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Perme Intensive Care Unit Mobility Score

Original Editor - Redisha Jakibanjar Top Contributors - Redisha Jakibanjar, Uchechukwu Chukwuemeka, Kirenga Bamurange Liliane and Dinalize Purcell

Objective

  • To measure the patient's mobility status. [1]
  • The scoring starts with the ability of the patient to follow the command and ends in the distance walked in 2 minutes[1]
  • This tool is indicative of functional performance especially, the patient's walking capacity in the ICU at a specific moment. [1]

Intended Population

  • Patients with limited independent activities and are in critical illness.[1]

Method of Use

The outcome tool has 15 items and the score ranges from 0 to 32. There are 7 categories namely:

  1. Mental status (items 1-2, maximum points:3)
  2. Potential mobility barriers (items 3-6, maximum points:4)
  3. Functional strength (items 7-8, maximum points:4)
  4. Bed mobility (items 9-10, maximum points:6)
  5. Transfers (items 11-13, maximum points:9)
  6. Gait (item 14, maximum points:3)
  7. Endurance (item 15, maximum points:3)

A higher score indicates fewer potential mobility barriers and decreased assistance. The lower the score, the more potential barriers to mobility and more assistance needed for mobility.[1]

Mental health

The items included in the mental health category are alertness level and ability to follow the command. The alertness level can be scored as unresponsive (0), lethargic (1), and awake and alert (2). The ability to follow commands can be scored as no (0) and yes (1). The result from this category helps us to determine the patient's ability to do the mobility. The maximum score in this category is 3.[1]

Potential mobility barriers

This category includes items 3 to 6 i.e., use of a mechanical ventilator, pain, use of multiple lines and tubes, and use of any drips. The 3rd item is scored as yes (0) or no (1) based on whether the patient is on mechanical ventilation or noninvasive ventilation. Item 4 is pain and if the patient has no pain, it is scored as 1 and if the patient has pain or is unable to express it, it is scored as 0. The 5th item of the scale is related to external appliances or any assistive device and scored as yes (0) and no (1). And if the patient has any drip or medication in use, item 6 is scored as yes (0) and no (1).[1]

Example of mobility errors in the form of mechanical ventilation and lines and drips.

Functional strength

Functional strength focuses on the capacity of the patient to move the upper and lower limbs. Item 7 assesses the strength of the legs whereas item 8 assesses the strength of the arms. Each item is again divided into the right and left sides and scored as yes (1) or no (0). The maximum point scored in this category is 4. To achieve the maximal point, the patient must lift both legs against gravity to 20 degrees with the knees in extension and lift both arms to 45 degrees with the elbows in extension. [1]

Bed mobility

The 4th category of the scale is bed mobility, and it includes items 9 and 10. The patient is asked to do the bed mobility from supine to sit in item 9 and in item 10, the static sitting balance is assessed. The maximum score obtained in this category is 6. [1]

Transfers

In this category the patient's ability to transfer is assessed. Item 11 addresses the sit-to-stand, item 12 addresses the standing balance, and item 13 addresses the transfer from bed to chair or chair to bed. The scoring of all three items is done based on the assistance required.[1]

Gait

Gait addresses the patient's ability to walk with or without assistance and is scored based on the assistance required. The maximum score that can be obtained is 3. [1]

Endurance

Endurance focuses on the patient's capacity to walk in 2 minutes regardless of the level of assistance required including rest periods (sitting or standing), with or without an assistive device. The scoring is done on the basis of distance walked and the maximum score obtained is 3. [1]

[2]

Evidence

Reliability

Interrater reliability (Cohen κ coefficient) for[3]

  • items 2, 3, 5, 6, 7, 8, 13, and 15 were 1.0000
  • item 1, 0.8276
  • item 4, 0.8000
  • item 9, 0.6000
  • item 10, 0.7297
  • item 11, 0.7260
  • item 12, 0.7872
  • and item 14, 0.9048

The intraclass correlation coefficient (95% confidence interval) was 0.9880 (0.97743-0.99859)[3]

Validity

  • supported by expert concurrence and
  • The clinical use of this outcome tool is acceptable.

Links

Link to the Perme score on the Perme ICU rehab seminars page.

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Perme C, Nawa RK, Winkelman C, Masud F. A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score. Methodist DeBakey cardiovascular journal. 2014 Jan;10(1):41.
  2. ↑ Christian Litz. Perme ICU Mobility Test. Available from: http://www.youtube.com/watch?v=lXWMOQhO-FI[last accessed 18/1/2023]
  3. ↑ 3.0 3.1 Nawa RK, Lettvin C, Winkelman C, Evora PR, Perme C. Initial interrater reliability for a novel measure of patient mobility in a cardiovascular intensive care unit. Journal of Critical Care. 2014 Jun 1;29(3):475-e1.
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