De Morton Mobility Index Score Research Articles

EFFECTIVENESS OF THE LEBED METHOD THERAPEUTIC INTERVENTION ON PHYSICAL STABILITY AMONG ELDERLY INDIVIDUALS IN KAKAMEGA COUNTY

Background. In Kenya, falls among individuals over 60 years of age are a major concern. Despite physical activity being known to reduce fall risks, existing studies face challenges like high drop-out rates and limited exercise types. The Lebed Method, a dance program originally developed for breast cancer survivors by Sherry Lebed Davis, has shown potential to improve physical and emotional well-being. This study aimed to explore its effectiveness in improving physical stability among the elderly in Kakamega County. Methods. The study involved a community-based randomized control trial with 30 participants aged 60 and older, selected based on low social support scores. They were divided into intervention and control groups, meeting specific inclusion criteria. Baseline functional stability (mobility and balance) was assessed by Timed Up and Go (TUG), Berg Balance Scale (BBS) scores, gait speed time, and de Morton Mobility Index (DEMMI) score. To ensure the reliability of the study, biases such as selection, performance, detection, attrition, and reporting biases were addressed. Changes in physical stability between the groups were analyzed using the Analysis of Covariance, accounting for baseline differences, while within-group changes were evaluated using the dependent sample t-test. The threshold for statistical significance was set at p < 0.05. Results. The findings showed that the intervention group improved significantly in physical stability compared to the control group. Specifically, notable enhancements were observed on TUG times (p < .001, ηp2 = 0.53, d = 3.38), BBS scores (p < .001, ηp2 = 0.64, d = 1.97), gait speed (p < .001, ηp2 = 0.65, d = 1.99) and DEMMI score (p < .001, ηp2 = 0.38, d = 1.94). Conclusions. The intervention significantly improved mobility and balance among participants, demonstrating the effectiveness of the Lebed method for elderly individuals. Future research could explore specific components of dance-based therapy that contribute to functional mobility and balance improvements

Validation of the de Morton mobility index (DEMMI) among acute stroke patients aged ≥65 years: a register study

Purpose To validate the de Morton Mobility Index (DEMMI) in older (≥65 years) patients with acute stroke in a hospital setting within the first week after stroke onset. Materials and methods In the Danish National Database of Geriatrics, we identified 4,176 patients with acute stroke (≥65 years). Floor and ceiling effects of DEMMI were investigated. Furthermore, convergent validity was investigated by correlations between DEMMI and the Barthel Index using Spearman’s rho. Known-groups validity was tested by comparing DEMMI scores for different groups (with/without dementia, depression, comorbidity, and walking aids), and unidimensionality of DEMMI was evaluated by Mokken scale analysis. Results A floor effect was identified with 22.1% of the patients scoring 0 on DEMMI on admission. Both convergent and known-groups validity were confirmed for DEMMI. Patients who were bedbound had a lower DEMMI score (median [IQR]: 0 [0;0]) than patients without any walking aid (median [IQR]: 62 [33;74]). Furthermore, Mokken scale analysis identified unidimensionality with overall fit to the model (Loevinger H 0.88 (p < 0.0001)). Conclusion DEMMI is a valid instrument for use in patients with acute stroke (≥65 years) in a hospital setting within the first week after stroke onset.

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study

BackgroundMajor emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation.PurposeTo investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications.MethodsThe study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test.ResultsThe study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien–Dindo (CD) grade ≥ 3.ConclusionsIn patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.

The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study

ObjectiveTo examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. MethodsA nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0–24), low mobility (DEMMI=27–39), moderately reduced mobility (DEMMI=41–57), and independent mobility (DEMMI=62–100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. ResultsHRs for readmission within 30-days were 1.36 (1.24–1.48) for very low mobility, 1.30 (1.20–1.42) for low mobility and 1.17 (1.08–1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29–10.53) for lowest compared with the highest DEMMI mobility subcategory. ConclusionIn geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.

81 Does premorbid frailty status affect rehabilitation outcome?

Abstract Background Frailty is associated with poorer rehabilitation outcome in functional gains, Length of Stay (LoS) and discharge destination. The aim of the study is to determine if pre-morbid frailty status affect functional gains, LoS, and discharge destination of patients undergoing rehabilitation. Methods 188 men and 241 women were (age 81+/− 10 years) admitted for rehabilitation with median LoS of 36 days. All data were collected as part of routine physiotherapy. Age, Clinical Frailty Score (CFS), functional gains [change in Berg Balance Score (BBS) and de Morton Mobility Index (DEMMI)], LoS and discharge destination (home or non-home) were recorded. 392 (91%) had CFS, 331 (77%) BBS, DEMMI 325 (75%) recorded. Patient with CFS category 1–4 were defined as Non-frail, Category 5–7 as Frail. Results are presented as mean (SD). Statistical tests included unpaired t-test, paired t-test and chi-square test. Significance is set at p &amp;lt; 0.05. Results Of the patients, 76% were living with frailty and were older (83.6 [7.9] years vs 78.4 [8.1] years) than the non-frail group (p &amp;lt; 0.0001), had longer LoS (49.1 [34.2] days vs 41.0 [31.8] days, p = 0.044) but just as likely to return home (71% vs 78%, p = 0.14). Patients living with frailty had lower pre and post-BBS and DEMMI score, both groups had significant functional gains (p &amp;lt; 0.0001). Pre and post-BBS in Frail group and Non- frail groups were (19 [13] vs 26 [15]) and (30[15] vs 42[13]) respectively. DEMMI in Frail and Non-frail group pre vs post were 32(15) vs 45(16) and 43(17) vs 60(18) respectively. While there was no difference in functional gains in BBS between groups (p = 0.17), the difference in DEMMI score were lower in frail group (p = 0.018). Conclusion Our study showed that both frail and Non-frail patients made functional gains with rehabilitation and patients living with frailty are just as likely to return home.

The Lübeck Scale of Basic Mobility : Assessment of geriatric patients with severely impaired mobility

In the geriatric assessment of mobility, the timed up and go (TUG) test is often used; however, many inpatients are unable to master this test. The Lübeck Scale of Basic Mobility (LSBM) was developed as aperformance test for this target group. The study investigated the properties of the 7‑task LSBM, which has ascaling at item level based on the 5‑level assessment of impairments according to the ICF. In 77patients who had not mastered the TUG test at acute geriatric hospital admission, the LSBM was completed at intervals of 7-18days (t0, t1), including one rating by 2investigators. For convergent validity, the De Morton Mobility Index (DEMMI) was used. The LSBM score and DEMMI score were highly correlated (-0.880, p < 0.001).A floor effect did not occur with LSBM and occurred with DEMMI in 5patients (6.5%). The predictive validity for predicting coping with TUG test at discharge based on the sum score at t0 was -0.577 for the LSBM, and 0.542 for the DEMMI (Spearman's correlation, p = 0.001). The interrater reliability of the LSBM was 0.983 (p < 0.001), the correlation between test and retest was 0.836 (p < 0.001) and the internal consistency via Cronbach'sα was 0.876. The effect size as ameasure of change sensitivity was Cohen'sd 0.711. The LSBM facilitates treatment goal setting and allows standardized documentation of even small improvements and deteriorations in patients with reduced basic mobility.

Clinimetric properties of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit survivors – a cross-sectional observational study

Purpose To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. Methods Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. Results One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = –0.515), and total mechanical ventilation duration (r = –0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. Conclusion The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. Trial registration number NCT05196997 Implications for Rehabilitation The Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors. The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge.

The immediate impact of physical function and quality of life after hematopoietic stem cell transplantation.

Although hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic malignancies, HSCT survivors often experience declined physical function and quality of life (QoL). However, the physical function and QoL changes in acute post-transplant patients remain unclear. This study aimed to investigate the impact of HSCT on physical function. This retrospective control study included 107 HSCT patients. Physical function was evaluated weekly from admission to discharge using the de Morton Mobility Index (DEMMI). Impaired physical function was defined as a baseline raw ordinal DEMMI score of < 17 and a decrease of ≥ 2 points. We collected the Visual Analog Scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Zung Self-rating Depression Scale (SDS) at enrollment and discharge. Based on the DEMMI scores, 41 patients (38.3%) showed impaired physical function. A notable decrease in the DEMMI score was found in the first week after HSCT. In the EORTC QLQ-C30, physical function differed between the groups at admission and discharge. The good physical function group showed better cognitive function and social function. For the SDS, the impaired physical function group showed significantly higher depression at discharge. A third of the patients showed physical impairment during the acute transplant period. Patients with low physical function suffered more from depression and lower QoL. Evaluating patients' pre-transplant physical function and early detection is needed as impaired physical function mainly occurs at 1week post-transplant.

C1q and mobility score in predicting sarcopenia in an Australian cohort of cancer surgery patients.

Sarcopenia has been shown to have significant adverse health outcomes in a range of patient populations. Particularly, sarcopenic patients having cancer surgery are a unique group who demonstrate poorer post-operative outcomes. Currently, the gold standard in diagnosing sarcopenia is through the use of computed tomography. However, the widespread use of imaging to diagnose patients with sarcopenia is neither cost-effective nor practical. Identifying a serum biomarker or a simple mobility scoring system as an alternative diagnostic tool may aid in identifying more patients at risk of sarcopenia. C1q, a novel biomarker, has previously been shown to correlate with sarcopenia. Similarly, we sought to explore whether mobility scores may provide a useful surrogate marker for sarcopenia. This was a prospective cohort study of patients who presented for colorectal cancer surgery between the dates of 6/10/2016 and 4/10/2017 at John Hunter Hospital. Computed tomography was utilized to calculate the psoas area at the L3 spinal level. Pre-operative blood samples were obtained for C1q analysis and de Morton Mobility Index (DEMMI) was also performed. A total of 51 patients were included in the study. The median age of the patients were 69 years old. We did not demonstrate a correlation between serum C1q and DEMMI scores with psoas area. Our findings suggest that neither C1q nor DEMMI scores are correlated with psoas area in a colorectal cancer population.

The responsiveness and predictive validity of the de Morton Mobility Index in geriatric rehabilitation

Introduction The de Morton Mobility Index (DEMMI) is a unidimensional clinical instrument proven reliable and valid for measuring mobility in the elderly, but its responsiveness has not been evaluated when applying the methodology recommended by COSMIN. Purpose To evaluate the responsiveness and the predictive validity of the DEMMI. Materials and methods Elderly people, referred for municipality-based rehabilitation, were consecutively included. Eight hypotheses regarding the relationship between the change scores in the DEMMI and other functional measures of mobility were tested by assessing the participants before and after rehabilitation. Three months after completing the rehabilitation, the participants’ functional status was evaluated. Results 250 elderly people (mean age 85 years, 63% women) were included. The change scores in the DEMMI and the other measures correlated (r = 0.422 to 0.547), but only three out of the eight hypotheses were confirmed. A DEMMI score of less than 48 and less than 67 can predict inability of ambulating close to the participant’s residence and using public transport, respectively. Conclusions We found a moderate responsiveness and a high predictive validity of the DEMMI score. The DEMMI appears to be an appropriate instrument for monitoring change in mobility and predicting functional status among elderly patients undergoing rehabilitation. Implications for rehabilitation The de Morton Mobility Index (DEMMI) is a clinical instrument for measuring mobility. This study shows that the DEMMI was responsive to change in mobility and predicted disability among a diverse group of elderly individuals referred to rehabilitation after hospital discharge. The DEMMI is applicable as an outcome measure in trials investigating the effect of rehabilitation and for clinical decision-making concerning geriatric rehabilitation.

Reliability, validity, interpretability and responsiveness of the DEMMI mobility index for Brazilian older hospitalized patients.

AimTo translate and adapt cross-culturally the De Morton Mobility Index from English to Brazilian Portuguese. Furthermore, to test the content validity, reliability, construct validity, interpretability and responsiveness for older hospitalized patients.MethodsAfter we carried out the translation and the cross-cultural adaptation of the De Morton Mobility Index and its administration instructions according to international guidelines, the content validity of De Morton Mobility Index was tested by experienced physiotherapists. In the sequence, the reliability, construct validity, interpretability and responsiveness were tested in a test-retest design with 93 older patients hospitalized in ward for clinical reasons. The reliability was tested by Cronbach's alpha coefficient (internal consistency), standard error measurement (agreement), and interclass correlation coefficients (intra and inter-examiner reliability). The construct validity was tested by Pearson's correlation between the De Morton Mobility Index score and the number of steps. Interpretability was analyzed by determining the minimum detectable change and the floor and ceiling effects (frequency of maximum and minimum scoring). Responsiveness was analyzed by effect size.ResultsThe Brazilian version of the De Morton Mobility Index was made and adapted. The internal consistency (α = 0.89), reliability intra-(ICC = 0.94) and inter-examiners (ICC = 0.82), agreement were all adequate. The De Morton Mobility Index is validity when correlated with number of steps (r = 0.46). Floor or ceiling effects (<15%) were not observed and the responsiveness was high (ES = 3.65).ConclusionThe De Morton Mobility Index has shown adequate reliability, validity, interpretability and responsiveness for the evaluation of the mobility of older hospitalized patients.

Importance of Monitoring Physical Function for Quality of Life Assessments in Hematopoietic Stem Cell Transplantation Patients: A Prospective Cohort Study.

Physical function is known to decrease after hematopoietic stem cell transplantation (HSCT), with the most substantial impairment noted at 90 days post-transplantation. Little is known about the natural course of physical function during the acute post-transplant period preciously. The aim of the study was to monitor the changes in physical function through serial evaluations of the physical function, and identify the effect of physical function on QoL during the acute post-transplant period. This prospective cohort study included 41 patients admitted for planned autologous or allogeneic HSCT. Physical impairment was evaluated with decrease in the de Morton Mobility Index (DEMMI) every week and defined as a DEMMI score of more than 2 points after HSCT. The outcome variables for QoL included visual analogue scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Zung Self-rating Depression Scale (SDS) at enrollment and discharge. Based on DEMMI scores, 24.40% of all HSCT patients showed physical impairment, for whom the DEMMI score showed an overall decrease during hospitalization with significant differences in scores at 1, 2, and 3 weeks after HSCT, between 1 week before and 3 weeks after HSCT, and between 1 and 3 weeks after HSCT. There was no significant difference of VAS between admission and discharge between the groups. Each functional subscale of EORTC QLQ-C30 differed significantly between the groups, with lower scores in the physical impairment group. There was only a significant difference in SDS at discharge between the groups. QoL pre-transplantation can be a predictive factor for physical impairment during the acute post-transplant period, which can be detected in the early period after HSCT. Patients during acute post-transplant period had physical impairment and QoL of pre-transplantation was considered a predictive factor for physical impairment. The physical impairment can be detected in the early period after HSCT. Therefore, monitoring of standardized functional outcome measures is important to prevent physical impairment following HSCT.

Validity and Responsiveness to Change of the 30-Second Chair-Stand Test in Older Adults Admitted to an Emergency Department.

Few physical performance measurement tools are validated for acutely admitted older adults, and for this reason we aimed to examine the validity and responsiveness to change of the 30-second Chair-Stand Test (30s-CST) used to assess physical performance in older adults admitted to a short-stay unit in an emergency department. Construct validity of the 30s-CST, using 8 as a cutoff point for dependency in activities of daily living, was examined using 207 patients. Self-reported information on everyday activities was obtained by asking patients about need for help in bathing, dressing, cooking, cleaning, and shopping. Concurrent validity of the 30s-CST compared with the de Morton Mobility Index (DEMMI) on physical performance of acutely admitted older adults was examined with 156 patients. The analysis of concurrent validity included the entire DEMMI and 2 subsets of DEMMI: "DEMMI walking" and "DEMMI dynamic balance." The responsiveness to change in the 30s-CST compared with DEMMI was examined with 117 patients. All patients were classified as having either low physical performance (30s-CST ≤8) or high physical performance (30s-CST >8); these groups were used in the analysis of validity and responsiveness to change. Regarding construct validity using 8 as a cutoff point, the study showed a significant difference between patients with low physical performance compared with patients with high physical performance. Moreover, a decrease in the 30s-CST was followed by an increase in the need for help with everyday activities. There was a significant association between the 30s-CST and DEMMI (r = 0.72); for every extra repetition in the 30s-CST, the DEMMI score increased by 4.9. There was a significant association between the 30s-CST and the 2 subsets "DEMMI walking" and "DEMMI dynamic balance"; yet, a pronounced floor effect was found in the subsets. The analysis demonstrated a very wide prediction interval, indicating that DEMMI has a better responsiveness to change than the 30s-CST, especially in older adults with low physical performance. However, the 30s-CST is easier and faster to use than DEMMI. This study found a significant difference in the patients' need for help with everyday activities when comparing low and high physical performance groups. The concurrent validity of the 30s-CST was acceptable in assessing physical performance in older adults at the time of admission; the 30s-CST is thus a tool that is easy to use in older adults with acute disease. In contrast, based on very wide prediction intervals, DEMMI demonstrated better responsiveness to change than the 30s-CST, especially in older adults with low physical performance.

Correction: Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy.

OBJECTIVE To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy. METHODS Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy. RESULTS There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly. CONCLUSION In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.

DEMMI Scores, Length of Stay, and 30-Day Readmission of Acute Geriatric Patients in Denmark: A Cross-Sectional Observational Study with Longitudinal Follow-Up.

The aims of this study are to describe the mobility of acute geriatric patients, the length of stay, and to characterise patients who were readmitted within 30 days based on the De Morton Mobility Index (DEMMI). A cross-sectional observational study with longitudinal follow-up was conducted in the period from 1 March 2016 to 31 August 2016. Inclusion criteria were acute geriatric patients hospitalised for a minimum of 24 h. Of the 418 patients hospitalised during the study period, 246 (59%) participated in this study (44% male, median age 83 years [70; 94]). For patients in an acute geriatric department, the median DEMMI score was 41 and the mean score was 39.95. Patients with a DEMMI score ≤40 show a significantly lower Barthel 100 index, lower 30 s. sit-to-stand scores and were significantly more likely to be bedridden or, amongst those not bedridden, to use a mobility aid. Lower DEMMI scores were associated with longer admissions. DEMMI seems to have the ability to predict discharge within one week. There was no significant association between a lower DEMMI score and higher risk for 30-day readmission. Further research is needed to determine whether the DEMMI is suitable for identifying the patient’s need for further rehabilitation following the discharge.

Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy.

ObjectiveTo investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy.MethodsHematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy.ResultsThere was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9–14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly.ConclusionIn hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.

Mobility scores as a predictor of length of stay in general surgery: a prospective cohort study.

Post-operative length of stay (LOS) is an increasingly important clinical indicator in general surgery. Despite this, no tool has been validated to predict LOS or readiness for discharge in general surgical patients. The de Morton Mobility Index (DEMMI) is a functional mobility assessment tool that has been validated in rehabilitation patient populations. In this prospective cohort study, we aimed to identify if trends in DEMMI scores were associated with discharge within 1 week and overall LOS in general surgical patients. A total of 161 patients who underwent elective gastrointestinal resections were included. DEMMI scores were performed preoperatively, on days 1, 2, 3 and 30 post-operative. Statistical analysis was performed to identify any association between DEMMI scores and discharge within 1 week and LOS. Functional recovery (measured by achieving 80% of baseline DEMMI score by post-operative day 1) was significantly associated with discharge within 1 week. Presence of a stoma was associated with longer LOS. The area under the receiver operating characteristic curve using functional recovery on post-operative day 1 as a predictor of discharge within 1 week is 0.772. The DEMMI score is a fast, easy and useful tool to, on post-operative day 1, predict discharge within 1 week. The utility of this is to act as an anticipatory trigger for more proactive and efficient discharge planning in the early post-operative period, and there is potential to use the DEMMI as a comparator in clinical trials to assess functional recovery.

Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index

BackgroundMobility is a key outcome in older patients with cognitive impairment. The de Morton Mobility Index (DEMMI) is an established measure of older people’s mobility that is promising for use in older patients with cognitive impairment. The aim of this study was to examine the DEMMI’s psychometric properties in older patients with dementia, delirium or other cognitive impairment.MethodsThis cross-sectional study was performed in a geriatric hospital and includes older acute medical patients with cognitive impairment indicated by a Mini Mental State Examination (MMSE) score ≤ 24 points. A Rasch analysis was performed to check the DEMMI’s unidimensionality. Construct validity was assessed by testing 13 hypotheses about expected correlations between the DEMMI and outcome measures of similar or related constructs, and about expected differences of DEMMI scores between groups differing in mobility related characteristics. Administration times were recorded.ResultsA sample of 153 patients with mild (MMSE 19–24 points; 63%) and moderate (MMSE: 10–18 points; 37%) cognitive impairment was included (age range: 65–99 years; mean MMSE: 19 ± 4, range: 8–24 points; diagnosis of dementia and delirium: 40% and 18%, respectively). Rasch analysis indicated unidimensionality with an overall fit to the model (P = 0.107). Internal consistency reliability was excellent (Cronbach’s alpha = 0.92). Eleven out of 13 (85%) hypotheses on construct validity were confirmed. The DEMMI showed good feasibility, and no adverse events occurred. The mean administration time of 5 min (range: 1–10) was not influenced by the level of cognitive impairment. In contrast to some other comparator instruments, no floor or ceiling effects were evident for the DEMMI.ConclusionsResults indicate sufficient psychometric properties of the DEMMI in older patients with cognitive impairment.Trial registrationGerman Clinical Trials Register (DRKS00005591). Registered February 2, 2015.

Exergames to Improve the Mobility of Long-Term Care Residents: A Cluster Randomized Controlled Trial.

Finding suitable and engaging ways for older people living in long-term care (LTC) to engage in physical activity, to maintain function is challenging. There is a need to explore the use of exergames for LTC residents who have mobility and cognitive impairments. We investigated the effect of a group-based Xbox Kinect (Microsoft Corp., Redmond, WA) exergame program on mobility in LTC residents with and without cognitive impairment. Facilities were randomly assigned to the intervention (four facilities, n = 29, aged 84.7 ± 7.4 years) or control group (five facilities, n = 36, aged 85.8 ± 7.2 years). The intervention group played Xbox Kinect exergames twice weekly for 8 weeks. The control group continued usual activities. The primary outcome measure was mobility, assessed pre- and postintervention using the de Morton Mobility Index (DEMMI). DEMMI scores improved in residents who played exergames, although this did not reach significance (P = 0.06). There was no interaction between cognition scores and DEMMI scores (P = 0.86). Participants attended an average of 55% of scheduled exergames sessions. The trend toward improvement in mobility, as well as attendance rates indicate that the Xbox Kinect exergames were engaging for a proportion of residents. On this basis, further exergames development for LTC residents warrants attention.