Elderly Mobility Scale
Original Editor - Lauren Lopez
Top Contributors - Lauren Lopez, Kim Jackson, Shaimaa Eldib and Lucinda hampton
Objective[edit | edit source]
To measure the function of frail elderly adults[1].
The Elderly Mobility Scale (EMS) was developed in 1994 as part of an assessment package[1]. It is a relatively simple outcome measure and is quick to administer[2].
Intended Population[edit | edit source]
Frail elderly adults in hospital.
Method of Use[edit | edit source]
The following is from the Chartered Society of Physiotherapists and can be accessed here (includes instructions, form for recording scores and some simple interpretation of scores).
Equipment: Metre rule, stopwatch, access to a bed and chair, usual walking aid, form to record scores
Physical space needed: Space for bed, chair, wall, space for 6m walk
See here for an online calculator for the EMS.
Evidence[edit | edit source]
Reliability[edit | edit source]
Inter-rater reliability: High[3]: two studies[1][4](n=19 and n=15) have shown no significant difference between scores
Intra-rater reliability: No statistically significant differences in scoring by 15 physiotherapists[5].
Validity[edit | edit source]
Content validity: The items of the test show a hierarchy of difficulty with "lie to sit" being the easiest task to perform and the functional reach being the most difficult task to perform[6]. It has been proposed that the EMS measures two dimensions of mobility: bed mobility and functional mobility [6].
Concurrent validity: EMS scores had highly significant correlations with both the Barthel and Functional Independence Measure (FIM) scores for 36 patients, age 70–93 years. (Spearman's rho for Barthel: 0.962, FIM: 0.948)[1]. A significant correlation between EMS and Barthel scores has been demonstrated in a second study (n=66, aged 66-69 years)[4]. A third study[5] (n=32, aged >55 years) has demonstrated concurrent validity with the Modified Rivermead Mobility Index.
Predictive validity: Is not conclusive. One study has shown that those discharged to home from hospital have higher EMS scores than those discharged to inpatient rehabilitation[2]. Another study has demonstrated the use of EMS scores to classify residential care placements[6]. Although results were limited by the study design (cross-sectional rather than prospective), there appears there may be some useful cut off scores which could correlate the level of mobility with a type of residential care required. As the authors suggest, further research is required to confirm this. A third study[4] found EMS scores showed no predictive validity for placement on discharge from hospital.
Responsiveness[edit | edit source]
In one study of 83 patients with a mean age of 79 in a clinical day hospital, researchers found the EMS was significantly more likely (p<0.001) to detect an improvement in mobility following a course of physiotherapy, compare to two other functional measures[7].
Limitations[edit | edit source]
The EMS has been shown to have a ceiling effect[2][3].
Modifications[edit | edit source]
A correction was published by Smith because of an error in the functional reach measurement in the original publication[8]. See above for correct scale.
Evidence for two different modifications to the EMS was published in 2006: the Modified Elderly Mobility Scale (MEMS)[9] and the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS)[3].
The MEMS has added a stair climbing task to the EMS and increased the walk distance from six metres to 10 metres to minimise the ceiling effect[9].
The Swe M-EMS was translated into Swedish from its original English and research shows high inter-rater reliability and correlations with two other functional measures. Researchers found the EMS was limited in its sensitivity as a single measure to record improvement following an acute stroke[3].
Links[edit | edit source]
The Chartered Society of Physiotherapists provides an excellent manual for the use of the EMS, see here.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Smith R. Validation and reliability of the Elderly Mobility Scale. Physiotherapy. 1994; 80 (11): 744-747.
- ↑ 2.0 2.1 2.2 de Morton NA, Nolan J, O'Brien M, Thomas S, Govier A, Sherwell K, Harris B, Markham N. A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population. 2015. Disabil Rehabil, 37:20, 1881-1887.
- ↑ 3.0 3.1 3.2 3.3 Linder A, Winkvist L, Nilsson L, Sernert N. Evaluation of the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS) in patients with acute stroke. Clin Rehabil. 2006; 20 (7): 584-597.
- ↑ 4.0 4.1 4.2 Prosser L, Canby A. Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people. 1997. Clin Rehabil. 11; 338-343.
- ↑ 5.0 5.1 Nolan JS, Remilton LE, Green MM. The Reliability and Validity of the Elderly Mobility Scale in the Acute Hospital Setting. The Internet Journal of Allied Health Sciences and Practice. 2008; 6 (4):1-7.
- ↑ 6.0 6.1 6.2 Yu MSW, Chan CCH, Tsim RKM. Usefulness of the Elderly Mobility Scale for classifying residential placements. Clin Rehabil. 2007; 21(12): 1114–1120.
- ↑ Spilg EG, Martin BJ, Mitchell SL. A comparison of mobility assessments in a geriatric day hospital. Clin Rehabil. 2001; 15: 296-300.
- ↑ Chartered Society of Physiotherapists. EMS section of Outcome Measures manual Version 2. 2012.
- ↑ 9.0 9.1 Kuys SS, Brauer SG. Validation and reliability of the Modified Elderly Mobility Scale. Australas J Ageing. 2006; 25(3): 140-144.
