DEVELOPMENT OF A PHYSICAL PERFORMANCE AND MOBILITY EXAMINATION

OBJECTIVE: To develop and validate the Physical Performance and Mobili ty Examination (PPME), an observer-administered, performance-based ins trument assessing 6 domains of physical functioning and mobility for h ospitalized elderly. DESIGN: Development of a pass-fail and 3-level sc oring system and training manuals for the PPME instrument for use in b oth clinical and research settings. Two patient samples were used to a ssess construct validity and interrater reliability of the PPME. A thi rd sample was selected to assess the test-retest reliability of the in strument. SETTING/PATIENTS: (1) 146 subjects greater than or equal to 65 years of age with impaired mobility admitted to Medical Units of St anford University Hospital. (2) 352 subjects greater than or equal to 65 admitted to acute Medical and Surgical Services of the Pale Alto VA Medical Center. Patient samples were obtained during hospitalization and followed until 3 months post-discharge. To study test-retest relia bility, 50 additional patients, whose clinical condition was stable, w ere selected from both settings. METHODS: An expert panel selected 6 m obility tasks integral to daily life: bed mobility, transfer skills, m ultiple stands from chair, standing balance, step-up, and ambulation. Tasks were piloted with frail hospitalized subjects for appropriatenes s and safety. Test-retest and interrater reliability and construct val idity were evaluated. Construct validity was tested using the Folstein Mini-Mental State Examination, Activities of Daily Living (ADL), Inst rumental Activities of Daily Living (IADL), Geriatric Depression Scale , and modified Medical Outcomes Study Measure of Physical Functioning (MOS-PFR). Two scoring schema were developed for each task: (1) dichot omous pass-fail and (2) 3-level high pass, low pass, and fail. A summa ry scale was developed for each method of scoring. MAIN RESULTS: High interrater reliability and intrarater reliability were demonstrated fo r individual tasks. The mean percent agreement (interrater) for each p ass/fail task ranged from 96 to 100% and from 90 to 100% for the 3 pai rs of raters for each task using the 3-level scoring. Kappas for indiv idual pairs of raters ranged from .80 to 1.0 for pass-fail scoring and from .75 to 1.0 for 3-level scoring (all P < 0.01). Intraclass correl ation coefficients for 3-level scoring by pairs of raters ranged from .66 to 1.0. For summary scales, the mean intraclass correlation was .9 9 for both scoring schema. Test-retest reliability for summary scales using kappa coefficients was .99 for both pass-fail and 3-level scorin g, and .99 and .98, respectively, using Pearson Product Moment Correla tion. Correlations of PPME with other instruments (construct validity) suggest that the PPME adds a unique dimension of mobility beyond that measured by self-reported ADLs and physical functioning, and it is no t greatly influenced by mood or mental status (r = 0.70 (ADL), r = 0.4 3 (LADL), r = 0.36 (MMSE), r = 0.71 (MOS-PFR), r = 0.23 (GDS)). The 3- level summary scale was sensitive to the variability in the patient po pulation and exhibited neither ceiling nor floor effects. CONCLUSIONS: The PPME is a reliable and valid performance-based instrument measuri ng physical functioning and mobility in hospitalized and frail elderly .