Patient and therapist agreement on performance rated ability on the de Morton Mobility Index

Publication date: Available online 30 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Romi Haas, Kelly-Ann Bowles, Lisa O'Brien, Terry Haines
ObjectiveTo determine the level of agreement between patient self-report and therapist-assessed performance of mobility using the de Morton Mobility Index (DEMMI).DesignInter-rater agreement study; Setting: Outpatient hospital clinic in (blinded). Participants: Consecutive sample of patients (n=128) undergoing preoperative assessment for elective lower limb (LL) arthroplasty.InterventionsParticipants completed a therapist-directed assessment of the DEMMI followed by self-report of performance. A random subsample (n=62) also completed a self-report of anticipated performance prior to the therapist-directed assessment. Both raters (participant and therapist) were blinded to the scores obtained from the other rater.Main Outcome Measure(s)Inter-rater agreement between patient self-reported and therapist-directed assessment total DEMMI scores was calculated using the intraclass correlation coefficient (ICC) (Model 2,1) with a 95% confidence interval. Bland-Altman plots were also used to illustrate the agreement between the two raters.ResultsThe ICC between patient self-reported and therapist-directed assessment following performance of the total DEMMI score was 0.967 (95% confidence interval 0.952, 0.977). The ICC between patient anticipated performance and therapist-directed assessment of the total DEMMI score was 0.830 (95% confidence interval 0.730, 0.894). The Bland-Altman plots depicted greater levels of agreement amongst participants with impaired levels of mobility (≤74/100) than those with near maximum DEMMI scores.ConclusionsPatient self-report of anticipated performance is an acceptable proxy for DEMMI scores derived from therapist rating of performance. Caution should be applied when interpreting self-report scores of patients with near maximum levels of mobility. Further research is required to establish whether these results can be generalized across a range of patient populations and to clinicians with differing backgrounds and expertise.



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