State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy.

PURPOSE OF REVIEW: Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS: Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

Reliability and validity of the German translation of the de Morton Mobility Index (DEMMI) performed by physiotherapists in patients admitted to a sub-acute inpatient geriatric rehabilitation hospital.

BACKGROUND: Mobility is a key outcome in geriatric rehabilitation. The de Morton Mobility Index (DEMMI) is an internationally well-established, unidimensional measure of mobility with good psychometric properties. The aim of this study was to examine the reliability and construct validity of the German translation of the DEMMI in geriatric inpatients. METHODS: This cross-sectional study included patients admitted to a sub-acute inpatient geriatric rehabilitation hospital (reliability sample: N = 33; validity sample: N = 107). Reliability, validity, and unidimensionality were investigated. RESULTS: Inter-rater reliability between two graduate physiotherapists was excellent, with intra-class correlation coefficient of 0.94 (95% confidence interval: 0.88-0.97). The minimal detectable change with 90% confidence was 9 points. Construct validity for the DEMMI was evidenced by significant moderate to strong correlations with other measures of mobility and related constructs (Performance Oriented Mobility Assessment: rho = 0.89; Functional Ambulation Categories: rho = 0.70; six-minute walk test: rho = 0.73; gait speed: rho = 0.67; Falls Efficacy Scale International: rho = -0.68). Known-groups validity was indicated by significant DEMMI mean group differences between independent versus dependent walkers and walking aid users versus non-users. Unidimensionality of the German DEMMI translation was confirmed by Rasch analysis. CONCLUSIONS: The German translation of the DEMMI is a unidimensional instrument producing valid and reproducible measurement of mobility in an inpatient geriatric rehabilitation setting.

A systematic review of interventions for children with cerebral palsy: state of the evidence.

AIM: The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). METHOD: This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. RESULTS: Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). INTERPRETATION: Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

The development of the de morton mobility index (DEMMI) in an older acute medical population: item reduction using the Rasch model (part 1).

The DEMMI (de Morton Mobility Index) is a new and advanced instrument for measuring the mobility of all older adults across clinical settings. It overcomes practical and clinimetric limitations of existing mobility instruments. This study reports the process of item reduction using the Rasch model in the development of the DEMMI. Prior to this study, qualitative methods were employed to generate a pool of 51 items for potential inclusion in the DEMMI. The aim of this study was to reduce the item set to a unidimensional subset of items that ranged across the mobility spectrum from bed bound to high levels of independent mobility. Fifty-one physical performance mobility items were tested in a sample of older acute medical patients. A total of 215 mobility assessments were performed. Seventeen mobility items that spanned the mobility spectrum were selected for inclusion in the new instrument. The 17 item scale fitted the Rasch model. Items operated consistently across the mobility spectrum regardless of patient age, gender, cognition, primary language or time of administration during hospitalisation. Using the Rasch model, an interval level scoring system was developed with a score range of 0 to 100.

The Development of the de Morton Mobility Index (DEMMI) in an independent sample of older acute medical patients: refinement and validation using the Rasch model (part 2).

This study describes the refinement and validation of the 17-item DEMMI in an independent sample of older acute medical patients. Instrument refinement was based on Rasch analysis and input from clinicians and researchers. The refined DEMMI was tested on 106 older general medical patients and a total of 312 mobility assessments were conducted. Based on the results of this study a further 2 items were removed and the 15 item DEMMI was adopted. The Rasch measurement properties of the DEMMI were consistent with estimates obtained from the instrument development sample. No differential item functioning was identified and an interval level scoring system was established. The DEMMI is the first mobility instrument for older people to be developed, refined and validated using the Rasch model. This study confirms that the DEMMI provides clinicians and researchers with a unidimensional instrument for measuring and monitoring changes in mobility of hospitalised older acute medical patients.

An investigation of the validity of six measures of physical function in people awaiting joint replacement surgery of the hip or knee.

OBJECTIVE: To assess and compare the validity of six physical function measures in people awaiting hip or knee joint replacement. DESIGN: Eighty-two people awaiting hip or knee replacement were assessed using six physical function measures including the WOMAC Function scale, SF-36 Physical Function scale, SF-36 Physical Component Summary scale, Patient Specific Functional Scale, 30-second chair stand test, and 50-foot timed walk. Validity was assessed using a head-to-head comparison design. RESULTS: Convergent validity was demonstrated with significant correlations between most measures (Spearman's rho 0.22 to 0.71). The Patient Specific Functional Scale had the lowest correlations with other measures of physical function. Discriminant validity was demonstrated with low correlations between mental health and physical function scores (Spearman's rho -0.12 to 0.33). Only the WOMAC Function scale, 30-second chair stand test, and 50-foot timed walk demonstrated known groups validity when scores for participants who walked with a gait aid were compared with those who did not. Standardized response means and Guyatt's responsiveness indexes indicated that the SF-36 was the least responsive measure. CONCLUSIONS: For those awaiting joint replacement surgery of the hip or knee, the current investigation found that the WOMAC Function scale, 30-second chair stand test, and 50-foot timed walk demonstrated the most evidence of validity. The Patient Specific Functional Scale might complement other measures by capturing a different aspect of physical function.

Factors that predict discharge destination for patients in transitional care: a prospective observational cohort study.

OBJECTIVE: To investigate factors that predict discharge destination for patients making the transition from hospital to the community. METHODS: Using a prospective cohort design, 696 patients from 11 Transition Care Programs were recruited. Baseline patient and program characteristics were considered for predicting discharge destination, functional status, and patient length of stay. RESULTS: An increased physiotherapy staffing ratio in Transition Care Program was associated with an increased likelihood that a patient was discharged home, with an improved functional or mobility status, and after a shorter length of stay. The other factor that predicted discharge to home included having an Aged Care Assessment Service classification of low level care or home with a support package. An increased physiotherapy staffing level also reduced the likelihood of discharge to low level or high level care. The other factors that predicted discharge to low level care were having higher mobility status and older age; the other factor associated with increased likelihood of predicting discharge to high level care was having an Aged Care Assessment Service classification of high level care. CONCLUSIONS: Factors on admission that predicted discharge destination were program physiotherapy staffing ratios, Aged Care Assessment Service assessment, age and mobility status.

Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults.

OBJECTIVE: To investigate the clinimetric properties of the de Morton Mobility Index (DEMMI) in healthy, community-dwelling older adults. DESIGN: Cohort study. SETTING: Retirement village and Returned and Services League (RSL) club in Melbourne, Australia. PARTICIPANTS: All participants were 65 years or older, healthy, and living within the community. The validation study included participants recruited from a retirement village (n=61), and the reliability studies included participants recruited from an RSL club and a subset of participants from the retirement village. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility was assessed using the DEMMI. The percentage of participants who scored the highest and lowest possible score on the DEMMI was calculated to determine whether a floor or ceiling effect occurred. The minimal clinically important difference (MCID) was estimated using a distribution-based method. Reliability was assessed independently and concurrently using the minimal detectable change at 90% confidence (MDC90). RESULTS: Evidence of convergent and discriminant validity was obtained for the DEMMI by examining correlations with measures of related constructs, the Lower Extremity Functional Scale (r=.69) and Quality of Life Scale scores (r=.28), respectively. Participants who ambulated without a gait aid (82.62±10.63) had significantly higher (P<.0) DEMMI scores than those who ambulated with an aid (64.1±12.40), providing evidence of known groups validity. No floor or ceiling effect was identified. The MCID was 7 points. The MDC90 was 13 (95% CI, 8.76-17.05) points on the 100-point scale. CONCLUSION: DEMMI scores in healthy, community-dwelling older adults are both valid and reliable.

Reproducibility and validity of the Dutch translation of the de Morton Mobility Index (DEMMI) used by physiotherapists in older patients with knee or hip osteoarthritis.

OBJECTIVE: To examine the reproducibility, construct validity, and unidimensionality of the Dutch translation of the de Morton Mobility Index (DEMMI), a performance-based measure of mobility for older patients. DESIGN: Cross-sectional study. SETTING: Rehabilitation center (reproducibility study) and hospital (validity study). PARTICIPANTS: Patients (N=28; age >65y) after orthopedic surgery (reproducibility study) and patients (N=219; age >65y) waiting for total hip or total knee arthroplasty (validity study). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The intraclass correlation coefficient for interrater reliability was high (.85; 95% confidence interval, 71-.93), and minimal detectable change with 90% confidence was 7 on the 100-point DEMMI scale. Rasch analysis identified that the Dutch translation of the DEMMI is a unidimensional measure of mobility in this population. DEMMI scores showed high correlations with scores on other performance-based measures of mobility (Timed Up and Go test, Spearman r=-.73; Chair Rise Time, r=-.69; walking test, r=.74). A lower correlation of .44 was identified with the self-report measure Western Ontario and McMaster Universities Osteoarthritis Index. CONCLUSIONS: The Dutch translation of the DEMMI is a reproducible and valid performance-based measure for assessing mobility in older patients with knee or hip osteoarthritis.

Validity, responsiveness and the minimal clinically important difference for the de Morton Mobility Index (DEMMI) in an older acute medical population.

BACKGROUND: The de Morton Mobility Index (DEMMI) is a new mobility instrument that overcomes the limitations of existing instruments. It is the first mobility instrument that accurately measures the mobility of all older adults. The aim of this study was to provide a detailed report of investigations of the validity, responsiveness to change and minimal clinically important difference (MCID) of the DEMMI during its development in an older acute medical population. METHODS: This study was conducted using a head to head comparison design in two independent samples of older acute medical patients (development sample, n = 86; validation sample, n = 106). Consecutive patients (≥ 65 years) were assessed using the DEMMI, Barthel Index (BI) and Hierarchical Assessment of Balance and Mobility (HABAM) within 48 hours of hospital admission and discharge. Convergent and discriminant validity were investigated using Spearman's rho and known groups validity was investigated using a independent t test to compare DEMMI scores for patients who were discharged to home compared to inpatient rehabilitation. Criterion and distribution based methods were employed for estimating instrument responsiveness to change and the MCID. RESULTS: Significant moderate to high correlations were identified between DEMMI and BI scores (r = 0.76 and r = 0.68) and DEMMI and HABAM scores (r = 0.91 and r = 0.92) in both samples. In both samples, DEMMI scores for patients who were discharged to home were significantly higher than for patients discharged to inpatient rehabilitation and provided evidence of known groups validity. Patients who were discharged to inpatient rehabilitation (n = 8) had a mean DEMMI score of 50.75 (sd = 11.29) at acute hospital discharge compared to patients who were discharged to home (n = 70) with a mean DEMMI score of 62.14 (sd = 18.41). MCID estimates were similar across samples using distribution and criterion based methods. The MCID for the DEMMI was 10 points on the 100 point interval scale. The DEMMI was significantly more responsive to change than the BI using criterion and distribution based methods in the validation sample. CONCLUSION: This study has validated the DEMMI in two independent samples of older acute medical patients. Estimates of its responsiveness and MCID have also been established. This study confirms that the DEMMI overcomes the limitations of the BI and HABAM and provides an advanced method for objectively assessing mobility for older acute medical patients.

The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.

QUESTIONS: Does the PEDro scale measure only one construct ie, the methodological quality of clinical trials? What is the hierarchy of items of the PEDro scale from least to most adhered to? Is there any effect of year of publication of trials on item adherence? Are PEDro scale ordinal scores equivalent to interval data? DESIGN: Rasch analysis of two independent samples of 100 clinical trials from the PEDro database scored using the PEDro scale. RESULTS: Both samples of PEDro data showed fit to the Rasch model with no item misfit. The PEDro scale item hierarchy was the same in both samples, ranging from the most adhered to item random allocation, to the least adhered to item therapist blinding. There was no differential item functioning by year of publication. Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores (r = 0.99). CONCLUSION: The PEDro scale is a valid measure of the methodological quality of clinical trials. It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis.

The de Morton Mobility Index (DEMMI): an essential health index for an ageing world.

BACKGROUND: Existing instruments for measuring mobility are inadequate for accurately assessing older people across the broad spectrum of abilities. Like other indices that monitor critical aspects of health such as blood pressure tests, a mobility test for all older acute medical patients provides essential health data. We have developed and validated an instrument that captures essential information about the mobility status of older acute medical patients. METHODS: Items suitable for a new mobility instrument were generated from existing scales, patient interviews and focus groups with experts. 51 items were pilot tested on older acute medical inpatients. An interval-level unidimensional mobility measure was constructed using Rasch analysis. The final item set required minimal equipment and was quick and simple to administer. The de Morton Mobility Index (DEMMI) was validated on an independent sample of older acute medical inpatients and its clinimetric properties confirmed. RESULTS: The DEMMI is a 15 item unidimensional measure of mobility. Reliability (MDC(90)), validity and the minimally clinically important difference (MCID) of the DEMMI were consistent across independent samples. The MDC(90) and MCID were 9 and 10 points respectively (on the 100 point Rasch converted interval DEMMI scale). CONCLUSION: The DEMMI provides clinicians and researchers with a valid interval-level method for accurately measuring and monitoring mobility levels of older acute medical patients. DEMMI validation studies are underway in other clinical settings and in the community. Given the ageing population and the importance of mobility for health and community participation, there has never been a greater need for this instrument.

A systematic review of mobility instruments and their measurement properties for older acute medical patients.

BACKGROUND: Independent mobility is a key factor in determining readiness for discharge for older patients following acute hospitalisation and has also been identified as a predictor of many important outcomes for this patient group. This review aimed to identify a physical performance instrument that is not disease specific that has the properties required to accurately measure and monitor the mobility of older medical patients in the acute hospital setting. METHODS: Databases initially searched were Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials without language restriction or limits on year of publication until July 2005. After analysis of this yield, a second step was the systematic search of Medline, Cinahl and Embase until August 2005 for evidence of the clinical utility of each potentially suitable instrument. Reports were included in this review if instruments described had face validity for measuring from bed bound to independent levels of ambulation, the items were suitable for application in an acute hospital setting and the instrument required observation (rather than self-report) of physical performance. Evidence of the clinical utility of each potentially suitable instrument was considered if data on measurement properties were reported. RESULTS: Three instruments, the Elderly Mobility Scale (EMS), Hierarchical Assessment of Balance and Mobility (HABAM) and the Physical Performance Mobility Examination (PPME) were identified as potentially relevant. Clinimetric evaluation indicated that the HABAM has the most desirable properties of these three instruments. However, the HABAM has the limitation of a ceiling effect in an older acute medical patient population and reliability and minimally clinically important difference (MCID) estimates have not been reported for the Rasch refined HABAM. These limitations support the proposal that a new mobility instrument is required for older acute medical patients. CONCLUSION: No existing instrument has the properties required to accurately measure and monitor mobility of older acute medical patients.

Rasch analysis of the barthel index in the assessment of hospitalized older patients after admission for an acute medical condition.

OBJECTIVE: To investigate the validity of item score summation for the original and modified versions of the Barthel Index. DESIGN: Rasch analysis of Barthel Index data. SETTING: General medical wards at 2 acute care hospitals in Australia. PARTICIPANTS: Consecutive older medical patients (N=396). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Activity limitation was assessed by using the Barthel Index at hospital admission and discharge. At 1 hospital site, the original Barthel Index was used, and at the other hospital site the Modified Barthel Index (MBI) was used. RESULTS: More than half of the items showed misfit to the Rasch model for both versions of the Barthel Index. The continence items appear to measure a different construct to the other items. After the removal of the continence items, data for the remaining items still did not fit the Rasch model. Neither the original nor the MBI are unidimensional scales. An exception to this occurred when the original Barthel Index was rescored and only then for discharge and not for admission Barthel Index data. CONCLUSIONS: Because clinicians do not typically rescore outcomes obtained by using the Barthel Index, these findings, combined with unacceptable ceiling effects, render the Barthel Index an assessment tool with limited validity for measuring and monitoring the health of older medical patients.

Additional exercise does not change hospital or patient outcomes in older medical patients: a controlled clinical trial.

QUESTION: What are the effects of additional exercise on hospital and patient outcomes for acutely-hospitalised older medical patients? DESIGN: Controlled clinical trial. PARTICIPANTS: 236 Patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003. INTERVENTION: The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge. The control group received usual care only. OUTCOME MEASURES: The primary outcome was discharge destination. Secondary outcomes were measures of activity limitation (Barthel Index, Timed Up and Go, Functional Ambulation Classification), length of stay, and adverse events. RESULTS: There was no significant effect of the additional exercise program on any outcome. There were no significant differences between groups for the proportion of the patients discharged to home (RR 0.99, 95% CI 0.86 to 1.14) or inpatient rehabilitation (RR 0.76, 95% CI 0.30 to 1.51) or for measures of activity limitation at hospital discharge. A one day difference in length of stay was identified between groups but this difference was not significant (p = 0.45). There were no significant differences between groups for adverse events: 28-day readmission (RR 1.10, 95% CI 0.65 to 1.86), patient mortality (RR 1.15, 95% CI 0.16 to 8.0), intensive care admission (RR 0.16, 95% CI 0.01 to 3.13) and falls (RR 0.69, 95% CI 0.17 to 2.81). CONCLUSION: Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes.

A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population.

PURPOSE: To compare the clinimetric properties of the de Morton Mobility Index (DEMMI®) and the Elderly Mobility Scale (EMS). METHOD: A head-to-head comparison of the EMS and DEMMI® with 120 consecutive older acute medical patients. The DEMMI® and EMS were administered within 48 h of hospital admission and discharge. RESULTS: At admission, 6% and 15% of participants scored the lowest scale score for the DEMMI® and EMS, respectively. For the DEMMI®, 17% of participants scored within the minimal detectable change of the lowest scale score compared to 20% for the EMS at admission. At hospital discharge, DEMMI® scores were normally distributed and the EMS had a ceiling effect. Similar evidence of convergent, discriminant and known groups validity were obtained for the DEMMI® and EMS. There was no significant difference in responsiveness to change between the DEMMI® and EMS. The EMS was significantly quicker to administer compared to the DEMMI®. CONCLUSION: The DEMMI® and EMS are both valid measures of mobility for older acute medical patients. The DEMMI® has a broader scale width than the EMS with interval level measurement and therefore provides a more accurate method for measuring and monitoring changes in mobility for older acute medical patients. Implications for Rehabilitation Mobility of older acute medical patients. Hospitalised older acute medical patients are at "high risk" of mobility decline. Accurate measurement of mobility is essential for preventing and treating mobility decline. Many existing mobility measures have significant measurement limitations. The DEMMI® is a more accurate measure of mobility than the EMS in an older acute medical population.

Back pain and social isolation: cross-sectional validation of the friendship scale for use in studies on low back pain.

BACKGROUND: Low back pain (LBP) is common, and social isolation is both a risk factor for poor recovery and a consequence. However, no studies seem to have validated social isolation measures in LBP populations. AIMS: This study assessed the validity of the Friendship Scale (FS), a brief measure of social isolation. METHODS: LBP participants were 100 consecutive consenting adult patients attending physiotherapy outpatient clinics, matched (1:2) by age and gender with a general population sample (GPS; n=200). FS validation was through factor analysis, internal consistency, sensitivity by known groups, and Rasch analysis. RESULTS: : There were significant differences between LPB and GPS on 5 of the 6 FS items. Social isolation on the FS was reported by 26% of the LBP cohort compared with 9% of the GPS. All FS items loaded on the principal component >0.60, suggesting unidimensionality. Internal consistency was α=0.81. The FS was sensitive by pain severity and study cohort. Rasch analysis showed no disordered items, although 2 items were marginally misfitting. Differential item functioning by sex was observed on 1 item; there was no other observed differential item functioning. After removal of the worst fitting item (feeling alone), the remaining items fit the Rasch model. This, however, may have been a function of study samples. CONCLUSIONS: Generally, the FS performed well, and its descriptive system contains excess capacity beyond that needed in the study population; that is, those with LBP were not particularly socially isolated, and responses indicating severe social isolation were barely reported by these participants. Overall, the FS appears to be a suitable instrument for assessing social isolation among LBP patients.

Measuring mobility in patients living in the community with Parkinson disease.

QUESTION: Is the de Morton Mobility Index (DEMMI) valid for measuring the mobility of patients living in the community with Parkinson disease (PD)? DESIGN: A prospective cohort study comparing the DEMMI with existing mobility-related activity measures. PARTICIPANTS: 102 consecutive patients with PD (mean age 72.4 years, SD 8.3) who received multidisciplinary outpatient care in a community rehabilitation facility over 6 to 8 weeks. OUTCOME MEASURES AND ANALYSIS: The DEMMI and other measures of mobility-related activity at admission and discharge (10 metre walk test, Berg balance scale, timed up and go test, functional reach test and pull test) were used to assess convergent validity. Discriminant validity of the DEMMI was assessed by comparison to measures of other constructs, and. unidimensionality was examined using Rasch analysis. RESULTS: Evidence of convergent (rho ranged from 0.47 to 0.84), discriminant (rho ranged 0.12 to 0.22), and known groups validity were obtained for the DEMMI (Mean difference 20.3 units, 95% CI 14.5 to 26.0). Rasch analysis confirmed that the DEMMI was unidimensional. CONCLUSION: The DEMMI has a broader scale width than existing mobility-related activity measures, provides interval level measurement and is a unidimensional measure of mobility in patients with PD living in the community.

Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation.

PURPOSE: Many patients suffer long term loss of mobility after hip fracture but there is no gold standard method for measuring mobility in this group. We aimed to validate a new mobility outcome measure, the de Morton Mobility Index (DEMMI) in a hip fracture population during inpatient rehabilitation. METHOD: The DEMMI was compared with the existing measures of activity limitation: 6 minute walk test, 6 metre walk test and Barthel Index on 109 consecutive patients admitted to rehabilitation after surgery for hip fracture. Patients were assessed by a physiotherapist at admission and discharge. Scale width, validity, minimal clinically important difference (MCID), responsiveness, and unidimensionality were investigated. RESULTS: Evidence of convergent, discriminant and known groups validity were obtained for the DEMMI. Responsiveness was similar across instruments and the MCIDs were consistent with previous reports. A floor effect was identified for the 6 metre walk test and 6 minute walk test at hospital admission. Rasch analysis identified that the DEMMI maintains its unidimensional properties in this population. CONCLUSIONS: The DEMMI has a broader scale width than existing measures of activity limitation and provides a unidimensional measure of mobility for hip fracture patients during inpatient rehabilitation.