Background.The lack of common language among interprofessional inpatient clinical teams is an important barrier to achieving inpatient mobilization. In The Johns Hopkins Hospital, the Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF), also called “6-Clicks,”and the Johns Hopkins Highest Level of Mobility (JH-HLM) are part of routine clinical practice. The measurement characteristics of these tools when used by both nurses and physical therapists for interprofessional communication or assessment are unknown. Objective.The purposes of this study were to evaluate the reliability and minimal detectable change of AM-PAC IMSF and JH-HLM when completed by nurses and physical therapists and to evaluate the construct validity of both measures when used by nurses. Design.A prospective evaluation of a convenience sample was used. Methods.The test-retest reliability and the interrater reliability of AM-PAC IMSF and JH-HLM for inpatients in the neuroscience department (n = 118) of an academic medical center were evaluated. Each participant was independently scored twice by a team of 2 nurses and 1 physical therapist; a total of 4 physical therapists and 8 nurses participated in reliability testing. In a separate inpatient study protocol (n = 69), construct validity was evaluated via an assessment of convergent validity with other measures of function (grip strength, Katz Activities of Daily Living Scale, 2-minute walk test, 5-times sit-to-stand test) used by 5 nurses. Results.The test-retest reliability values (intraclass correlation coefficients) for physical therapists and nurses were 0.91 and 0.97, respectively, for AM-PAC IMSF and 0.94 and 0.95, respectively, for JH-HLM. The interrater reliability values (intraclass correlation coefficients) between physical therapists and nurses were 0.96 for AM-PAC IMSF and 0.99 for JH-HLM. Construct validity (Spearman correlations) ranged from 0.25 between JH-HLM and right-hand grip strength to 0.80 between AM-PAC IMSF and the Katz Activities of Daily Living Scale. Limitations.The results were obtained from inpatients in the neuroscience department of a single hospital. Conclusions.The AM-PAC IMSF and JH-HLM had excellent interrater reliability and test-retest reliability for both physical therapists and nurses. The evaluation of convergent validity suggested that AM-PAC IMSF and JH-HLM measured constructs of patient mobility and physical functioning.

Background A history of falls or imbalance may lead to a fear of falling, which may lead to self-imposed avoidance of activity; this avoidance may stimulate a vicious cycle of deconditioning and subsequent falls. Objective The purpose of this study was to develop a questionnaire that would quantify avoidance behavior due to a fear of falling. Design This study consisted of 2 parts: questionnaire development and psychometric testing. Questionnaire development involved an expert panel and 39 residents of an assisted living facility. Sixty-three community-dwelling individuals with various health conditions participated in psychometric testing. Method Questionnaire development included the evaluation of face and content validity and factor analysis of the initial questionnaire. The final result of questionnaire development was the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). In order to determine its psychometric properties, reliability and construct validity were assessed through administration of the FFABQ to participants twice, 1 week apart, and comparison of the FFABQ with other questionnaires related to fear of falling, functional measures of balance and mobility, and daily activity levels using an activity monitor. Results The FFABQ had good overall test-retest reliability (intraclass correlation coefficient=.812) and was found to differentiate between participants who were considered “fallers” (ie, at least one fall in the previous year) and those who were considered “nonfallers.” The FFABQ predicted time spent sitting or lying and endurance. Limitations A relatively small number of people with a fear of falling were willing to participate. Conclusion Results from this study offer evidence for the reliability and validity of the FFABQ and support the notion that the FFABQ measures avoidance behavior rather than balance confidence, self-efficacy, or fear.

This cohort study examines whether use of a mobility assessment tool in hospitalized patients with impaired mobility is associated with discharge to a postacute

The Friedman test is often used for a randomized complete block design when the normality assumption is not satisfied or the data are ordinal. The Friedman test can be viewed as an extension of the sign test for multiple measurements within each subject or block. We propose a modified Friedman test based on the Wilcoxon sign rank approach. Coincidentally, Tukey proposed a test statistic similar to our proposed test, but blocks are ranked by the minimum difference within each block. In the proposed test, we use the variance of block to rank the blocks, with the least variance being ranked the smallest. In both Tukey test and the modified Friedman test, linear ranks are used for blocks and treatments. The Tukey test belongs to the family of weighted-ranking test from Quade ( 1979 Quade, D. (1979). Using weighted rankings in the analysis of complete blocks with additive block effects. Journal of the American Statistical Association 74(367):680–683. [Google Scholar] ).The modified Friedman test, the Friedman test and the Tukey test are compared under various conditions and the results indicate that the proposed test is generally more powerful than the Friedman test and the Tukey test when the number of groups is small.