Skip to main content

Physical performance among patients aged 70 + in acute care: a preliminar comparison between the Short Physical Performance Battery and the De Morton Mobility Index with regard to sensitivity to change and prediction of discharge destination

Aging Clinical and Experimental Research volume 32, pages 579–586 (2020)Cite this article

Abstract

Background

The Short Physical Performance Battery (SPPB) and the De Morton Mobility Index (DEMMI) are two commonly used instruments to assess mobility in older patients.

Aims

To compare the two assessments in acute senior trauma patients with regard to sensitivity to change during an acute care, and prediction of discharge destination.

Methods

Medical records were extracted for consecutive trauma patients aged 70 + receiving acute care rehabilitation in the geriatric ward during 9 months. SPPB and DEMMI were obtained at admission and discharge. Sensitivity was analyzed using paired t tests and Cohen’s d, and discharge destination with logistic regression predicting the probability of returning home.

Results

A total of 69 patients were included in the study [83.7 years (SD 6.3), 78% women, length of stay 10 (IQR 8–10) days]. Overall, SPPB improved from 2.0 (SD 2.5) to 3.8 (SD 2.7; p ≤ 0.001) and DEMMI from 41 (SD 19) to 53 (SD 14; p ≤ 0.001) (Cohen’s d: 0.72 for SPPB, 0.62 for DEMMI). Among patients admitted from home each additional point in SPPB at admission and acquired during acute care rehabilitation increased the odds of returning home by 1.7 times (95% CI 1.1–2.8, p = 0.02) and 1.6 times (95% CI 1.1–2.5, p = 0.02). For DEMMI, every 10 points at admission, but not in change, increased the odds of returning home by 2.5 times (95% CI 1.3–5.0, p = 0.007).

Discussion and conclusion

SPPB and DEMMI are both valid mobility assessments for senior patients in acute care. However, SPPB is a better predictor than DEMMI for discharge destination.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Fried TR, Tinetti ME, Iannone L et al (2011) Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Arch Intern Med 171:1854–1856. https://doi.org/10.1001/archinternmed.2011.424

    Article  PubMed  PubMed Central  Google Scholar 

  2. Covinsky KE, Palmer RM, Fortinsky RH et al (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51:451–458

    Article  Google Scholar 

  3. Patrick DL, Kinne S, Engelberg RA et al (2000) Functional status and perceived quality of life in adults with and without chronic conditions. J Clin Epidemiol 53:779–785

    CAS  Article  Google Scholar 

  4. Moreland JD, Richardson JA, Goldsmith CH et al (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52:1121–1129. https://doi.org/10.1111/j.1532-5415.2004.52310.x

    Article  PubMed  Google Scholar 

  5. McCloskey R (2004) Functional and self-efficacy changes of patients admitted to a geriatric rehabilitation unit. J Adv Nurs 46:186–193. https://doi.org/10.1111/j.1365-2648.2003.02978.x

    Article  PubMed  Google Scholar 

  6. Gaugler JE, Duval S, Anderson KA et al (2007) Predicting nursing home admission in the US: a meta-analysis. BMC Geriatr 7:13. https://doi.org/10.1186/1471-2318-7-13

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zisberg A, Shadmi E, Sinoff G et al (2011) Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc 59:266–273. https://doi.org/10.1111/j.1532-5415.2010.03276.x

    Article  PubMed  Google Scholar 

  8. Campbell SE, Seymour DG, Primrose WR et al (2004) A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing 33:110–115. https://doi.org/10.1093/ageing/afh036

    Article  PubMed  Google Scholar 

  9. Everink IH, van Haastregt JC, van Hoof SJ et al (2016) Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr 16:5. https://doi.org/10.1186/s12877-016-0187-4

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kool J, Oesch P, Bachmann S (2017) Predictors for living at home after geriatric inpatient rehabilitation: a prospective cohort study. J Rehabil Med 49:185–190. https://doi.org/10.2340/16501977-2182

    Article  PubMed  Google Scholar 

  11. Eagles D, Yadav K, Perry JJ et al (2017) Mobility assessments of geriatric emergency department patients: a systematic review. CJEM. https://doi.org/10.1017/cem.2017.46

    Article  PubMed  Google Scholar 

  12. Soares Menezes KVR, Auger C, de Souza Menezes WR et al (2017) Instruments to evaluate mobility capacity of older adults during hospitalization: a systematic review. Arch Gerontol Geriatr 72:67–79. https://doi.org/10.1016/j.archger.2017.05.009

    Article  PubMed  Google Scholar 

  13. Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    CAS  Article  Google Scholar 

  14. Fisher S, Ottenbacher KJ, Goodwin JS et al (2009) Short physical performance battery in hospitalized older adults. Aging Clin Exp Res 21:445–452

    Article  Google Scholar 

  15. Guralnik JM, Ferrucci L, Pieper CF et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231

    CAS  Article  Google Scholar 

  16. Volpato S, Cavalieri M, Guerra G (2008) Performance-based functional assessment in older hospitalized patients: feasibility and clinical correlates. J Gerontol A Biol Sci Med Sci 63:1393–1398

    Article  Google Scholar 

  17. Volpato S, Cavalieri M, Sioulis F et al (2011) Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci 66:89–96. https://doi.org/10.1093/gerona/glq167

    Article  PubMed  Google Scholar 

  18. de Morton NA, Davidson M, Keating JL (2008) The de Morton Mobility Index (DEMMI): an essential health index for an ageing world. Health Qual Life Outcomes 6:63. https://doi.org/10.1186/1477-7525-6-63

    Article  PubMed  PubMed Central  Google Scholar 

  19. de Morton NA, Davidson M, Keating JL (2010) Validity, responsiveness and the minimal clinically important difference for the de Morton Mobility Index (DEMMI) in an older acute medical population. BMC Geriatr 10:72. https://doi.org/10.1186/1471-2318-10-72

    Article  PubMed  PubMed Central  Google Scholar 

  20. de Morton NA, Brusco NK, Wood L et al (2011) The de Morton Mobility Index (DEMMI) provides a valid method for measuring and monitoring the mobility of patients making the transition from hospital to the community: an observational study. J Physiother 57:109–116. https://doi.org/10.1016/S1836-9553(11)70021-2

    Article  PubMed  Google Scholar 

  21. Hulsbæk S, Larsen RF, Rosthøj S et al (2018) The Barthel Index and the Cumulated Ambulation Score are superior to the de Morton Mobility Index for the early assessment of outcome in patients with a hip fracture admitted to an acute geriatric ward. Disabil Rehabil. https://doi.org/10.1080/09638288.2018.1424951

    Article  PubMed  Google Scholar 

  22. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    CAS  Article  Google Scholar 

  23. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    CAS  Article  Google Scholar 

  24. Guigoz Y (2006) The mini nutritional assessment (MNA) review of the literature—what does it tell us? J Nutr Health Aging 10:466–485 (discussion 485–467)

    CAS  PubMed  Google Scholar 

  25. Husted JA, Cook RJ, Farewell VT et al (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    CAS  Article  Google Scholar 

  26. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592. https://doi.org/10.1097/01.MLR.0000062554.74615.4C

    Article  Google Scholar 

  27. Corsonello A, Lattanzio F, Pedone C et al (2012) Prognostic significance of the short physical performance battery in older patients discharged from acute care hospitals. Rejuvenation Res 15:41–48. https://doi.org/10.1089/rej.2011.1215

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dasenbrock L, Berg T, Lurz S et al (2016) The De Morton Mobility Index for evaluation of early geriatric rehabilitation. Z Gerontol Geriatr 49:398–404. https://doi.org/10.1007/s00391-016-1061-x

    CAS  Article  PubMed  Google Scholar 

  29. de Morton NA, Nolan J, O’Brien M et al (2015) A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population. Disabil Rehabil 37:1881–1887. https://doi.org/10.3109/09638288.2014.982832

    Article  PubMed  Google Scholar 

  30. Perera S, Mody SH, Woodman RC et al (2006) Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 54:743–749. https://doi.org/10.1111/j.1532-5415.2006.00701.x

    Article  PubMed  Google Scholar 

  31. Bachmann S, Finger C, Huss A et al (2010) Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 340:c1718

    Article  Google Scholar 

  32. Guralnik JM, Ferrucci L, Simonsick EM et al (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561. https://doi.org/10.1056/NEJM199503023320902

    CAS  Article  PubMed  Google Scholar 

  33. Quadri P, Tettamanti M, Bernasconi S et al (2005) Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients. Aging Clin Exp Res 17:82–89

    Article  Google Scholar 

Download references

Funding

This study was performed without external funding.

Author information

Affiliations

  1. Centre on Aging and Mobility, University Hospital of Zurich, Stadtspital Waid and Triemli, and University of Zurich, C/o Stadtspital Waid, Tièchestrasse 99, 8037, Zurich, Switzerland

    A. Gazzotti, U. Meyer, G. Freystaetter, M. Palzer, R. Theiler, L. Abderhalden & H. A. Bischoff-Ferrari

  2. Department of Geriatric Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    A. Gazzotti, U. Meyer, G. Freystaetter, M. Palzer, R. Theiler, L. Abderhalden & H. A. Bischoff-Ferrari

Authors
  1. A. Gazzotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Freystaetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Palzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Theiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Abderhalden
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. A. Bischoff-Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. A. Bischoff-Ferrari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The local ethics committee has approved the study.

Informed consent

We only included data of patients who gave written general consent to use their data for research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gazzotti, A., Meyer, U., Freystaetter, G. et al. Physical performance among patients aged 70 + in acute care: a preliminar comparison between the Short Physical Performance Battery and the De Morton Mobility Index with regard to sensitivity to change and prediction of discharge destination. Aging Clin Exp Res 32, 579–586 (2020). https://doi.org/10.1007/s40520-019-01249-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01249-9

Keywords

  • Mobility assessment
  • Discharge destination
  • Older adults
  • Early rehabilitation
  • Geriatric assessment