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Zupanc A1, Novak P1, Puh U2
1University Rehabilitation Institute, Republic of Slovenia - Soča, Ljubljana, Slovenia, 2University of Ljubljana, Faculty of Health Sciences, Physiotherapy, Ljubljana, Slovenia
Background: De Morton mobility index (DEMMI) was primarily developed for assessment of older adults. It includes 15 items of different difficulties; in bed, on chair, static and dynamic balance, and walking (total score: 0-100). It is reliable and valid for assessment of patients after hip fracture, with hip or knee osteoarthritis, at rehabilitation and of critically ill patients. The measurement properties were evaluated mainly in geriatric population; however, it has a potential for use in all adults at low and basic functioning level.
Purpose: To evaluate inter-rater reliability, construct validity, responsiveness, MCID, floor and ceiling effects of DEMMI in patients with musculoskeletal impairments at rehabilitation, regardless of age.
Methods: Two groups of patients with musculoskeletal impairments with or without impairments of peripheral nerves participated. The Slovenian translation of DEMMI was used. To test inter-rater reliability of DEMMI three physiotherapists simultaneously assessed 38 patients (aged 24-85 years). To evaluate other measurement properties 30 patients (aged 22-84 years) were assessed with DEMMI, Berg balance scale, and 10 meter walk test at admission and after four weeks of rehabilitation. Intraclass correlation coefficient, Spearman's correlation coefficient, paired sample t-test, effect size, and MCID (using the distribution-based method) were calculated. Floor and ceiling effects were defined with 15% of the minimal or maximal scale score.
Results: The inter-rater reliability was excellent (ICC=0.99). After 27.5 days (SD 1.8) of rehabilitation the average increase of DEMMI score was 23 points (SD 9.4), the difference was statistically significant (p 0.0001). Correlations between DEMMI and Berg balance scores were very good (rho=0.78 and rho=0.92), in first and second assessment respectively. Correlation with the 10 meter walk test was very good at first (rho=0.75) and good at the second assessment (rho=0.70). DEMMI was highly responsive to change of mobility after four weeks of rehabilitation (ES=1.97). MCID was 5 points, no floor and ceiling effects were identified.
Conclusion(s): Inter-rater reliability of DEMMI to assess young to old adults with musculoskeletal impairments at rehabilitation is excellent. Its construct validity as a measure of balance and walking mobility in this population is confirmed. It is sensitive measurement tool with MCID of 5 points and has no floor or ceiling effects, regardless of age.
Implications: Despite different causes and levels of decreased mobility DEMMI showed its improvement after four weeks of rehabilitation in adults of all age. We recommend DEMMI for mobility assessment in patients with musculoskeletal impairments at low and basic functioning level.
Keywords: DEMMI, musculoskeletal impairments, measurement tool
Funding acknowledgements: None.
Purpose: To evaluate inter-rater reliability, construct validity, responsiveness, MCID, floor and ceiling effects of DEMMI in patients with musculoskeletal impairments at rehabilitation, regardless of age.
Methods: Two groups of patients with musculoskeletal impairments with or without impairments of peripheral nerves participated. The Slovenian translation of DEMMI was used. To test inter-rater reliability of DEMMI three physiotherapists simultaneously assessed 38 patients (aged 24-85 years). To evaluate other measurement properties 30 patients (aged 22-84 years) were assessed with DEMMI, Berg balance scale, and 10 meter walk test at admission and after four weeks of rehabilitation. Intraclass correlation coefficient, Spearman's correlation coefficient, paired sample t-test, effect size, and MCID (using the distribution-based method) were calculated. Floor and ceiling effects were defined with 15% of the minimal or maximal scale score.
Results: The inter-rater reliability was excellent (ICC=0.99). After 27.5 days (SD 1.8) of rehabilitation the average increase of DEMMI score was 23 points (SD 9.4), the difference was statistically significant (p 0.0001). Correlations between DEMMI and Berg balance scores were very good (rho=0.78 and rho=0.92), in first and second assessment respectively. Correlation with the 10 meter walk test was very good at first (rho=0.75) and good at the second assessment (rho=0.70). DEMMI was highly responsive to change of mobility after four weeks of rehabilitation (ES=1.97). MCID was 5 points, no floor and ceiling effects were identified.
Conclusion(s): Inter-rater reliability of DEMMI to assess young to old adults with musculoskeletal impairments at rehabilitation is excellent. Its construct validity as a measure of balance and walking mobility in this population is confirmed. It is sensitive measurement tool with MCID of 5 points and has no floor or ceiling effects, regardless of age.
Implications: Despite different causes and levels of decreased mobility DEMMI showed its improvement after four weeks of rehabilitation in adults of all age. We recommend DEMMI for mobility assessment in patients with musculoskeletal impairments at low and basic functioning level.
Keywords: DEMMI, musculoskeletal impairments, measurement tool
Funding acknowledgements: None.
Topic: Musculoskeletal; Outcome measurement
Ethics approval required: Yes
Institution: University Rehabilitation Institute, Republic of Slovenia - Soča
Ethics committee: Ethics Committee of University Rehabilitation Institute, Republic of Slovenia
Ethics number: (9/5/2016)
All authors, affiliations and abstracts have been published as submitted.
