Hierarchical Assessment Of Balance And Mobility Research Articles

Delirium and Delirium Severity Predict the Trajectory of the Hierarchical Assessment of Balance and Mobility in Hospitalized Older People: Findings From the DECIDE Study.

BackgroundDelirium is common, distressing, and associated with poor outcomes. Despite this, delirium remains poorly recognized, resulting in worse outcomes. There is an urgent need for methods to objectively assess for delirium. Physical function has been proposed as a potential surrogate marker, but few studies have monitored physical function in the context of delirium. We examined if trajectories of physical function are affected by the presence and severity of delirium in a representative sample of hospitalized participants older than 65 years.MethodDuring hospital admissions in 2016, we assessed participants from the Delirium and Cognitive Impact in Dementia study daily for delirium and physical function, using the Hierarchical Assessment of Balance and Mobility (HABAM). We used linear mixed models to assess the effect of delirium and delirium severity during admission on HABAM trajectory.ResultsOf 178 participants, 58 experienced delirium during admission. Median HABAM scores in those with delirium were significantly higher (indicating worse mobility) than those without delirium. Modeling HABAM trajectories, HABAM scores at first assessment were worse in those with delirium than those without, by 0.76 (95% CI: 0.49–1.04) points. Participants with severe delirium experienced a much greater perturbance in their physical function, with an even lower value at first assessment and slower subsequent improvement.ConclusionsPhysical function was worse in those with delirium compared to without. This supports the assertion that motor disturbances are a core feature of delirium and monitoring physical function, using a tool such as the HABAM, may have clinical utility as a surrogate marker for delirium and its resolution.

Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders

BackgroundIn older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment.MethodsIn a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches.ResultsOf the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects.ConclusionsMost outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error.Trial registrationGerman Clinical Trials Register (DRKS00005591). Registered February 2, 2015.

The Hierarchical Assessment of Balance and Mobility (HABAM): a useful tool to estimate length of hospital stay following hip and knee replacement

Background/Aims The Hierarchical Assessment of Balance and Mobility is a measure of balance and mobility that can detect recovery of physical function, and can be used to identify patients at risk of delayed discharge. The aim of this study was to investigate the use of Hierarchical Assessment of Balance and Mobility scores as a predictor of length of hospital stay in patients following hip and knee replacement. Methods Hierarchical Assessment of Balance and Mobility scores were collected on 191 patients following primary total joint replacement. Regression and receiver operating characteristic curve analyses were conducted to assess the relationship between Hierarchical Assessment of Balance and Mobility and length of stay. Results Hierarchical Assessment of Balance and Mobility scores of <31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Receiver operating characteristic curve analyses showed that a Hierarchical Assessment of Balance and Mobility score of 50 was the optimal cut-off point for discharge. Conclusions Hierarchical Assessment of Balance and Mobility offers a practical way to quantify and objectively track patients' physical function, and can help identify patients at risk of an increased length of stay on post-operative day one.

The Hierarchical Assessment of Balance and Mobility (HABAM): an underutilised tool to track physical function and estimate length of stay

Purpose: Impaired mobility and balance correlate strongly with an individual's function and overall state of health. The Hierarchical Assessment of Balance and Mobility (HABAM) is a graphic and rapid assessment of balance and mobility originally designed for use within the hospitalised elderly. The measure has been used predominantly within frail elderly populations; however the aims of this study were to assess the utility of the HABAM to an elective orthopaedic population.

Comparison of the de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility in older acute medical patients.

To compare the measurement properties of the de Morton Mobility Index (DEMMI) and the Hierarchical Assessment of Balance and Mobility (HABAM) in an older acute medical inpatient population. Cross-sectional. Older acute medical inpatients. The DEMMI, HABAM and further assessments were performed after hospital admission. Construct validity was assessed by testing 13 hypotheses on convergent and known-groups validity. Test-retest reliability and minimal detectable change were estimated based on a re-assessment of unchanged patients. Floor and ceiling effects were used to indicate adequacy of scale width. For both the DEMMI and HABAM, 11 (85%) hypotheses regarding construct validity were confirmed (n = 158). Both scales showed strong correlations with other multi-component mobility scales (Spearman's rho 0.75-0.92). Neither floor nor ceiling effects were evident. The intraclass correlation coefficient was 0.98 (95% confidence interval (95% CI) 0.96-0.99) for the DEMMI and 0.99 (95% CI 0.99-0.99) for the HABAM, respectively (n = 30). The minimal detectable change with 90% confidence was 6 points on the 100-point DEMMI scale and 1 point on the 26-point HABAM scale. The DEMMI and the HABAM appear to be suitable for measuring mobility in older acute medical patients.

Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital.

to investigate how frailty and mobility impairment affect recovery of balance and mobility in acutely ill older patients. secondary analysis of cohort study. general and geriatric medicine inpatient units, QEII Health Sciences Centre, Dalhousie University, Canada. four hundred and nine older adults (mean age = 81 ± 7 standard deviation, 64% women). we constructed a frailty index based on a comprehensive geriatric assessment (FI-CGA), at baseline (2 weeks before admission; mean 0.31 ± 0.10), and on admission (mean 0.40 ± 0.10), and recorded Hierarchical Assessment of Balance and Mobility (HABAM) scores daily. Recovery was measured as the difference in HABAM scores between discharge and admission. the odds of no or incomplete recovery increased by 1.06 (95% confidence interval: 1.01-1.11) for each 0.1 increment in the baseline FI-CGA. Recovery odds were similarly dependent on age, but independent of baseline HABAM scores. Recovery time was related to Day 1 HABAM scores, initial treatment response and change in the FI-CGA from baseline to admission (r = 0.35, P < 0.001). Recovery time was independent of age. Patients whose mobility improved within 48 h (n = 113; 28%) showed greater improvement and quicker recovery. frailer patients are at a greater risk of incomplete or lengthier recovery from impaired mobility and balance. Tracking mobility and balance might help providers, patients and families understand the course of acute illness in older adults.

Assessing balance and mobility to track illness and recovery in older inpatients.

Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death. To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital. Prospective cohort study. Four hundred nine patients, with a mean age of 81.8years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age. The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA). Death and discharge destination. Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery. Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.

Validity, responsiveness and the minimal clinically important difference for the de Morton Mobility Index (DEMMI) in an older acute medical population

BackgroundThe de Morton Mobility Index (DEMMI) is a new mobility instrument that overcomes the limitations of existing instruments. It is the first mobility instrument that accurately measures the mobility of all older adults. The aim of this study was to provide a detailed report of investigations of the validity, responsiveness to change and minimal clinically important difference (MCID) of the DEMMI during its development in an older acute medical population.MethodsThis study was conducted using a head to head comparison design in two independent samples of older acute medical patients (development sample, n = 86; validation sample, n = 106). Consecutive patients (≥ 65 years) were assessed using the DEMMI, Barthel Index (BI) and Hierarchical Assessment of Balance and Mobility (HABAM) within 48 hours of hospital admission and discharge. Convergent and discriminant validity were investigated using Spearman's rho and known groups validity was investigated using a independent t test to compare DEMMI scores for patients who were discharged to home compared to inpatient rehabilitation. Criterion and distribution based methods were employed for estimating instrument responsiveness to change and the MCID.ResultsSignificant moderate to high correlations were identified between DEMMI and BI scores (r = 0.76 and r = 0.68) and DEMMI and HABAM scores (r = 0.91 and r = 0.92) in both samples. In both samples, DEMMI scores for patients who were discharged to home were significantly higher than for patients discharged to inpatient rehabilitation and provided evidence of known groups validity. Patients who were discharged to inpatient rehabilitation (n = 8) had a mean DEMMI score of 50.75 (sd = 11.29) at acute hospital discharge compared to patients who were discharged to home (n = 70) with a mean DEMMI score of 62.14 (sd = 18.41). MCID estimates were similar across samples using distribution and criterion based methods. The MCID for the DEMMI was 10 points on the 100 point interval scale. The DEMMI was significantly more responsive to change than the BI using criterion and distribution based methods in the validation sample.ConclusionThis study has validated the DEMMI in two independent samples of older acute medical patients. Estimates of its responsiveness and MCID have also been established. This study confirms that the DEMMI overcomes the limitations of the BI and HABAM and provides an advanced method for objectively assessing mobility for older acute medical patients.

Reliability of the Hierarchical Assessment of Balance and Mobility in Frail Older Adults

To study the test-retest and interrater reliability of the Hierarchical Assessment of Balance and Mobility (HABAM) in frail older adults. Convenience sample of 167 frail older adults seen as part of routine care by an academic geriatrician at a tertiary care teaching hospital. Inpatient medical and geriatric wards, geriatric ambulatory care clinic, emergency department, home visits. The interrater reliability sample consisted of 98 inpatients and 69 outpatients. The test-retest reliability sample tracked 63 of the inpatients over the first 2 days of their hospital stay. Mobility and balance were assessed using the HABAM. Frailty was assessed using a frailty index based on a standardized Comprehensive Geriatric Assessment. Reliability was assessed using Pearson correlations and the intraclass correlation coefficients. The interrater reliability of the HABAM was 0.92 and ranged from 0.88 to 0.96 across settings for the various components (balance, transfers, mobility). Test-retest reliability was 0.91 (range 0.85-0.92). The HABAM appears to be a reliable means of assessing mobility and balance in frail older adults.

A systematic review of mobility instruments and their measurement properties for older acute medical patients

BackgroundIndependent mobility is a key factor in determining readiness for discharge for older patients following acute hospitalisation and has also been identified as a predictor of many important outcomes for this patient group. This review aimed to identify a physical performance instrument that is not disease specific that has the properties required to accurately measure and monitor the mobility of older medical patients in the acute hospital setting.MethodsDatabases initially searched were Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials without language restriction or limits on year of publication until July 2005. After analysis of this yield, a second step was the systematic search of Medline, Cinahl and Embase until August 2005 for evidence of the clinical utility of each potentially suitable instrument. Reports were included in this review if instruments described had face validity for measuring from bed bound to independent levels of ambulation, the items were suitable for application in an acute hospital setting and the instrument required observation (rather than self-report) of physical performance. Evidence of the clinical utility of each potentially suitable instrument was considered if data on measurement properties were reported.ResultsThree instruments, the Elderly Mobility Scale (EMS), Hierarchical Assessment of Balance and Mobility (HABAM) and the Physical Performance Mobility Examination (PPME) were identified as potentially relevant. Clinimetric evaluation indicated that the HABAM has the most desirable properties of these three instruments. However, the HABAM has the limitation of a ceiling effect in an older acute medical patient population and reliability and minimally clinically important difference (MCID) estimates have not been reported for the Rasch refined HABAM. These limitations support the proposal that a new mobility instrument is required for older acute medical patients.ConclusionNo existing instrument has the properties required to accurately measure and monitor mobility of older acute medical patients.

Discharge Delay in Patients with Community‐Acquired Pneumonia Managed on a Critical Pathway

It has previously been reported that a critical pathway for community-acquired pneumonia (CAP) significantly reduces bed days per patient managed but results in no difference in average length of stay, suggesting that discharge criteria were not successfully implemented. The present study sought to identify factors in the timing of discharge not taken into account by discharge criteria. Patients admitted with CAP and placed on a pneumonia critical pathway were studied. Patients' functional and cognitive status were evaluated using the Barthel Index, Hierarchical Assessment of Balance and Mobility (HABAM) and the Mini-Mental Status Examination. Once discharge criteria were met, the patient, a family member and the treating physician were interviewed to identify other factors contributing to length of stay. Thirty-one patients were enrolled in the study; 12 were discharged when they met discharge criteria and 19 stayed in hospital longer. There were no differences between patients discharged at stability versus those with an increased length of stay in terms of demographics, pneumonia severity score, functional or cognitive status at discharge using the Barthel Index (87.3+/-11.1 versus 83.8+/-8.6, respectively; P=0.46) and MMSE (27.1+/-1.1 versus 27.3+/-1.1, respectively; P=0.64); however, there was a significant difference in HABAM score at the time clinical stability was reached (22.6+/-1.3 versus 17.4+/-3.5, respectively; P=0.03), which correlated with physician and family assessments of patients' readiness for discharge. HABAM may be a useful tool to identify patients at risk of remaining in hospital after objective discharge criteria are met. Additional resources may be targeted at these patients to reduce length of stay in CAP.

Rasch analysis of the hierarchical assessment of balance and mobility (HABAM)

Measuring changes in mobility and balance offers a means of responding to the clinically important challenge of tracking progression and recovery in frail elderly patients who become ill. This article uses Rasch analysis to construct an interval scale from ordinal observations of such changes, using the Hierarchical Assessment of Balance and Mobility (HABAM) on 204 frail elderly inpatients. Principal components analysis confirmed the unidimensionality of the scale. The Rasch analysis confirmed the hierarchy of the HABAM, and pointed to gaps and redundant items. On this basis, an improved version of the HABAM was developed, suitable in its graphical form for everyday clinical use and for research, using the interval numbers that were generated.