title: Feasibility and inter-rater reliability of the ICU Mobility Scale.
abstract: OBJECTIVE
  The objectives of this study were to develop a scale for measuring the highest level of mobility in adult ICU patients and to assess its feasibility and inter-rater reliability.
  
  
  BACKGROUND
  Growing evidence supports the feasibility, safety and efficacy of early mobilization in the intensive care unit (ICU). However, there are no adequately validated tools to quickly, easily, and reliably describe the mobility milestones of adult patients in ICU. Identifying or developing such a tool is a priority for evaluating mobility and rehabilitation activities for research and clinical care purposes.
  
  
  METHODS
  This study was performed at two ICUs in Australia. Thirty ICU nursing, and physiotherapy staff assessed the feasibility of the 'ICU Mobility Scale' (IMS) using a 10-item questionnaire. The inter-rater reliability of the IMS was assessed by 2 junior physical therapists, 2 senior physical therapists, and 16 nursing staff in 100 consecutive medical, surgical or trauma ICU patients.
  
  
  RESULTS
  An 11 point IMS scale was developed based on multidisciplinary input. Participating clinicians reported that the scale was clear, with 95% of respondents reporting that it took <1 min to complete. The junior and senior physical therapists showed the highest inter-rater reliability with a weighted Kappa (95% confidence interval) of 0.83 (0.76-0.90), while the senior physical therapists and nurses and the junior physical therapists and nurses had a weighted Kappa of 0.72 (0.61-0.83) and 0.69 (0.56-0.81) respectively.
  
  
  CONCLUSIONS
  The IMS is a feasible tool with strong inter-rater reliability for measuring the maximum level of mobility of adult patients in the ICU.
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia. Electronic address: carol.hodgson@monash.edu.
authors.forename: Carol
authors.initials: C
authors.lastname: Hodgson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Needham
authors.affiliation: Austin Health, Heidelberg, VIC, Australia.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Haines
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Ward
authors.affiliation: Curtin University, Perth, WA, Australia; Royal Perth Hospital, Perth, WA, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Harrold
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital and Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zanni
authors.affiliation: The Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Heidi
authors.initials: H
authors.lastname: Buhr
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
authors.forename: Alisa
authors.initials: A
authors.lastname: Higgins
authors.affiliation: Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Presneill
authors.affiliation: Austin Health, Heidelberg, VIC, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Berney
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015588:Observer Variation; D010564:Personnel, Hospital; D059825:Physical Therapists; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Critical care; Early mobilization; Mechanical ventilation; Rehabilitation