Physiotherapy Outcome Measures for Rehabilitation of Elderly People: Responsiveness to change of the Rivermead Mobility Index and Barthel Index

Abstract

Summary This study was part of an on-going exercise to identify and implement outcome measures in physiotherapy practice on the rehabilitation wards of the Department of Clinical Geratology at the Radcliffe Infirmary, Oxford. The aim was to compare the responsiveness to change and other measurement properties (floor and ceiling effects) of the Rivermead Mobility Index (RMI) and Barthel Index (BI). The RMI and BI were scored at admission to the rehabilitation ward, and on discharge, by therapy and nursing staff. Mobility prior to the admission was assessed by self or proxy report from the patients and carers. Fifty-eight people were recruited into the study (mean age 83 years, range 63–99 years, 22 men and 36 women), and had a range of orthopaedic, neurological, cardiorespiratory, and other conditions for which physiotherapy was indicated. Eight people died, and their data were excluded from the results. Overall, the participants improved in their functional and mobility abilities as scored by the RMI and BI. Both the RMI and BI are responsive to changes in older people having physiotherapy (effect sizes 1 and 0.87 respectively). The RMI was more efficient in measuring outcome than the BI, but only by a modest amount (parametric relative efficiency 1.42; non-parametric relative efficiency 1.25). Floor and ceiling effects are evident in the RMI and BI respectively, and it is concluded that this could limit their usefulness for in-patients. The findings of this study have implications for the use of outcome measures in physiotherapy practice and research.