 0(means acceptable floor) and 4% scored 10 (means acceptable ceiling)at the time of discharge and 96% scored 0 at the time of admission when the patient was deeply sedated. [3]

Minimal Important Difference

Links

http://www.mobilization-network.org/Network/Documents_files/icu_mobility_scale.pdf

References

  1. 1.0 1.1 1.2 1.3 Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J, Buhr H, Higgins A, Presneill J. Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart & Lung. 2014 Jan 1;43(1):19-24.
  2. 2.0 2.1 2.2 Tipping CJ, Holland AE, Harrold M, Crawford T, Halliburton N, Hodgson CL. The minimal important difference of the ICU mobility scale. Heart & Lung. 2018 Sep 1;47(5):497-501.Tipping CJ, Holland AE, Harrold M, Crawford T, Halliburton N, Hodgson CL. The minimal important difference of the ICU mobility scale. Heart & Lung. 2018 Sep 1;47(5):497-501.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Tipping CJ, Bailey MJ, Bellomo R, Berney S, Buhr H, Denehy L, Harrold M, Holland A, Higgins AM, Iwashyna TJ, Needham D. The ICU mobility scale has construct and predictive validity and is responsive. A multicenter observational study. Annals of the American Thoracic Society. 2016 Jun;13(6):887-93.