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A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods.

Caitlin E Deom1, Julia Carpenter, Andrew J Bodine

  • 1Shirley Ryan AbilityLab, Chicago, Illinois (C.E.D., J.C., A.J.B., S.M.T., A.W.H., R.L.L., J.A.S.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (S.M.T.); Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois (A.W.H., R.L.L., J.A.S.); and Department of Biomedical Engineering, Northwestern University, Evanston, Illinois (R.L.L.).

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Summary

A new mobility measure, the Mobility Ability Quotient (Mobility AQ), shows better patient progress tracking than Quality Indicators (QI) in inpatient rehabilitation facilities. This tool enhances functional status assessment for improved patient care.

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Area of Science:

  • Rehabilitation Medicine
  • Health Services Research
  • Psychometrics

Background:

  • Inpatient rehabilitation facilities (IRFs) use Quality Indicators (QI) to report patient functional status for payment.
  • Current QI have limited measurement properties for monitoring patient progress during rehabilitation.
  • Enhanced mobility assessment is needed to better track patient improvement.

Purpose of the Study:

  • To develop and validate a new mobility measure, the Mobility Ability Quotient (Mobility AQ), for use in IRFs.
  • To improve the assessment of patient mobility and functional status during inpatient rehabilitation.
  • To create a measure more sensitive to change than existing QI.

Main Methods:

  • Developed the Mobility AQ using multidimensional item response theory (MIRT) on data from 10,036 IRF inpatients.
  • Utilized confirmatory factor analysis to define mobility subdimensions.
  • Included QI items and standardized mobility, motor performance, and transfer assessments.

Main Results:

  • Confirmatory factor analysis supported models for three distinct locomotion groups (walking, wheelchair, combined).
  • The Mobility AQ demonstrated significantly higher sensitivity to change compared to QI mobility items (dlast-first = 1.08 vs 0.60).
  • True score equating showed the Mobility AQ has a higher ceiling and lower floor than the QI.

Conclusions:

  • The Mobility Ability Quotient (Mobility AQ) offers improved sensitivity for tracking patient mobility changes in IRFs.
  • This MIRT-based measure can reduce assessment burden and enhance communication of patient functional status.
  • The Mobility AQ has the potential to improve the monitoring of patient progress and outcomes in inpatient rehabilitation.