Archives of Gerontology and Geriatrics 72 (2017) 67–79

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Archives of Gerontology and Geriatrics

journal homepage: www.elsevier.com/locate/archger

Review

Instruments to evaluate mobility capacity of older adults during T

hospitalization: A systematic review
⁎
Karla Vanessa Rodrigues Soares Menezesa, , Claudine Augerb,
Weslley Rodrigues de Souza Menezesc, Ricardo Oliveira Guerraa
a
Department of Physiotherapy, Federal University of Rio Grande do Norte, Av Sen. Salgado Filho, 3000, Campus Universitário, Natal 59078-970, RN, Brazil
b
Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), CRIR-CRLB du CIUSSS Centre-Sud-de-l’Ile-de-Montréal |Centre de réadaptation
Lucie-Bruneau 2275, avenue Laurier Est Montréal, QC H2H 2N8, Canada
c
Department of Physiotherapy, Potiguar University, Av Sen. Salgado Filho 1610, Lagoa Nova, Natal 59056-000, RN, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: Independent mobility is a key factor in predicting morbidity and determining hospital discharge readiness for
Aged older patients. The main objective was identify and appraise relevant instruments for the measurement of
Mobility limitation mobility of hospitalized geriatric patients. A systematic review was performed in two consecutive steps. Based on
Hospitalization the definition of mobility of the International Classification of Functioning (ICF). Step 1 identified mobility
Validity of testes
measurement instruments used to assess patients 60 years of age and over hospitalized in acute care or intensive
Reproducibility of tests
geriatric rehabilitation unit. Aim of the instrument, coverage of mobility construct, applicability (format,
training required, administration time and use of assistive devices) were extracted. For each included instru-
ment, Step 2 identified and appraised articles reporting about their measurement properties. Consensus-based
Standards for the selection of health status Measurement INstruments (COSMIN) was used by two independent
reviewers to critically appraise and compare the measurement properties. Step 1 resulted in 6350 articles, of
which 28 articles reported about 17 different instruments. Step 2 retained 11 instruments with 70 articles re-
porting about their measurement properties in various settings. Judgement-based instruments (n = 5) covered
the ICF mobility construct more broadly than performance-based measures (n = 6). Our results showed that 3
instruments (DEMMI, SPPB and Tinetti scale) had the most extensive and robust measurement properties, and
from those, SPPB and DEMMI covered the mobility construct more broadly but SPPB had the longest admin-
istration (10–15 min). Conclusion SPPB presents the best balance between mobility coverage, measurement
properties and applicability to acute care or intensive geriatric rehabilitation unit.

1. Introduction difficulty with specifics tests, and possible health risks caused by im-
mobility.
The World Health Organization’s International Classification of Older adultś mobility limitation is a marker for risk of adverse
Functioning, Disability and Health (ICF) defines mobility as moving and outcome (Chung, Demiris, & Thompson, 2015). Loss of mobility can
changing body position or location or by transferring from one place to result in a decline in independence, physical disability and injuries,
another, by carrying, moving or manipulating objects, by walking, rendering individuals reliant on caregivers to meet their basic needs,
running or climbing, and by using various forms of transportation being unable to remain living independently (Macri, Lewis, Khan,
(Organization, 2001). Mobility is an important marker and predictor of Ashe, & de Morton, 2012; Studenski et al., 2003). Such functional de-
physical abilities, independence, morbidity, and mortality [2–7]. Mo- cline can also lead to institutionalization, increased hospital admissions
bility is viewed as a dynamic condition that varies even within the same (Macri et al., 2012) and high mortality (Rozzini et al., 2005). De-
age range. Thus the evaluation of mobility in older adults is a critical termining mobility status is an important component of any medical or
component of assessment. Tinetti (1986) suggested that mobility as- health assessment for older adults. Accurately measuring mobility can
sessment has multiple purposes including identifying components of help a clinician determine an individual’s abilities at a single time point
mobility difficulty related to performing daily activities, reasons for to identify potential impairment or to establish a baseline for

⁎
Corresponding author.
E-mail addresses: [email protected] (K.V.R. Soares Menezes), [email protected] (C. Auger), [email protected] (W.R. de Souza Menezes),
[email protected] (R.O. Guerra).

http://dx.doi.org/10.1016/j.archger.2017.05.009
Received 14 October 2016; Received in revised form 5 April 2017; Accepted 23 May 2017
Available online 27 May 2017
0167-4943/ © 2017 Elsevier B.V. All rights reserved.
K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

comparison following a subsequent reassessment (Macri et al., 2012). Studies were excluded if the authors did not explicitly address how
Mobility measures can also (i) help determine whether an in- mobility had been defined and measured, if they used a mobility as-
dividual’s mobility has changed, (ii) identify early signs of decline, and sessment solely as an inclusion criterion, or if the instrument was dis-
(iii) assist with guiding therapeutic intervention, goal setting, and dis- ease-specific (e.g. mobility in Parkinson, mobility in stroke). The latter
charge planning in inpatient programs (Macri et al., 2012). Restricted criterion was used because a generic measure was considered more
mobility and bed rest are common occurrences during acute care. Pa- applicable for the context of acute care or inpatient rehabilitation.
tients experience a decline in mobility from their pre-admission base-
line to the second hospital day, with most patients failing to improve by 2.2. Second step
discharge (Brown, Friedkin, & Inouye, 2004; De Buyser et al., 2014;
Zaslavsky, Zisberg, & Shadmi, 2015). Some of those patients failure to 2.2.1. Search strategy
recover from the prehospitalization functional decline (Zisberg, For each included instrument a second search was done in Web of
Shadmi, Gur-Yaish, Tonkikh, & Sinoff, 2015). Diminished independence science and Medline with the terms “reliability”, “validity” and “re-
in hospitalized older people is associated with increased risk of transfer sponsiveness” and the name of the instrument (see Appendix B). Arti-
to a nursing home, greater care burden and, healthcare costs after cles were screened by one reviewer based on their titles and abstracts
discharge, as well as mortality (de Morton, Berlowitz, & Keating, 2008). for data about measurement properties. Full articles of potentially re-
Although many measurement instruments are currently being used levant articles were obtained.
to assess mobility in acute care or rehabilitation units, there is a lack of
consensus of which tool to use during hospitalization. In order to make 2.2.2. Selection criteria
a rational choice for the use of instruments for mobility assessments in An article was included if it was published in English, French,
research and practice, it is important to assess and compare their Spanish or Portuguese until 2015, provided data about the measure-
measurement properties (e.g. reliability, validity, responsiveness) with ment properties for instruments identified in the first step that enabled
a context-specific approach (e.g. applicability to the context of prac- estimations of reliability, validity and/or responsiveness to change. The
tice). To our knowledge, only one systematic review published in 2008 same exclusion criteria as for the first step were applied.
(de Morton et al., 2008) evaluated the measurement properties of
mobility instruments in the context of acute care or intensive re- 2.2.3. Extraction of conceptual coverage and applicability characteristics
habilitation units. They excluded instruments if they required any To describe the measurement instruments, the aim reported by the
clinical experience and they finally only included three instruments. authors, number of items, and summary score were extracted. We
The purpose of this article is to provide an updated review to coded the mobility concept using the ICF to describe the conceptual
identify relevant instruments for the measurement of older adult’s coverage of each measurement instrument. The ICF provides a frame-
mobility based on the ICF conceptual framework in the context of acute work to code a wide range of information about health and uses a
care or intensive geriatric rehabilitation unit and to compare their standardized common language permitting communication about
measurements properties. health and health care. Under the ICF, mobility is classified in domains
of “activity and participation” such as Changing and maintaining body
2. Methods position (d410-d429), Carrying, moving and handling objects (d430-
d449), Walking and moving (d450-d469), and Moving around using
The review was performed in two consecutive steps. Step one transportation (d470-d489) (Organization, 2001). Every single item of
identified existing measurement instruments that are used to assess each instrument was classified according to an ICF mobility code.
mobility in acute care or intensive rehabilitation units. For each in- Applicability to the clinical context may include information about
cluded instrument, a second step was conducted to identify primary the burden of assessment and format compatibility (Auger,
research articles reporting about their psychometric measurement Demers, & Swaine, 2006). Burden of assessment was described in terms
properties (reliability, validity and responsiveness). The second step of administration time, training needed to use the instrument, and use
was not constrained to studies about older adults. of assistive device during testing. Format was classified in three cate-
gories: (1) self-report, (2) judgment-based and (3) performance-based
2.1. First step (Arcand, 2008). Self-report instruments are composed of questions that
have to be answered by the evaluated person. Judgment-based instru-
2.1.1. Search strategy ments use a measurement scale that the evaluator scores based on the
We searched the following databases for the first search: Cinahl, subjectś answers or after his own observation of behaviors or tasks.
Embase, HaPI, Lilacs, Medline and PsyINFO. Our search strategy in- Finally the performance-based format requires the subject to accom-
cluded the terms “older adults”, “mobility”, “instrument”, “hospitali- plish one or more standardized tests and generates a ratio score
zation”. The full search strategy was validated by a librarian and is (duration in seconds, number of steps).
available in Appendix A. A hand search was done in the reference lists
of the included articles to identify additional relevant studies. 2.2.4. Assessment of methodological quality
The methodological quality of the studies was assessed to determine
2.1.2. Selection criteria whether the results of the included studies can be trusted. Data ex-
A study was included if it was a primary source article (e.g. not an traction and assessment of the methodological quality of the studies
editorial, review or abstract), published in English, French, Spanish or was performed independently by two reviewers using the COSMIN
Portuguese published between 2001 and 2015, reporting about older checklist (Mokkink et al., 2010). In case of disagreement between the
inpatients in acute care or intensive rehabilitation units. The instrument two reviewers, there was discussion in order to reach consensus. If
format had to be performance-based, judgment-based or self-report and necessary, a third reviewer made the decision.
used in a hospital or rehabilitation setting. For instruments that mea-
sured multiple domains (e.g. functional capacity, balance, strength), the 2.2.4.1. COSMIN approach. The Consensus-based Standards for the
report was included if a subtotal score for mobility could be de- selection of health status Measurement INstruments – COSMIN
termined. Mobility was defined from bed bound to independent levels checklist consists of nine boxes with 5–18 items concerning
of ambulation according to the activity and participation domains of methodological standards for how each measurement property should
the International Classification of Functioning, Disability and Health be assessed. Each item is scored on a 4-point rating scale (poor, fair,
(Organization, 2001). good or excellent) and an overall score for the methodological quality

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of a study is determined for each measurement property separately, by Table 1

taking the lowest rating of any of the items in a box. Using the COSMIN Levels of evidence for the overall quality of the measurement properties (van Tulder,
Furlan, Bombardier, & Bouter, 2003).
checklist allows to critically appraise the quality of studies about a
single measurement instrument and to compare measurement Level Rating Criteria
instruments.
Strong +++ or Consistent findings in multiple studies of good
−−− methodological quality OR in one study of excellent
3.2.4.2. Measurement properties. COSMIN divides the measurement
quality
properties in three domains: reliability, validity and responsiveness Moderate ++ or Consistent findings in multiple studies of fair
(Mokkink et al., 2010). COSMIN definitions of domains, measurement −− methodological quality OR in one study of good
properties and aspects of measurement properties can be accessed in methodological quality
the COSMIN checklist (see http://www.cosmin.nl). Limited + or − One study of fair methodological quality
Conflicting ± Conflicting findings
3.2.4.2.1. Reliability. Propertydefined as the extent to which scores
Unknown ? Only studies of poor methodological quality
for patients who have not changed are the same for repeated
measurement under several conditions: e.g. using different sets of (+) positive result (−) negative result.
items from the same questionnaire (internal consistency); over time
(test-retest); by different persons on the same occasion (inter-rater); or used to analyze single studies as described above, we then used the
by the same persons on different occasions (intra-rater) (Mokkink et al., classification proposed by the Cochrane Back Review Group (see
2010). Table 1) to summarize the evidence about the measurement
Reliability contains the following measurement properties: properties of each instrument. The possible overall rating of
measurement property is “positive”, “indeterminate”, or “negative”
1 Internal consistency: The degree among the interrelatedness among accompanied by levels of evidence. To assess the values for positive,
the items. Represented by Cronbach́ s α, factor analysis or Kuder- negative or indeterminate see criteria based on Terwee et al. (2007) and
Richardson Formula 20 (KR-20). Schellingerhout et al. (2012). These criteria were originally developed
2 Inter-rater, Intra-rater and test-retest Reliability: Represented by for systematics reviews of clinical trials, but as shown by
Intraclass Correlation Coefficient (ICC) and Cohen’s Kappa. Kappa is Schellingerhout et al. (2012), they are applicable for reviews on
the proportion of the total variance in the measurements, which is measurement properties of instruments.
due to “true” differences between patients.
3 Measurement error: The systematic and random error of patients
3. Results
score that is not attributed to true changes in the construct to be
measured. It is expressed by the Standard Error of Measurement
3.1. First-step review
(SEM) (Mokkink et al., 2010). The SEM can be converted into the
Smallest Detectable Change (SDC). Changes exceeding the SDC can
The first step search resulted in a total of 6350 articles. After re-
be labeled as change beyond measurement error.
moving duplicates (n = 2520) a total of 3830 were screened based on
3.2.4.2.2. Validity. Validity is the extent to which an instrument
their title and abstract. A total of 293 full-text articles were obtained
measures the construct it purports to measure. It includes:
and 265 of them were excluded. From the remaining 28 articles, 17
measurement instruments were identified and subjected to an indepth
1 Content validity: The degree to which the content of an instrument is
psychometric evaluation: Fig. 1 shows the flow diagram, reasons for
an adequate reflection of the construct to be measured. Includes also
exclusion, and the 17 measurement instruments identified at the first
face validity.
step.
2 Criterion validity: the extent to which the scores of an instrument are
an adequate reflection of a gold standard.
3 Construct validity: The degree which the scores of an instrument are 3.2. Second-step review
consistent with hypotheses based on the assumption that the in-
strument validly measures the construct to be measured. Construct 3.2.1. Search results
validity is further divided in: The second step was performed and 6 out of 17 instruments were
a Structural validity: The degree to which the scores of an instrument excluded (20 Feet Test, Low Mobility Test, 6-m test, Escala Física de
are an adequate reflection of the dimensionality of the construct Cruz Roja, Physical Performance Test and Lower Limb Summary
to be measured. Factor analysis should be performed. Performance Score) because no articles reporting about their mea-
b Hypothesis testing: Is an ongoing, iterative process. The more spe- surement properties were found.
cific the hypotheses are and the more hypotheses are being tested,
the more evidence is gathered for construct validity. 3.2.2. Conceptual coverage and applicability characteristics
c Cross-cultural validity: The degree to which the performance of the The conceptual coverage and applicability characteristics of the 11
items on a translated or culturally adapted instrument is an ade- measurement instruments are shown in Table 2. Regarding burden of
quate reflection of the performance of the items of the original assessment, the administration time varies between 10 s and 24 h, and
version of the instrument. is shortest for the Timed-up and go, 6-min walk test and 10-m walk test.
3.2.4.2.3. Responsiveness. Corresponds to the ability of the Five instruments (COVS, DEMMI, FGI, SPPB and Tinetti scale) require
instrument to detect change over time in the construct to be examiner training and need minimal equipment and resources. In fact
measured. The correlation between change scores of two equipment included pen, chronometer, and standardized chair with or
measurements should be in accordance with predefined hypotheses without arms. All instruments allow the use of assistive devices during
(Mokkink et al., 2013). Although responsiveness is considered to be a testing. Regarding the format of assessment, none of the instruments are
separate measurement property from validity, the only difference self-report, five are judgement-based and six are performance-based.
between construct and criterion validity and responsiveness is that Judgement-based measurement instruments include a broad coverage
validity refers to the validity of a single score, and responsiveness refers of mobility tasks defined by the ICF, ranging from maintaining and
to the validity of a change in score (Mokkink et al., 2010). changing basic position, transferring, lifting and carrying objects, fine
hand use, walking and moving around. In contrast, except for the TUG
2.2.4.3. Summary of levels of evidence. While the COSMIN criteria were and SPPB, all the performance-based instruments are restricted to

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K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

Fig. 1. Flow diagram of process of outcome measure inclusion and

exclusion.

walking (d4500). In a previous review about mobility instruments used to assess

mobility in acute care, de Morton et al. (2008) identified three instru-
3.2.3. Measurement properties ments (HABAM, Elderly Mobility Scale (Smith, 1994) and Physical
A total of 70 articles reporting about the measurement properties of Performance Mobility Examination (Winograd et al., 1994)) and they
the 11 retained instruments were found. The full text of these articles classified all of them as poor quality. However, they did not use a
was evaluated, which resulted in the exclusion of 23 articles (2 focused standardized approach to assess the tools’ measurement properties.
on balance validity not mobility as defined by the ICF, 8 focused on Moreover, their inclusion criteria (less than 10 min to administer, does
pulmonary capacity not mobility, 8 did not report on measurement not require minimal level of experience to administer, consisted of more
properties and 5 concerned full-text in excluded languages). Table 3 than one item to assess mobility) led to the exclusion of most of the
presents the general characteristics of the 47 eligible articles, of which instruments. For example, instruments like BFS, SAM, 6-min walk test
68% (n = 32) evaluated non-hospitalized subjects, 27.7% (n = 13) and 10-m walk test were excluded because they consisted of a single
evaluated hospitalized subjects and 4.3% evaluated a mix of hospita- item (walking). From this perspective, our review is the most compre-
lized and non-hospitalized subjects. Table 4 presents their measurement hensive report about mobility instruments for hospitalized older adults.
properties based on the COSMIN criteria and Table 5 summarizes the To achieve this, and according to the ICF mobility concept, we first kept
evidence about the measurement properties of each measurement in- any instrument used to assess mobility in hospitalized older adults
strument. without any consideration about their psychometric properties. To
evaluate the quality of these instruments we then used a reliable and
valuable approach to assess all the instruments in a standardized way.
4. Discussion Regarding the conceptual coverage of the mobility construct, a
majority of items assessed by the 11 retained measurement instruments
Our main goal was to identify and appraise relevant instruments for were coded as d4500 (walking short distance) according to the ICF.
the measurement of mobility capacity of older adults hospitalized in Four instruments actually evaluated only this aspect of mobility.
acute care and rehabilitation units. This review identified 11 mobility Regarding the remaining instruments, they evaluated two to seven
instruments.

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 Table 2
Characteristics of measurement instruments used to assess mobility in hospitalized older adults.

Instrument Aim of tool Format of ICF coverage Training Administration time Allow use of
assessment assistive device
K.V.R. Soares Menezes et al.

1. Body-fixed sensor (BFS) Evaluate mobility 24 h per day. These monitors can detect Performance- Walking (d4500) No 24-h/day Yes
moving, standing, sitting, and lying. The participants wear BFSs based
all day.
2. Clinical Outcome Variable Assess mobility status. The 13 items include tasks of bed Judgement-based Changing basic body position (d4100, d4108), Transferring Yes 15–45 min Yes
Scale (COVS) mobility, sitting balance, ambulation, wheelchair mobility and oneself while siting (d4200), Maintaining a sitting position
arm function. The items are scored on a 7-point scale with scores (d4153), Lifting and carrying objects (d4300), Fine hand use
ranging from 13 (total dependent) to 91 (independent). (d4400), Walking (d4500), Moving around using equipment
(d465)
3. De Morton Mobility Index Evaluate mobility in the acute care hospital setting. It is Judgement-based Changing basic body position (d4103, d4108), Maintaining a Yes Less than 9 min Yes
(DEMMI) administered by clinician observation of performance on 15 sitting and standing position (d4153, d4154), Lifting and
hierarchical mobility challenges (from bed to walk and jump). carrying objects (d4300, 4301), Walking (d4500), Moving
Each item scored from 0 (unable) to 2 (independent). Total around (d4553)
scores range from 0 (poor mobility) to 100 (independent
mobility).
4. Functional Gait Index (FGI) Evaluate gait on a 10-item walking-based scale. Includes walking Judgement-based Walking (d4500, d4508), Moving around climbing (d4551) Yes 10 min Yes
forward, backward, stepping over obstacles and changing gait
speed. Is scored in a 4-level (0–3) ordinal scale; scores range from
0 to 30. Lower scores indicating impairment.
5. Hierarchic Assessment of Detect changes in mobility and balance and provide standardized Judgement-based Changing basic body position (d4100), Maintaining a sitting No 10 min Yes
Balance and Mobility levels of mobility and balance for three items: in-bed mobility, position (d4153), Maintaining a standing position (d4154),
(HABAM) transfers and walking. Patients are scored at their highest level of Walking (d4500)
observed safe function.

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6. Short Physical Performance Evaluate balance and mobility. SPPB is composed of three tests: a Performance- SPPB: 1 st part: Maintaining a standing position (d4154), 2nd Yes 10–15 min Yes
Baterry (SPPB) hierarchical assessment of standing balance, a short walk at the based part: walking (d4500), 3rd part: Changing basic body position
usual pace, and standing five times from a seated position in a sitting/standing (d4103, d4104)
chair. Each SPPB component test is scored from 0 to 4
representing the highest category of performance. A summary
score ranges from 0 to 12.
7. Step Activity Monitor (SAM) Measure mobility, physical activity and gait parameters. SAM Performance- Walking (d4500) No 24-h/day Yes
synchronizes step count measurements to a 24-h clock at based
frequent intervals. The resulting temporal series of data can be
analysed to identify patterns of ambulatory activity.
8. Timed −up and Go (TUG) Measures time, in seconds, to stand up from a regular chair, walk Performance- Changing basic body position (d4103, d4104), walking No 10 s–2 min Yes
a 3-m distance at a comfortable pace, turn around, return to the based (d4500), Walking around obstacles (d4503)
chair, and sit down again. Scores of 10 s or less indicate normal
mobility, 11–20 s are within normal limits and greater than 20 s
means the person needs assistance outside and is at risk for falls.
9. Tinetti scale Evaluates balance and gait, ranging from 0 (maximum Judgement-based Changing basic body position (d4103), Walking (d4500), Yes 10–15 min Yes
impairment) to 28 (best performance) in 14 items. Gait is Walking around obstacles (d4503)
evaluated as initiation of gait, speed gait, length, symmetry, and
continuity, path deviation, trunk stability, and turning while
walking.
10. 6-min walk test Evaluates the distance walked in a period of 6 min. This test was Performance- Walking (d4500) No 6 min Yes
initially considered to measure endurance but now can be used based
to measure mobility and function.
11. 10-m walk test Evaluate gait velocity. Data are obtained from subjectś Performance- Walking (d4500) No 5 min or less Yes
performance at self-selected walking speeds. based
Archives of Gerontology and Geriatrics 72 (2017) 67–79
 Table 3
Characteristics of the studies included in the second review for psychometric measures.

Instruments Study Population Country Setting

1. Body-fixed Sensor Schwenk, Gogulla, Englert, Czempik, and Hauer Geriatric patients (H) Germany Therapist
(2012)
2. Clinical Outcome Variable Scale Choy, Kuys, Richards, and Isles, (2002) Patients with brain injury (NH) Australia Physiotherapist
K.V.R. Soares Menezes et al.

3. Clinical Outcome Variable Scale Barker, Amsters, Kendall, Pershouse, and Haines Patients with spinal cord injury (NH) Australia Physiotherapist
(2007)
4. Clinical Outcome Variable Scale Salter et al. (2010) Patients with stroke (H) Canada Researcher
5.De Morton Mobility Index de Morton and Lane (2010) Geriatric population (H) Australia Physiotherapist
6.De Morton Mobility Index Davenport and de Morton (2011) Community-dwelling older adults (NH) Australia Physiotherapist and physical therapist students
7.De Morton Mobility Index de Morton et al. (2011) Patients admitted to Transition Care Programs (NH) Australia Physiotherapist
8.De Morton Mobility Index de Morton, Davidson et al. (2013), de Morton, Patients with hip fracture (H) Australia Physiotherapist
Harding et al. (2013)
9.De Morton Mobility Index Braun et al. (2015) Patients admitted to a sub-acute inpatient geriatric Germany Physiotherapist
rehabilitation hospital (H)
10.Functional Gait Assessment Wrisley, Marchetti, Kuharsky, and Whitney (2004) Patients with vestibular disorders (NH) USA Physiotherapist and physical therapist students
11.Functional Gait Assessment Leddy, Crowner, and Earhart (2011) Community-dwelling with Parkinson disease (NH) USA Physiotherapist and physical therapist students
12.Functional Gait Assessment Lin, Hsu, Hsu, Wu, and Hsieh (2010) Patients with Parkinson disease (NH) Taiwan Physiotherapist
13.Functional Gait Assessment Wrisley and Kumar (2010) Community-dwelling older adults (NH) USA Physiotherapist
14.Functional Gait Assessment Foremen et al. (2011) Persons with Parkinson disease (NH) USA Doctoral-trained physical therapist
15.Functional Gait Assessment Yang et al. (2014) Patients with Parkinson disease (H) China Physiotherapist
16.Functional Gait Assessment Marchetti et al. (2014) Persons with balance and vestibular disorders (NH) USA Physiotherapist
17. Hierarchical Assessment of Balance and Rockwood et al. (2008) Frail older adults (H) Canada Physiotherapist
Mobility
18.Short Physical Miller et al. (2008) African American (NH) USA Interviewers
Performance Test
19.Short Physical Performance Test Mangione et al. (2010) Elderly african americans (NH) USA Study investigators

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20.Short Physical Performance Test Corsonello et al. (2012) Older patients discharged from acute care hospitals (M) Italy Physician
21.Short Physical Performance Test Freire et al. (2012) Older adults (NH) Brazil/Canada Interviewers
22.Short Physical Performance Test Gomez et al. (2013) Non-disabled adults (NH) Colombia Interviewers
23.Stem Activity Monitor Bowden and Behrman (2007) Persons with incomplete spinal cord injury (NH) USA Researcher
24.Stem Activity Monitor Schmidt et al. (2011) Persons with Parkinson disease and Multiple Sclerosis USA Researcher
(NH)
25.Timed up and go Piva et al. (2004) Patients with knee osteoarthritis (NH) USA Physiotherapist
26.Timed up and go Yeung et al. (2008) Inpatient orthopaedic (H) Canada Physiotherapist or research assistant
27.Timed up and go Mahoney et al. (2004) Individuals with Alzheimer Disease (M) USA Researcher
28.Timed up and go Mangione et al. (2010) Elderly african americans (NH) USA Study investigators
29.Timed up and go Galan-Mercant et al. (2014) Healthy elderly (NH) Spain and Australia Researcher
30.Tinetti scale Kegelmeyer et al. (2007) Individuals with Parkinson Disease (NH) USA Physiotherapist and second-year physical therapist
students
31.Tinetti scale Sterke et al. (2010) Nursing home residents with dementia (NH) The Netherlands Physiotherapist
32.Tinetti scale Canbek et al. (2013) Individuals with stroke (NH) USA Physiotherapist
33.Tinetti scale Kloss et al. (2014) Individuals with Huntington’s Disease (NH) USA Experienced researcher
34.6 min Walk Test Rikli and Jones, (1998) Older adults (NH) USA Researcher
35.6 min Walk Test Pankoff et at. (2000) People with fibromyalgia (NH) Canada Researcher
36.6 min Walk Test Demers et al. (2001) Patients with heart failure (H) Canada Researcher
37.6 min Walk Test Moriello et al. (2008) Patients after elective colon resection surgery (H) Canada Researcher
38.6 min Walk Test Ries et al. (2009) Individuals with Alzheimer Disease (M) USA Researcher
39.6 min Walk Test Mangione et al. (2010) Elderly african americans (NH) USA Study investigators
40.6 min Walk Test Ziegler et al. (2010) Patients with cystics fibrosis (NH) Brazil Physiotherapist
41.6 min Walk Test Elmahgoub et al. (2012) Patients with overweight and obese with intellectual Belgium Physiotherapist
disability (NH)
42.6 min Walk Test Mossberg and Fortini (2012) Ambulatory patients with traumatic brain injury (H) USA Researcher
43.6 min Walk Test Guerra-Balic et al. (2015) Adults and seniors with intellectual disabilities (NH) Spain Researcher
44.10 min Walk Test Salbach et al. (2001) Patients with stroke (H) Canada Physical and Occupational Therapist
45.10 min Walk Test Green et al. (2002) Patients with stroke (NH) United Kingdon Researcher
(continued on next page)
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K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

aspects of mobility. Besides, walking, instruments that have higher

coverage of mobility include change in mobility across a broad spec-
trum of abilities including bed mobility, maintaining and changing
position, chair transfers, upper extremity mobility and moving around.
This variety in coverage offers multiple options to clinicians and re-
searchers. If it is important to evaluate the full spectrum from bed
mobility up to climbing stairs, instruments like COVS and DEMMI
would be a better choice. But if the goal is a straightforward and quick
measure, an instrument that measures only one item of mobility (e.g.
walking) like BFS, SAM or 6-min walk test would present good re-
sponse.
Researcher
Researcher
Researcher
Researcher
Researcher

Increasingly, standardized tests of physical performance are being

Setting

applied in research and geriatric assessment (Guralnik et al., 2000).

Performance-based instruments have been found to be strongly asso-
ciated with multiple measures of health status, are more sensitive to
change than self-report instruments and might be more useful in
longitudinal evaluations (Guralnik et al., 2000). Time of administration
is another crucial factor when evaluating hospitalized patients and
Australia
Australia

Thailand
Country

Sweden

actually eight instruments required less than 15 min to be administered.

USA

These instruments are practical and may be a good fit for use in a

hospital ward. However, a limitation of those instruments, especially
M = Mixed hospitalized and not hospitalized older adults

for DEMMI and SPPB, is that for specific populations some of the items
Ambulatory patients with traumatic brain injury (NH)

(pick up a pen from the floor, sitting/standing or jump) may not be

Older people living in a residential care unit (NH)

appropriate at admission in a hospital or rehabilitation unit (de Morton,

Harding, Taylor, & Harrison, 2013). Regarding the need for training, we
observed that five instruments required training. This may reduce bias
Patients with traumatic brain injury (H)
Patients with spinal cord injury (NH)

Patients with spinal cord injury (NH)

and lead to higher standardization of results. Other resemblance be-

tween those instruments is that they did not require a lot of material to
evaluate mobility, although some instruments like SPPB and Tinetti
scale require a specific chair. Sometimes in a hospital setting finding a
standardized chair with some specifications like height, with or without
arms could be a problem and it may influence a person’s ability to
transfer from sit to stand. Auger et al. (2007) also raised the same
problem and suggested further studies to investigate the impact of floor
Population

covering, armrests and chair heights to provide norms that could be

used in different contexts.
Methodological quality criteria are crucial for assessment and to
identify efficient instruments for clinical practice(10). The COSMIN
criteria facilitated a separate judgment about the methodological
quality of the included studies and their results. In our review, SPPB
and Tinetti scale had good to excellent intra-rater and interrater relia-
bility. Although instruments like COVS, DEMMI and TUG showed po-
NH = Not hospitalized older adults

sitive results for reliability (ICC > 0.80), they shared similar metho-
dological problems. The most frequent was the small sample size, which
Amatachaya et al. (2014)

led to fair or poor measurement properties results. The COSMIN score

Poncunhak et al. (2013)

system was first developed for assessing psychometric properties in self-

Van Loo et al. (2003)

Hirsch et al. (2014)

Adell et al. (2013)

report questionnaires and defines a minimum adequate sample size as

30 (fair), and adequate sample size as 100 (excellent). Dobson et al.
(2012) anticipated this problem and used modified COSMIN criteria.
They used the total sample size of eligible combined studies what they
Study

called as “second worst score counts”. Evidence was assigned as:

“strong” when the total sample size of eligible combined studies was
≥100; “moderate” with total samples between 50 and 99; “limited”
with total samples between 25 and 49, and “unknown” with samples
less than 25. By doing this they avoided the exclusion of many small
studies. In our study we followed the original COSMIN criteria, thus the
reliability was low for 73% of our sample and 3 tools met the highest
H = Hospitalized older adults

reliability standards (SPPB, Tinetti Scale and 6-min walk test).

Our review showed important gaps in validity for most of the
measurement instruments. None of them were evaluated for content
46.10 min Walk Test
47.10 min Walk Test
48.10 min Walk Test
49.10 min Walk Test
50.10 min Walk Test
Table 3 (continued)

validity, and structural validity was missing in most of the instruments

with multiple dimensions. It was difficult to report about the content
Instruments

coverage of the instruments because none of the studies examined the

constructs of the instruments. This problem may be due to the fact that
mobility is a variable for which content is considered implicit.
Evaluating content validity would ensure that the instrument

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K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

Table 4
Methodological quality of studies reporting on the measurement properties of the 11 instruments.

Study Internal Reliability Measurement error Content Structural Hypotheses Criterion Responsiveness
consistency validity validity testing Validity

1. BFS
Schwenk et al. (2012) Fair Fair

2. COVS
Low Choy et al. (2002) Poor
Barker et al. (2007) Poor
Salter et al. (2010) Good Excellent Good

3. DEMMI
de Morton and Lane (2010) Poor Poor Good Good
Davenport and de Morton (2011) Poor Poor Good
de Morton et al. (2011) Excellent Excellent Excellent
de Morton, Davidson et al. (2013), Excellent Excellent Excellent
de Morton, Harding et al.
(2013)
Braun et al. (2015) Good Fair Fair Excellent

4. FGI
Wrisley et al. (2004) Poor Poor Poor
Leddy et al. (2011) Poor Good Poor
Lin et al. (2010) Fair Fair Fair Fair
Wrisley and Kumar (2010) Fair Fair
Foreman et al. (2011) Fair Fair Fair
Yang et al. (2014) Excellent Excellent Excellent
Marchetti et al. (2014) Fair Good

5. HABAM
Rockwood et al. (2008) Fair

6. SPPB
Miller et al. (2008) Excellent
Mangione et al. (2010) Good
Corsonello et al. (2012) Excellent
Freire et al. (2012) Good Poor
Gómez et al. (2013) Fair Excellent

7. SAM
Bowden and Behrman (2007) Poor Poor
Schimdt et al. (2011) Poor
8. Time Up and Go
Piva et al. (2004) Poor Poor Good
Yeung et al. (2008) Poor Good
Ries et al. (2009) Poor Poor
Mangione et al. (2010) Good
Galan-Mercant et al. (2014) Poor Poor

9. Tinetti scale
Kegelmeyer et al. (2007) Poor Poor
Sterke et al. (2009) Good Fair
Canbek et al. (2013) Good Good Good Good
Kloos et al. (2014) Poor Poor Poor

10. 6 mWT
Rikli and Jones (1998) Fair Fair
Pankoff et al. (2000) Poor Poor
Demers et al. (2001) Good Good Good
Moriello et al. (2008) Good Good
Ries et al. (2009) Poor Poor
Mangione et al. (2010) Good
Ziegler et al. (2010) Poor Poor
Elmahgoub et al. (2012) Fair Fair Good
Mossberg and Fortini (2012) Poor Poor
Guerra-Balic et al. (2015) Fair Fair Fair

11. 10-m
Salbach et al. (2001) Fair
Green et al. (2002) Poor Poor
van Loo et al. (2003) Poor Poor
Adell et al. (2013) Fair Fair
Poncumhak et al. (2013) Poor Fair
Amatachaya et al. (2014) Good
Hirsch et al. (2014) Poor

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Table 5
Summary of evidence about the measurement properties of each measurement instrument based on van Tulder et al. (2003).

Instrument Internal consistency Reliability Measurement error Content validity Structural validity Hypothesis testing Criterion Validity Responsiveness

1. BFS * + + Na * na na na
2. COVS Na ? na Na na ++ +++ ++
3. DEMMI ++ + +++ na na na +++ +++
4. FGI ? + + na +++ ++ +++ +++
5. HABAM Na + na na na na na na
6. SAM * ? ? na * na ? na
7. SPPB Na ++ ++ na na na +++ +++
8.TUG Na ? ++ na na ++ ? ++
9.Tinetti scale Na +++ ++ na na ++ ++ +
10. 6mWT * ++ ++ na * na ++ ++
11.10mWT * + + na * na ++ +

+++ or − - Strong evidence positive/negative result, ++ or − moderate evidence positive/negative result, + or − limited evidence.
Positive/negative result, ± conflicting evidence,? Unknown, due to poor methodological quality, na no information available, * not applicable.

adequately covers the domain under investigation (Vogelzang, 2015). independence in activities of daily living. Those two instruments are
Four instruments presented multiple dimensions but only FGI reported commonly used in acute care but if the goal is to evaluate change in
about structural validity. Structural or construct validity refers to how mobility DEMMI is the best choice.
well a measurement instrument is capable of measuring the theoretical Our summary assessment of the measurement properties showed
concept being investigated and to the number of dimensions that the that DEMMI, SPPB and Tinetti scale had the most extensive and robust
score can explain. Assessment of structural validity involves factor qualities, but DEMMI was the only instrument that had its measurement
analysis and aims to identify scale potential structure and to reduce the properties evaluated in acute care patients. Among the three, DEMMI
number of items (Yang et al., 2014). More studies regarding the covered more broadly the mobility concept and can be used at the
structural validity of the instruments presented in this review would bedside. SPPB presented a mixed population evaluated at hospital and
allow researchers to choose an instrument capable to cover the mobility in community and Tinetti scale was used only in the community. This
concept and to evaluate more precisely the subjects. information might be considered when choosing an instrument for the
Criterion validity was evaluated for most of the measurement in- hospital field, since psychometric properties are context-specific
struments. COVS, DEMMI, FGI and SPPB presented excellent criterion (Mortenson, Miller, & Auger, 2008). Despite good results, in fact, none
validity(Braun et al., 2015; de Morton et al., 2011; de Morton, of the instruments were scored as excellent on all measurement prop-
Davidson, & Keating, 2013; Gomez, Curcio, Alvarado, erties. They would all benefit from additional psychometric testing,
Zunzunegui, & Guralnik, 2013; Salter, Jutai, Foley, & Teasell, 2010; especially in terms of inter-rater and intra-rater reliability, content and
Yang et al., 2014). FGI is a good instrument to measure mobility and structural validity and responsiveness (Mortenson et al., 2008).
has a good predictive validity for falls (FGI score of 18 being the cutoff For older adults hospital admission in itself is a risky event. Many
point for predicting falls). FGI had a 84% chance of making a correct older patients suffer from functional and mobility decline related to
prediction of falls using a cutoff point of 18 for inpatients. It is of great hospitalization. Identifying patients at risk for mobility decline is an
importance to predict patients who are at increased risk for falling so important step to prevent this event. Independent mobility is also a key
that the clinical team should be alerted to that risk and provide ap- factor in determining readiness for discharge for older adults hospita-
propriate interventions to avoid potentially serious adverse outcomes lized. An instrument that accurately measures and monitors this im-
(Yang et al., 2014). SPPB predicts mortality and functional decline in portant construct for hospitalized older adults would have a range of
older adults discharged from acute care hospitals (Corsonello et al., useful applications in clinical care (de Morton et al., 2008). Studies with
2012). Factors associated with decline in SPPB summary scores over high quality are needed to guarantee appropriate conclusions about the
time can be an early warning system to identify persons at greater risk measurement properties (Schellingerhout et al., 2012). Instruments
for subsequent decline in essential lower body functioning. Regarding capable to detect mobility problems in older adults during the period of
SPPB scores, interventions can be performed to increase falls efficacy hospitalization, including before discharge, are extremely important.
and to improve outcomes in persons recently discharged from hospital The detection of deficits at discharge may mean that further re-
(Miller, Wolinsky, Andresen, Malmstrom, & Miller, 2008). Therefore habilitation services are required to optimize the independence of
choosing an instrument capable of predicting functional decline, falls, lifestyle or that home care services are required to prevent undesired
or other negative outcomes during the hospital stay and in the first outcomes such as falls (Stanko, Goldie, & Nayler, 2001).
weeks after discharge can provide additional information on future
health risk in older acutely ill patients. It also may support and en- 4.1. Limitations
courage the systematic assessment of these objective tests in everyday
clinical practice (Volpato et al., 2011). Our results must be interpreted in the light of some limitations. We
Finally the last measurement property evaluated was responsive- did not evaluate the floor and ceiling effects of the instruments.
ness. DEMMI, FGI and SPPB presented excellent responsiveness. Although COSMIN considered interpretability apart from the mea-
According to Vogelzang (2015) responsiveness is the ability of an in- surement properties evaluation, we believe that those characteristics
strument to measure a meaningful or clinically change in a clinical must be assessed to improve the instruments evaluations especially in
state. Responsiveness is a very important characteristic of a tool since it acute care where older adults may present functional decline before
makes it possible to detect improvements or worsening in mobility and hospitalization. One study about applicability of a toolkit for geriatric
furthermore to determine the therapeutic effectiveness when per- rehabilitation outcomes identified ceiling effects as an important lim-
forming rehabilitative treatment during the stay (Pieber et al., 2015). itation for older patients (Auger et al., 2007). Other limitation is related
DEMMI was significantly more responsive than the Modified Barthel to the evaluation of the content validity. Although we believe that some
Index (small to moderate effect size) in a population making transition instruments may have their content evaluated elsewhere we could not
from hospital to community (de Morton et al., 2011). DEMMI is a find this information in the scientific articles we consulted. As we re-
unidimensional measure of mobility while Barthel measures viewed only the literature presented in databases other sources related

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K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

to the content validity of the instruments were not evaluated by this 30 “questionnaire*".ab,ti.
systematic review. 31 “test*".ab,ti.
32 “measurement*".ab,ti.
5. Conclusion 33 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32
34 exp Inpatients/
This review has provided an important contribution to knowledge 35 “inpatient*".ab,ti.
by comprehensively examining existing of mobility instruments that 36 hospitali?ed.ab,ti.
could be used in older adults in acute care or intensive rehabilitation. 37 acute care.ab,ti.
Eleven mobility instruments used to evaluate older adults in acute care 38 34 or 35 or 36 or 37
and rehabilitation units were identified. Judgement-based instruments 39 8 and 22 and 33 and 38
covered the mobility construct more broadly than performance-based 40 limit 39 to yr = “2001 −Current”
measures. We concluded that DEMMI, SPPB and Tinetti scale had the
best balance between applicability, reliability, validity and respon- HaPI search strategy for existing mobility outcome measures
siveness. We recommend more studies about the measurement prop-
erties of these instrument especially regarding reliability (larger re- 1 aged.mp. [mp = title, acronym, descriptors, measure descriptors,
presentative samples), content and structural validity. Selecting which sample descriptors, abstract, source]
instrument to use in acute care and rehabilitation units remains a 2 geriatric*.mp. [mp = title, acronym, descriptors, measure de-
challenge. scriptors, sample descriptors, abstract, source]
3 gerontol*.mp. [mp = title, acronym, descriptors, measure de-
Funding scriptors, sample descriptors, abstract, source]
4 elder*.mp. [mp = title, acronym, descriptors, measure descriptors,
This study was funded by Coordination for the Improvement of sample descriptors, abstract, source]
Higher Education Personnel (CAPES), Rio Grande do Norte, Brazil 5 (old people or older).mp. [mp = title, acronym, descriptors, mea-
(Soares Menezes), with salary support from the Fonds de recherche en sure descriptors, sample descriptors, abstract, source]
santé du Québec, Canada (Auger). 6 1 or 2 or 3 or 4 or 5
7 mobility.mp. [mp = title, acronym, descriptors, measure de-
Conflicts of interest scriptors, sample descriptors, abstract, source]
8 gait.mp. [mp = title, acronym, descriptors, measure descriptors,
The authors declare that there is no real or potential conflict of sample descriptors, abstract, source]
interest regarding the possible publication of this paper. 9 walk*.mp. [mp = title, acronym, descriptors, measure descriptors,
sample descriptors, abstract, source]
Appendix A 10 physical performance.mp. [mp = title, acronym, descriptors, mea-
sure descriptors, sample descriptors, abstract, source]
Medline, EMBASE, PsyINFO and COCHRANE search strategy for 11 ambulation.mp. [mp = title, acronym, descriptors, measure de-
existing mobility outcome measures scriptors, sample descriptors, abstract, source]
12 ((disability or disabilities) adj2 (function* or physical)).mp.
1 exp Aged/ [mp = title, acronym, descriptors, measure descriptors, sample de-
2 exp Geriatrics/ scriptors, abstract, source]
3 aged.ab,ti 13 handicap*.mp. [mp = title, acronym, descriptors, measure de-
4 “geriatric*".ab,ti scriptors, sample descriptors, abstract, source]
5 “gerontol*".ab,ti 14 (impairment* adj2 (physical or function*)).mp. [mp = title, ac-
6 “elder*".ab,ti ronym, descriptors, measure descriptors, sample descriptors, ab-
7 (old people or older).ab,ti stract, source]
8 1 or 2 or 3 or 4 or 5 or 6 or 7 15 disabled.mp. [mp = title, acronym, descriptors, measure de-
9 exp Mobility Limitation/ scriptors, sample descriptors, abstract, source]
10 exp Disability Evaluation/ 16 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15
11 exp Disabled Persons/ 17 inpatient*.mp. [mp = title, acronym, descriptors, measure de-
12 exp Gait/ scriptors, sample descriptors, abstract, source]
13 exp Postural Balance/ 18 hospitali?ed.mp. [mp = title, acronym, descriptors, measure de-
14 exp Walking/ scriptors, sample descriptors, abstract, source]
15 gait.ab,ti. 19 acute care.mp. [mp = title, acronym, descriptors, measure de-
16 “walk*".ab,ti. scriptors, sample descriptors, abstract, source]
17 physical performance.ab,ti. 20 17 or 18 or 19
18 ambulation.ab,ti. 21 6 and 16 and 20
19 ((disability or disabilities) adj2 (function* or physical)).ab,ti. 22 limit 21 to yr = “2001 −Current”
20 “handicap*".ab,ti.
21 (impairment* adj2 (physical or function*)).ab,ti. CINHAL search strategy for existing mobility outcome measures
22 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or
21 1 (MH “Aged+")
23 exp Questionnaires/ 2 (MH ‘Geriatrics’)
24 exp Disability Evaluation/ 3 TI aged OR AB aged
25 exp “Outcome and Process Assessment (Health Care)"/ 4 TI geriatric* OR AB geriatric*
26 exp Data Collection/ 5 TI gerontol* OR AB gerontol*
27 exp Geriatric Assessment/ 6 TI elder* OR AB elder*
28 “assessment*".ab,ti. 7 TI (old people OR older) OR AB (old people OR older)
29 “instrument*".ab,ti. 8 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7

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K.V.R. Soares Menezes et al. Archives of Gerontology and Geriatrics 72 (2017) 67–79

9 (MH “Physical Mobility”) 14 “GAIT'S” or “GAIT/" or ‘GAIT/DE’ or “GAIT/DI” or “GAIT/ET” or

10 (MH “Disability Evaluation + ") “GAIT/GE” or “GAIT/IS” or “GAIT/PA” or “GAIT/PH” or “GAIT/PP”
11 (MH “Gait + ") or “GAIT/RH” or “GAIT/TH”
12 (MH “Balance, Postural”) 15 “WALK” or “WALK'"
13 MH “Walking + ") 16 ‘WALK-TEST’
14 TI gait OR AB gait 17 “WALKABILITY”
15 TI walk* OR AB walk* 18 “WALKING”
16 TI physical performance OR AB physical performance 19 “WALKING-RUNNING”
17 TI mobility OR AB mobility 20 “WALKING/CL” or “WALKING/ED” or “WALKING/PH” or
18 TI ambulation OR AB ambulation “WALKING/PX” or “WALKING/SN” or “WALKING/ST” or
19 TI ((disability OR disabilities) N2 (function* or physical)) OR AB “WALKING/TD”
((disability OR disabilities) N2 (function* or physical)) 21 “POSTURAL BALANCE” or “POSTURAL BALANCE/" or ‘POSTURAL
20 TI handicap* OR AB handicap* BALANCE/DE’ or “POSTURAL BALANCE/PH”
21 TI (impairment* N2 (physical OR function*)) OR AB (impairment* 22 “MOBILITY”
N2 (physical OR function*)) 23 “MOBILITY LIMITATION” or “MOBILITY LIMITATION/"
22 S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 24 ‘MOBILITY'S’
OR S18 OR S19 OR S20 OR S21 25 “MOBILITY." or ‘MOBILITY/" or “MOBILITY/CL’ or ‘MOBILITY/DI’
23 (MH “Questionnaires + ") or “MOBILITY/EP” or “MOBILITY/ET” or “MOBILITY/FVC” or
24 (MH “Disability Evaluation + ") “MOBILITY/HI”
25 (MH “Process Assessment (Health Care) + ") 26 “MOBILITY/LOCOMOTION”
26 (MH “Outcome Assessment”) 27 “MOBILITY/PC”
27 (MH “Data Collection + ") 28 “MOBILITY/PHYSICAL”
28 (MH “Geriatric Assessment + ") 29 “MOBILITY/PP” or “MOBILITY/RH” or “MOBILITY/SN” or
29 TI assessment* OR AB assessment* “MOBILITY/SU” or “MOBILITY/TD” or “MOBILITY/TH”
30 TI instrument* OR AB instrument* 30 “MOBILITYLIMITATIONS”
31 TI questionnaire* OR AB questionnaire*
32 TI test* OR AB test* Appendix B
33 TI measurement* OR AB measurement*
34 S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 Medline search strategy for clinimetric articles of existing mobility
OR S32 OR S33 outcome measures
35 (MH “Inpatients”)
36 (MH “Acute Care”) 1 clin?metric.mp
37 TI inpatient* OR AB inpatient* 2 exp Psychometrics/
38 TI hospitali?ed OR AB hospitali?ed 3 person?metric.mp
39 TI acute care OR AB acute care 4 validity.mp
40 S35 OR S36 OR S37 OR S38 OR S39 5 reliability.mp
41 S8 AND S22 AND S34 AND S40 6 unidimensional$.mp
7 (Rash adj analys$).mp
LILACS search strategy for existing mobility outcome measures 8 discriminability.mp
9 responsiveness.mp
1 “AGED” or “AGED, 80 and over” or “frail older adults” 10 interpretability.mp.
2 “HOSPITALIZED” or “HOSPITALIZED." 11 feasibility.mp.
3 “HOSPITALIZED/" 12 (minimal detectable change or MDC).mp.
4 “HOSPITALIZEDPATIENTS” 13 (minimally clinically important difference or MCID).mp.
5 “HOSPITALIZEDPERSONS” 14 sensitivity.mp.
6 “HOSPITALIZEDS” 15 (standardised response mean or SRM).mp.
7 “INPATIENT” 16 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14
8 “INPATIENT CARE UNITS” or “INPATIENT CARE UNITS/" or 15
9 ‘INPATIENT'S’ or “INPATIENT." or ‘INPATIENTS’ or “INPATIENTS'" 17 NAME OF EACH OUTCOME MEASURE.mp.
or “INPATIENTS'" or “INPATIENTS/" 18 16 AND 18
10 “GAIT” or “GAIT ATAXIA” or “GAIT ATAXIA/" or ‘GAIT ATAXIA/DI’
11 “GAIT ATAXIA/ET” or “GAIT ATAXIA/GE” or “GAIT ATAXIA/PA” References
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