Perme Intensive Care Unit Mobility Score

Original Editor - Redisha Jakibanjar Top Contributors - Redisha Jakibanjar

Objective

  • To measure the patient's mobility status. [1]
  • The scale scoring starts with the ability of the patient to follow the command and ends in the distance walked in 2 minutes[1]
  • The tool is indicative of functional performance especially, patient's walking capacity in the ICU at a specific moment in time. [1]

Intended Population

  • Patients with limited independent activities and are in critical illness.[1]

Method of Use

The outcome tool has 15 items and the score ranges from 0 to 32. There are 7 categories (mental status, potential mobility barriers, functional strength, bed mobility, transfers, gait, and endurance). The higher the score, it indicates fewer potential mobility barriers and decreased assistance whereas, the lower the score, it indicates more potential barriers to mobility and more assistance needed for mobility.[1]

The items included in the category mental health are alertness level and ability to follow the command. The alertness level can be scored as unresponsive (0), lethargic(1), and awake and alert(2). The ability to follow command can be scored as no(0) and yes (1). The result from this category helps us to determine the patient's ability to do the mobility. The maximum score of this category is 3.[1]

Potential mobility barriers include items 3 to 6 i.e, use of a mechanical ventilator, pain, use of multiple lines and tubes, use of any drips. The 3rd item is scored as yes(0) or no(1) based on whether the patient is on mechanical ventilation or noninvasive ventilation. Item 4 is pain and if the patient has no pain it is scored as 1 and if the patient has pain or unable to express, it is scored as 0. The 5th item of the scale is related to external appliances or any assistive device and scored as yes(0) and no (1). And if patient has any drip or medication on use, item 6 is scored as yes(0) and no (1).[1]

Functional strength focuses on the capacity of the patient to move the upper and lower limbs. Item 7 assesses the strength of legs whereas item 8 assesses the strength of arms.Each item is again divided into the right and left side and scored as ye(1)s or no(0). The maximum point scored in this category is 4. To achieve the maximal point, the patient must be able to lift both legs against gravity till 20 degrees with knees straight and lift both arms to 45 degrees with the elbow straight. [1]

The 4th category of the scale is bed mobility and it includes items 9 and 10.Patient is asked to do the bed mobility from supine to sit in item 9 and in item 10, the static sitting balance is assessed.the maximum score obtained in this category is 6. [1]

In the category 5, the patient's ability to transfer is assessed. Item 11 addresses the sit to stand, item 12 addresses the standing balance when standing is achieved and item 13 addresses transfer from bed to chair or chair to bed. The scoring of all three items is done based on the assistance required.[1]

The category gait addresses the patient's ability to walk with or without assistance and scored based on the assistance required. The maximum score that can be obtained is 3. [1]

The final category is endurance and it focuses on the patient's capacity to walk in 2 minutes regardless of the level of assistance required including rest periods (sitting or standing), with or without an assistive device. The scoring is done on basis of distance walked and the maximum score obtained is 3. [1]

Evidence

Reliability

Interrater reliability (Cohen κ coefficient) for[2]

  • items 2, 3, 5, 6, 7, 8, 13, and 15 was 1.0000
  • item 1, 0.8276
  • item 4, 0.8000
  • item 9, 0.6000
  • item 10, 0.7297
  • item 11, 0.7260
  • item 12, 0.7872
  • and item 14, 0.9048

The intraclass correlation coefficient (95% confidence interval) was 0.9880 (0.97743-0.99859)[2]

Validity

  • supported by expert concurrence and
  • The clinical use of this outcome tool is acceptable.

Links

https://www.permeicuseminars.com/copy-of-perme-score

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Perme C, Nawa RK, Winkelman C, Masud F. A tool to assess mobility status in critically ill patients: the Perme Intensive Care Unit Mobility Score. Methodist DeBakey cardiovascular journal. 2014 Jan;10(1):41.
  2. 2.0 2.1 Nawa RK, Lettvin C, Winkelman C, Evora PR, Perme C. Initial interrater reliability for a novel measure of patient mobility in a cardiovascular intensive care unit. Journal of Critical Care. 2014 Jun 1;29(3):475-e1.