Measurement properties of New Mobility Score to evaluate functional recovery in the elderly following total hip arthroplasty

Introduction/Objective. The aim of this study is to identify and evaluate the use of New Mobility Score in estimating functional recovery 3 months after total hip arthroplasty (THA). Methods. Seventy patients, aged > 60, who underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and New Mobility Score (NMS), and secondary one by Medical Outcomes Health Survey (Short Form Health Survey - SF-36). Questionnaires were collected before and three months after hip surgery. Results. Treatment group showed significant improvement 3 months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion. The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506

Use of the PROMIS Mobility score in assessing function in adolescents and adults previously affected by childhood hip disease

Aims The Patient-Reported Outcomes Measurement Information System (PROMIS) has demonstrated faster administration, lower burden of data capture and reduced floor and ceiling effects compared to traditional Patient Reported Outcomes Measurements (PROMs). We investigated the suitability of PROMIS Mobility score in assessing physical function in the sequelae of childhood hip disease. Methods In all, 266 adolscents (aged ≥ 12 years) and adults were identified with a prior diagnosis of childhood hip disease (either Perthes’ disease (n = 232 (87.2%)) or Slipped Capital Femoral Epiphysis (n = 34 (12.8%)) with a mean age of 27.73 years (SD 12.24). Participants completed the PROMIS Mobility Computer Adaptive Test, the Non-Arthritic Hip Score (NAHS), EuroQol five-dimension five-level questionnaire, and the Numeric Pain Rating Scale. We investigated the correlation between the PROMIS Mobility and other tools to assess use in this population and any clustering of outcome scores. Results There was a strong correlation between the PROMIS Mobility and other established PROMs; NAHS ( rs = 0.79; p < 0.001). There was notable clustering in PROMIS at the upper end of the distribution score (42.5%), with less seen in the NAHS (20.3%). However, the clustering was broadly similar between PROMIS Mobility and the comparable domains of the NAHS; function (53.6%), and activity (35.0%). Conclusion PROMIS Mobility strongly correlated with other tools demonstrating convergent construct validity. There was clustering of physical function scores at the upper end of the distributions, which may reflect truncation of the data caused by participants having excellent outcomes. There were elements of disease not captured within PROMIS Mobility alone, and difficulties in differentiating those with the highest levels of function. Cite this article: Bone Jt Open 2021;2(12):1089–1095.

Self-Assessment of Mobility of People over 65 Years of Age

Background and Objectives: Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under‑ or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. Materials and Methods: 222 participants over 65 years of age and one external, closely‑related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants’ mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank‑sum test and assumed with a p‑value of ≤ 0.05. Results: Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes. Conclusions: Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.

Proposed objective scoring algorithm for walking performance, based on relevant gait metrics: the Simplified Mobility Score (SMoS™)—observational study

Background Walking is a fundamental part of living, and its importance is not limited by age or medical status. Reduced walking speed (WS), or gait velocity, is a sign of advancing age, various disease states, cognitive impairment, mental illness and early mortality. Activity levels, as defined in the literature as “daily step count” (DSC), is also a relevant measure of health status. A deterioration in our walking metrics, such as reduced WS and DSC, is associated with poor health outcomes. These objective measures are of such importance, that walking speed has been dubbed “the 6th vital sign”. We report a new objective measure that scores walking using the relevant metrics of walking speed and daily step count, into an easy-to-understand score from 0 (nil mobility) to 100 (excellent mobility), termed the Simplified Mobility Score (SMoS™). We have provided equal weighting to walking speed and daily step count, using a simple algorithm to score each metric out of 50. Methods Gait data was collected from 182 patients presenting to a tertiary hospital spinal unit with complaints of pain and reduced mobility. Walking speed was measured from a timed walk along an unobstructed pathway. Daily step count information was obtained from patients who had enabled step count tracking on their devices. The SMoS of the sample group were compared to expected population values calculated from the literature using 2-tailed Z tests. Results There were significantly reduced SMoS in patients who presented to the spinal unit than those expected at each age group for both genders, except for the 50–59 age bracket where no statistically significant reduction was observed. Even lower scores were present in those that went on to have surgical management. There was a significant correlation of SMoS scores with subjective disability scores such as the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) in this cohort. Conclusions The SMoS is a simple and effective scoring tool which is demonstrably altered in spinal patients across age and gender brackets and correlates well with subjective disability scores. The SMoS has the potential to be used as a screening tool in primary and specialised care settings.

Characterization of Fed Cattle Mobility during the COVID-19 Pandemic

The COVID-19 pandemic had significant consequences on cattle slaughter capacity in the United States. Although industry stakeholders implemented strategies to minimize cattle welfare impacts of increased weights, days on feed (DOF), and increasing temperatures, there were concerns that mobility challenges would be observed at slaughter facilities. The objectives of this study were to characterize mobility in fed cattle during this recovery period and to identify factors impacting mobility. A total of 158 groups of cattle (15,388 animals) from one slaughter facility were included in the study. A 4-point mobility scoring system was used to assess cattle mobility. Cattle at the facility with normal mobility scores were reduced from the historical average of 96.19% to 74.55%. No increase in highly elevated mobility scores was observed. Mobility was impacted by weight, temperature humidity index (THI), distance hauled, sex, and DOF, with results differing by mobility category. Weather was a key contributor to mobility challenges; the relative risk of observing an elevated mobility score was 45.76% greater when the THI changed from No Stress to Mild Stress. Despite the challenges that the industry faced during this period, efforts to minimize negative effects on cattle welfare by enhanced focus on low-stress handling were effective.

A Retrospective Case Study into the Effect of Hoof Lesions on the Lying Behaviour of Holstein–Friesian in a Loose-Housed System

The association between hoof lesions and lying behaviour was assessed on a Holstein–Friesian dairy farm in England. Twenty-nine cows were included in the study. Cows with claw horn disruption lesions (CHDL, n = 8), soft tissue lesions (STL, n = 6), and no lesions (NL, n = 15) were assessed. Data were collected on parity, days in milk (DIM), and mobility scores. Cows were trimmed and treated, and lesions were recorded by a professional foot trimmer. Lying behaviour was assessed before and after claw trimming. The milking herd (n = 96) prevalence of lameness was 32.3%. Mobility was scored using the Agriculture and Horticulture Development Board (AHDB) Mobility Scoring system. Mobility scores were significantly different across lesions groups (p = 0.022). CHDL cows had a mean mobility score of 2.0 ± 0.9 (mean ± SD), STL were scored 1.2 ± 1.3, and NL cows were 0.9 ± 0.7. CHDL were associated with longer lying times (15.00 ± 1.04 h/d; p = 0.0006) and shorter standing times (9.68 ± 2.38 h/d; p = 0.0351) compared with NL lying times (11.77 ± 1.67 h/d) and standing times (12.21 ± 1.67 h/d). STL cows spent significantly less time lying (11.30 ± 2.44; p = 0.0013) than CHDL but not NL cows. No significant differences were found with any of the other lying behaviours. After trimming, CHDL cows spent significantly less time lying down than before trimming (13.66 ± 0.98; p = 0.0125). Cows with NL spent significantly more time lying down (12.57 ± 1.90; p = 0.0398) and had a shorter minimum lying bout duration (0.17 ± 0.09; p = 0.0236) after trimming. In conclusion, lying behaviour in dairy cattle was impacted by type of hoof lesions and hoof trimming.

PROMIS Paediatric Mobility tool is correlated with accelerometer-measured physical activity in children with hip diseases

Aims The reduction in mobility due to hip diseases in children is likely to affect their physical activity (PA) levels. Physical inactivity negatively influences quality of life and health. Our aim was to objectively measure PA in children with hip disease, and correlate it with the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Score. Methods A total of 28 children (12 boys and 16 girls) with hip disease aged between 8and 17 years (mean 12 (SD 3)) were studied between December 2018 and July 2019. Children completed the PROMIS Paediatric Item Bank v. 2.0 – Mobility Short Form 8a and wore a hip accelerometer (ActiGraph) for seven consecutive days. Sedentary time (ST), light PA (LPA), moderate to vigorous PA (MVPA), and vigorous PA were calculated from the accelerometers' data. The PROMIS Mobility score was classified as normal, mild, and moderate functions, based on the PROMIS cut scores on the physical function metric. A one-way analysis of covariance (ANCOVA) was used to assess differences among mobility (normal; mild; moderate) and measured PA and relationships between these variables were assessed using bivariate Pearson correlations. Results Children classified as normally functioning on the PROMIS had less ST (p = 0.002), higher MVPA, (p = 0.002) and VPA (p = 0.004) compared to those classified as mild or moderate function. A moderate correlation was evident between the overall PROMIS score and daily LPA ( r = 0.462, n = 28; p = 0.013), moderate-to-vigorous PA ( r = 0.689, n = 28; p = 0.013) and vigorous PA (VPA) ( r = 0.535, n = 28; p = 0.013). No correlation was evident between the mean daily ST and overall PROMIS score (r = -0.282, n = 28; p = 0.146) Conclusion PROMIS Pediatric Mobility tool correlates well with experimentally measured levels of physical activity in children with hip disease. We provide external validity for the use of this tool as a measure of physical activity in children. Cite this article: Bone Joint J 2021;103-B(2):405–410.

Translation, Reliability and Validity of the Spanish Version of the Modified New Mobility Score (NMS-ES)

The New Mobility Score (NMS) is an easy to administer self-report measure of functional ability, and is used worldwide as a hip fracture (HF) score, but a Spanish version does not exist. The aim of the study is to translate NMS into Spanish, and to measure its inter-rater reliability, internal consistency, and concurrent validity in a sample of Spanish speaking patients with HF. A reliability and validity study with a sample of 60 adults, 65 years or older (46 women and 14 men; mean age 81.7 years) with a hip fracture admitted consecutively to the acute trauma service of the Health Campus Hospital of Granada. The participants were interviewed during the first week after surgery by an occupational therapist or a physiotherapist. The statistical test used for analysis were: Cronbach’s α coefficient, McNemar–Bowker test, Bland–Altman plot, Spearman´s Rho, and Mann–Whitney U test. The Cronbach’s α coefficient was 0.90. No inter-rater systematic differences were found. We noted significant associations between the Spanish Version of the Modified New Mobility Score (NMS-ES) and selected health outcomes: Age, cognition, pre-fracture function, and basic mobility. The NMS-ES is a reliable and valid instrument to assess pre-injury functional levels for patients with HF in Spanish speaking countries.