Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease

Abstract

Background There are currently no validated tools that are reliable and easy to use for nurses to assess mobility in people with acute cardiovascular disease in the Cardiovascular Intensive Care Unit (CICU). Methods A multidisciplinary team at an academic tertiary care centre developed the Level of Function (LOF) Mobility Scale for use in a nurse‐driven early progressive mobilisation in the CICU. To determine inter‐rater reliability, the prehospital and admission LOF were assessed independently by two CICU nurses. Pairwise comparisons between raters were evaluated using Cohen's kappa statistic. To determine convergence validity, the LOF and Activity Measure for Post‐Acute Care 6‐Clicks score upon admission were compared with Spearman's correlation. To determine feasibility, a 9‐item mobility scale questionnaire was distributed to CICU nurses with and without experience using the LOF Mobility Scale. The STROBE reporting guidelines were used. Results The LOF Mobility Scale had good inter‐rater reliability for assessment of LOF prior to hospitalisation (N = 131, kappa = 0.66, p < .001) and at the time of CICU admission (N = 131, kappa = 0.71, p < .001). There was a moderate correlation (N = 79 observations; correlation coefficient = 0.525; p < .01) between the bedside nurses LOF and the 6‐Clicks score. All nurses surveyed (N = 54; 100%) thought that the LOF Mobility Scale was clear and unambiguous, the LOFs were well‐defined and the scale was an appropriate length. Nearly all of the nurses with experience using the scale (N = 22/24; 92%) felt that the scale took less than one minute to complete, compared with about half (N = 14/30; 47%) in the group of nurses without experience using the scale. Conclusion The LOF Mobility Scale is reliable and feasible for mobility assessment in a nurse‐driven early progressive mobilisation programme in patients with acute cardiovascular disease in the CICU. Relevance to clinical practice A nurse‐driven EM programme can be implemented in the CICU.

Clinical instruments for bedside functional assessment: Convergent validity among the AM‐PAC ‘6‐Clicks’ and BMAT

“…The '6-Clicks' tool is a commonly used instrument to measure mobility (Jette et al, 2007;Jette et al, 2014aJette et al, , 2014b in acute and post-acute settings (Dima et al, 2020;Hiser et al, 2020;Hoyer et al, 2018). In this study, the lowest level of convergent validity was seen in the Orthopaedic admitting service.…”

Early mobilization post-myocardial infarction: A scoping review

“…Recent critical care society guidelines also recommend engaging family members in care to improve patient and family member outcomes (i.e., mental health) [ 68 ]. Nurse-driven approaches to EM in post-MI care may also be considered as a pragmatic approach in less resource rich settings [ 69 , 70 ].…”

Health-Related Quality of Life in Older Adults With Acute Cardiovascular Disease Undergoing Early Mobilization

“…The EM program uses the validated Level of Function (LOF) scale to assess the patient's maximal functional capacity to guide tailored mobilization activities. 6 The LOF score ranges from 0 (maintain range of motion) to 5 (increase general endurance and mobility). Bedside nurses assess the LOF score on unit J o u r n a l P r e -p r o o f arrival and then subsequently twice daily (morning and evening shift) and administer three levelspecific activities per shift.…”

“…5 Nurse-driven EM has been shown to be feasible and effective in people with older adults with acute cardiovascular disease (CVD) and provides early physical rehabilitation that may prevent the physical deconditioning found in posthospital syndrome. 6 Physical activity may also improve posthospitalization mood and cognitive outcomes. 7 Older adults may prioritize functional independence and quality of life measures over other more standard outcome measures.…”

“… 5 Nurse-driven EM has been shown to be feasible and effective in older adults with acute CVD and provides early physical rehabilitation that may prevent the physical deconditioning found in posthospital syndrome. 6 Physical activity may also improve posthospitalization mood and cognitive outcomes. 7 …”