Related Experiment Video
Updated: Aug 14, 2026
Movement Retraining using Real-time Feedback of Performance
Published on: January 17, 2013
Evaluating the accuracy of minimum data set bed-mobility ratings against independent performance assessments:
Barbara M Bates-Jensen1, Sandra F Simmons, John F Schnelle
1Borun Center for Gerontological Research, School of Medicine, University of California, Los Angeles, 91335, USA. batesjen@ucla.edu
Purpose:
The Minimum Data Set (MDS) Activities of Daily Living (ADL) bed-mobility item, which rates the staff-assistance level necessary for bed movement, is used to target scheduled repositioning interventions and to identify physical function changes in nursing home residents; however, accuracy of the item is uncertain. The purpose of this study was to evaluate the accuracy of the MDS ADL bed-mobility item as completed by nursing home nurses with independent performance assessments conducted by research staff.
Design And Methods:
A convenience sample of 197 long-stay residents from 26 California nursing homes participating in a larger project was used in this cross-sectional study to compare independent research-staff performance assessments (using graduated assistance protocols of residents' ability to move in bed) and nursing home nurse MDS bed-mobility ratings. Participants also wore movement monitors to verify performance assessments.
Results:
Poor agreement existed between the nursing home nurse MDS bed-mobility ratings and the research-staff performance assessments across all assistance levels (kappa range, kappa = 0.007, p =.918 to kappa = 0.484, p <.001), with better agreement seen in totally dependent participants and with fewer elapsed days between MDS ratings and performance assessments. The odds of nursing home nurse errors (underestimating or overestimating dependency) on the MDS bed-mobility item were 2.1 times higher for participants judged independent by research staff compared with participants judged as requiring physical assistance by research staff (95% confidence interval, 1.14-4.03) when adjusted for number of days between nurse MDS ratings and research-staff performance assessments.
Implications:
Nursing home nurses overestimated resident dependency in bed mobility. The systematic inaccuracies in MDS bed-mobility ratings have implications for their use as a basis for targeting residents for repositioning programs and determining changes in residents' physical function. Performance assessments utilizing graduated assistance protocols are recommended as a method of improving the accuracy of MDS bed-mobility ratings.
Insights
Nursing home nurses often overestimate resident dependency in bed mobility. Accurate assessments are crucial for effective repositioning and tracking physical function changes in nursing home residents.
Area of Science:
- Gerontology
- Nursing Home Care
- Physical Function Assessment
Background:
- The Minimum Data Set (MDS) Activities of Daily Living (ADL) bed-mobility item is vital for care planning in nursing homes.
- Its accuracy in reflecting resident dependency and guiding interventions like repositioning is uncertain.
Purpose of the Study:
- To evaluate the accuracy of the MDS ADL bed-mobility item.
- To compare nurse ratings with independent research staff performance assessments.
Main Methods:
- A cross-sectional study involved 197 long-stay nursing home residents.
- Compared nurse-completed MDS ratings with research staff assessments using graduated assistance protocols.
- Movement monitors verified resident performance.
Main Results:
- Poor agreement was found between nurse MDS ratings and research staff assessments (kappa range: 0.007–0.484).
- Agreement improved for totally dependent residents and with shorter time intervals between assessments.
- Nurses overestimated dependency, with errors 2.1 times higher for residents deemed independent by researchers.
Conclusions:
- Nursing home nurses tend to overestimate resident dependency in bed mobility.
- Inaccurate MDS ratings can compromise repositioning targeting and physical function monitoring.
- Graduated assistance protocols are recommended to enhance MDS bed-mobility assessment accuracy.
