Elderly Mobility Scale: Difference between revisions
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== Objective == | == Objective == | ||
To measure the function of frail elderly adults (Smith). | |||
== Intended Population<br> | The Elderly Mobility Scale (EMS) was developed in 1994 as part of an assessment package (Smith). It is a relatively simple outcome measure and is quick to administer (de Morton). | ||
== Intended Population == | |||
<br>Frail elderly adults in hospital. | |||
== Method of Use == | == Method of Use == | ||
The following is from the The Chartered Society of Physiotherapists and can be accessed HERE (includes instructions, form for recording scores and some simple interpretation of scores). | |||
Equipment: Metre rule, stop watch, access to a bed and chair, and usual walking aid, form to record scores | |||
Physical space needed: Space for bed, chair, wall, space for 6m walk. | |||
Tasks: Lying to sitting | |||
Sitting to lying | |||
Sit to stand | |||
Standing | |||
Gait | |||
TImed 6 metre walk | |||
Functional reach | |||
See HERE for an online calculator for the EMS.<br> | |||
== Evidence == | == Evidence == | ||
=== Reliability === | === Reliability === | ||
Inter-rater reliability: High (Linder). Two studies (n=15 and n=19) have shown no significant difference between scores (Prosser and Canby) (Smith). | |||
Intra-rater reliability: No statistically significant differences in scoring by 15 physiotherapists (Nolan). | |||
=== Validity === | === Validity === | ||
Content validity: The items of the test show a heirarchy of difficulty with "lie to sit" being the easiest task to perform and the functional reach being the most difficult task to perform (Yu). It has been proposed that the EMS measures two dimensions of mobility: bed mobility and functional mobility (Yu). Inter-rater reliability was demonstrated on 19 patients with a significant correlation between scores. | |||
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) (Smith) A significant correlation between EMS and Barthel scores has been demonstrated in a second study (n=66, aged 66-69 years) (Prosser and Canby). A third study (n=32, aged >55) has demonstrated concurrent validity with the Modified Rivermead Mobility Index (Nolan) | |||
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 (de Morton). Another study has demonstrated the use of EMS scores to classify residential care placements (Yu). Although results were limited by the study design (cross sectional rather than prospective), there appears there may be some useful cut off scores which could correlate level of mobility with 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 (Prosser and Canby). | |||
=== Responsiveness === | === 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, compare to two other functional measures (Spilg). | |||
=== Limitations === | |||
Ceiling effect (Linder, de Morton) | |||
=== Modifications === | |||
A correction was published by Smith because of an error in the functional reach measurement in the original publication (CSP). See HERE for correct scale. | |||
Evidence for two different modifications to the EMS was published in 2006: the Modified Elderly Mobility Scale (MEMS) (Kuys and Brauer) and the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS) (Linder). | |||
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 (Kuys). | |||
The Swe M-EMS was translated into Swedish from its original English and research shows a high inter-rater reliability and correlations with two other functional measures (Linder). Researchers found the EMS was limited in its sensitivity as a single measure to record improvement following an acute stroke (Linder). | |||
== Links | === <span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span>Links === | ||
The Chartered Society of Physiotherapists provides an excellent manual for the use of the EMS, see HERE. | |||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 00:22, 2 August 2018
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Objective[edit | edit source]
To measure the function of frail elderly adults (Smith).
The Elderly Mobility Scale (EMS) was developed in 1994 as part of an assessment package (Smith). It is a relatively simple outcome measure and is quick to administer (de Morton).
Intended Population[edit | edit source]
Frail elderly adults in hospital.
Method of Use[edit | edit source]
The following is from the The Chartered Society of Physiotherapists and can be accessed HERE (includes instructions, form for recording scores and some simple interpretation of scores).
Equipment: Metre rule, stop watch, access to a bed and chair, and usual walking aid, form to record scores
Physical space needed: Space for bed, chair, wall, space for 6m walk.
Tasks: Lying to sitting
Sitting to lying
Sit to stand
Standing
Gait
TImed 6 metre walk
Functional reach
See HERE for an online calculator for the EMS.
Evidence[edit | edit source]
Reliability[edit | edit source]
Inter-rater reliability: High (Linder). Two studies (n=15 and n=19) have shown no significant difference between scores (Prosser and Canby) (Smith).
Intra-rater reliability: No statistically significant differences in scoring by 15 physiotherapists (Nolan).
Validity[edit | edit source]
Content validity: The items of the test show a heirarchy of difficulty with "lie to sit" being the easiest task to perform and the functional reach being the most difficult task to perform (Yu). It has been proposed that the EMS measures two dimensions of mobility: bed mobility and functional mobility (Yu). Inter-rater reliability was demonstrated on 19 patients with a significant correlation between scores.
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) (Smith) A significant correlation between EMS and Barthel scores has been demonstrated in a second study (n=66, aged 66-69 years) (Prosser and Canby). A third study (n=32, aged >55) has demonstrated concurrent validity with the Modified Rivermead Mobility Index (Nolan)
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 (de Morton). Another study has demonstrated the use of EMS scores to classify residential care placements (Yu). Although results were limited by the study design (cross sectional rather than prospective), there appears there may be some useful cut off scores which could correlate level of mobility with 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 (Prosser and Canby).
Responsiveness[edit | edit source]
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, compare to two other functional measures (Spilg).
Limitations[edit | edit source]
Ceiling effect (Linder, de Morton)
Modifications[edit | edit source]
A correction was published by Smith because of an error in the functional reach measurement in the original publication (CSP). See HERE for correct scale.
Evidence for two different modifications to the EMS was published in 2006: the Modified Elderly Mobility Scale (MEMS) (Kuys and Brauer) and the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS) (Linder).
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 (Kuys).
The Swe M-EMS was translated into Swedish from its original English and research shows a high inter-rater reliability and correlations with two other functional measures (Linder). Researchers found the EMS was limited in its sensitivity as a single measure to record improvement following an acute stroke (Linder).
Links[edit | edit source]
The Chartered Society of Physiotherapists provides an excellent manual for the use of the EMS, see HERE.
