Rivermead Mobility Index assesses

The Rivermead Mobility Index assesses functional mobility in gait, balance and transfers after stroke

Intended Population

Those with a diagnosis of Stroke, Spinal Cord Injury, Acquired Brain Injury, Lower Limb Amputees

Method of Use

Description:

• The Rivermead Mobility Index is appropriate for a range of disabilities that include anything from being bedridden to being able to run

15 items:

• 14-self-reported items
• 1 direct observation item
• Items progress in difficulty
• Items are coded as either 0 or 1, depending on whether the patient can complete the task according to specific instructions
• Items receive a score of 0 for a “No” response and 1 for a “Yes” response
• Total scores are determined by summing the points for all items
• A maximum of 15 points is possible; higher scores indicate better mobility performance
• A score of “0” indicates an inability to perform any of the activities on the measure

Evidence

Reliability

Test-retest Reliability:

Chronic Stroke:

(Chen et al, 2007; Green, Foster & Young, 2001; n = 22; 1 year post-stroke, assessed twice, with one week between assessments) ^[1]

• Excellent overall test-retest reliability (ICC = 0.96)
• Excellent test-retest reliability for the following subcategories:

Kappa for turning in bed = 1.0
Kappa for walking inside without aid = 0.89
Kappa for walking outside on uneven ground = 0.83
Kappa for bathing = 0.81
Kappa for picking objects off the floor = 0.79

• Adequate test-retest reliability for the following subcategories:

Kappa for stairs = 0.68
Kappa for lying to sitting = 0.64
Kappa for sitting balance = 0.64
Kappa for transfers = 0.64
Kappa for walking up and down 4 steps = 0.67

Lower Limb Amputees:

(Ryall et al, 2003; n = 62; mean age = 56.8 (18.8) years; mean time post amputation: 4.9 (14.7) years) ^[2]

• Excellent test-retest reliability (ICC = 0.99)

Interrater/Intrarater Reliability:

Acute Stroke: (Hsueh et al, 2003; n = 57; mean age of 64.2 (11.5) years; assessed at 14, 30, 90, and 180 days post stroke; Taiwanese sample) ^[3]

• Excellent interrater reliability for total score (ICC = 0.92)
• Poor to excellent interrater reliability for individual subcategories (Weighted Kappa = 0.37 – 0.94)

Validity

Criterion Validity:

Acute Stroke:

(Hsieh et al, 2000; n = 38 inpatients; Sommerfeld & vo Arbin, 2001; n = 115 inpatients aged > 65; Hsueh et al, 2003) ^[4]

• Excellent predictive validity with Barthel Index 24 days post stroke (r = 0.77)
• RMI scores of > 4 best predictor of early discharge home

Lower Limb Amputees:

(Ryall et al, 2003) ^[5]

• Adequate concurrent validity with TWT (r = -0.58)
• Only one value is outside the 95% limits of agreement

Construct Validity: 

Acute Stroke: (Hsueh et al, 2003) ^[6]

• Excellent correlation with BI at 14 days post stroke (r = 0.72)
• Excellent correlation with BI at 30 days post stroke (r = 0.88)
• Excellent correlation with BI at 90 days post stroke (r = 0.86)
• Excellent correlation with BI at 180 days post stroke (r = 0.88)

Lower Limb Amputees: (Franchignoni et al, 2003a, n = 140; mean age = 57 (18) years) ^[7]

· Excellent correlation with motFIM at beginning of prosthetic training (r = 0.83)
· Excellent correlation with motFIM at end of prosthetic training (r = 0.69)
· Excellent correlation of the change scores for the RMI with changes in motFIM (r = 0.75)
· Excellent correlation with TWT (timed walking test) at end of prosthetic training (r = -0.70)

Content Validity:

Acute Stroke: (Hsieh et al, 2000) ^[8]

• Critical values for two indices, coefficient of reproducibility (> 0.9) and coefficient of scalability (> 0.7), were all exceeded

Lower limb amputees: (Franchignoni et al, 2003a) ^[9]

• Coefficient of reproducibility was exceeded and ranged from 0.71-1.0
• Coefficient of scalability was not exceeded and ranged from 0.38-0.62

Lower limb amputees: (Ryall et al, 2003) ^[10]

• Coefficient of reproducibility was exceeded and ranged from 0.91-0.94

Responsiveness

Acute Stroke: (Hsueh et al, 2003) ^[11]

Values reported as SRM (Standardized Response Mean)

RMI = Rivermead Mobility Index
MRMI = Modified Rivermead Mobility Index
STREAM = Mobility Subscale of the Stroke Rehabilitation Assessment of Movement
BI = Barthel Index

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