ICU Mobility Scale
Original Editor - Redisha Jakibanjar Top Contributors - Redisha Jakibanjar, Janine van Dyk, Kim Jackson and Narayani Nagare
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.
Scale
The scale are divided in 11 assessment categories (0-10):[3]
| Classification | Defintion |
|---|---|
| 0: Nothing ( lying on the bed) | Passively rolled or exercised by staff passively, but not actively moving |
| 1: Sitting in bed, exercises in bed | Any activity in bed, including rolling, bridging, active exercises or active assisted exercises, cycle ergometry but not moving over edge of bed or out of bed |
| 2: Passively moved to a chair ( No standing) | By means of a hoist, passive transfer, slide transfer with no standing or sitting at the edge of the bed |
| 3: Sitting over edge of bed | Patient can be assisted by staff but needs to be actively sitting with some trunk control |
| 4: Standing | Weight bearing through the feet with or without assistance in the standing position. This can include the use of a standing lifter device or a tilt table |
| 5: Transferring bed to chair | Able to step or shuffle to chair. This involves transferring weight from one leg to another to move to the chair. If a medical device was used to assist patient to stand, they must take a step to the chair. |
| 6: Marching in spot ( Next to bedside) | Able to walk on the spot by lifting feet with or without assistance ( They must be able to take at least 4 steps, 2 per foot) |
| 7: Walking with assistance of 2 or more people | Walking away from the bed or chair by at least 5m with assistance by 2 or more people |
| 8: Walking with assistance of 1 person | Walking away from the bed or chair by at least 5m with assistance of 1 person |
| 9: Walking independently with a assistive device | Walking away from the bed or chair by at least 5m with a assistive device, but no physical assistance from a person. In a person that is wheelchair bound, this activity level includes wheeling the chair independently at least 5m away from the bed/chair. |
| 10: Walking independently without a assistive device | Walking away from the bed or chair by at least 5m without any assistance form a assistive device or person |
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
- 0.89-3[2]
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 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.