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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

The Charité Acute Rehabilitation Mobility Index (CHARMI) – A Mobility Assessment for Acute Rehabilitation displaying Efforts in Human Resources

Meeting Abstract

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  • corresponding author presenting/speaker Max Liebl - Charité Universitätsmedizin Berlin, Physikalische Medizin und Rehabilitation, Berlin, Germany
  • Stephanie Pögel - Charité Universitätsmedizin Berlin, Physikalische Medizin und Rehabilitation, Berlin, Germany
  • Anett Reißhauer - Charité Universitätsmedizin Berlin, Physikalische Medizin und Rehabilitation, Berlin, Germany

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm235

DOI: 10.3205/11esm235, URN: urn:nbn:de:0183-11esm2356

Published: October 24, 2011

© 2011 Liebl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Achieving mobility – from transfers to locomotion – is the core capability and goal of acute and early post-acute inpatient rehabilitation. Countless assessment tools serve as measures for treatment planning and outcome of rehabilitation. Unfortunately the most commonly used assessments like Barthel-Index, Functional Independence Measure (FIM) or Rivermead Mobility Index (RMI) are only partly suitable for the acute and early post-acute rehabilitation phase [1], [2].

The aim was to develop a simple mobility assessment tool for the acute rehabilitation setting concentrating on transfer and locomotion items with a resource-oriented scaling system. The assessment was to display the expenditure in human resources by the number of staff involved in patients’ transfer and locomotion, and by duration of conducting transfers and locomotion.

Material/Methods: Phase one – Development of the Assessment

Three rehabilitation physicians screened existing assessment tools and literature for test items addressing the rehabilitation phases of “verticalisation” (transfers) and locomotion. Seven items were identified and a scaling system was established. Items and scaling systems were tested in a pilot study. After remodelling of the scaling a structured expert vote (by four rehabilitation physicians) was conducted to assess face/content validity.

Phase two – Psychometric Test Evaluation

The Charité Acute Rehabilitation Mobility Index (acronym CHARMI) was used on 36 consecutive acute rehabilitation patients at admission and discharge in the Charité university hospital, Berlin, Germany. Reliability testing was conducted by calculating internal consistency (Cronbach’s alpha). Inter-rater reliability was tested using kappa-statistics to evaluate possible differences between ratings of physiotherapists and physicians.

Results: Phase one – Development of the Assessment

The CHARMI assesses mobility by testing seven items. Four items address transfer abilities, three locomotion. The CHARMI uses two four-point scales (0 to 3) for each item displaying effort in personnel (CHARMI-P) and time (CHARMI-T) needed to conduct these mobility functions.

The items used are based on the course of optimal mobilisation from transfers to locomotion. Content validity is logical, a formal validation by an expert panel confirmed content validity of all items and scaling.

Phase two – Psychometric Test Evaluation

The total CHARMI shows excellent internal consistency (Cronbach’s αtotal=.93), as do CHARMI-P (αP=.86) and CHARMI-T (αT=.86) alone. Inter-rater reliability was excellent for total CHARMI (κtotal=.96), as well as for CHARMI-P (κP=.93) and CHARMI-T (κT=.98).

Admission and discharge scores were compared to verify responsiveness to change. The mean admission score was 19.1 (SD=9.3), the mean discharge score was 27.4 (SD=9.2), effect size was large (d=1.12).

Conclusion: The CHARMI is an easy-to-use, graphically displayable mobility index for acute rehabilitation. It is a valid and reliable measure for mobility scaling efforts in personnel and time. Furthermore it is delegable to physiotherapists. Evaluation is currently going on. An “alpha-version” of the CHARMI will be presented in the future.


References

1.
Bussmann J, Stam H. Techniques for measurement and assessment of mobility in rehabilitation: a theoretical approach. Clin Rehabil. 1998;12(6):455-64.
2.
Johnson L, Selfe J. Measurement of mobility following stroke: a comparison of the Modified Rivermead Mobility Index and the Motor Assessment Scale. Physiotherapy. 2004;90(3):132-8.