Journal of Acute Care Physical Therapy
THE EDITOR
The Elderly Mobility Scale
T
he purpose of this letter is to familiarize acute
care physical therapy clinicians with the elderly
mobility scale (EMS) and its potential useful-
ness in acute care physical therapy. The EMS was
developed in 1994 to assess the functional mobility
of frail elderly patients in acute care settings. It tests
the following 7 items: lying to sitting, sitting to lying,
sitting to standing, standing, gait, timed walk (6 m),
and functional reach, with a total score range from
0 (totally dependent) to 20 (independent mobility).
The tests assess the mobility in a hierarchical pattern.
The balance and gait components of the EMS as-
sess the positional changes that are considered a
prerequisite for activities of daily living.1 The EMS
does not require training to complete the assessment,
and it takes no more than 5 minutes to complete the
test.2 A modified version of the elderly mobility scale
(MEMS) was developed in 2004 that replaces 6 m of
walk test to 10 m of walk test and additionally in-
cluded stair-climbing ability. Overall, it assesses 8
components with a maximum total score of 23.3 The
MEMS fulfills the highest level of mobility compo-
nents (ie, stair climbing). The minimally clinical im-
portant difference for the EMS is 2 points or 10% of
the scale width.4 It also helps the service providers in
predicting the discharge destination on the basis of
the EMS scores (ie, the EMS score for home is 14-20,
home with a caregiver is 6-13, and nursing home is
0-6)1,5; however, the patient should be able to compre-
hend simple instructions.5
RELIABILITY AND VALIDITY
The EMS and the MEMS are highly reliable and valid
tools to assess functional mobility of elder patients in
an acute care setting. The EMS demonstrated a sig-
nificant association with the Barthel index (r = 0.96)
and functional independence measure (r = 0.95). In
1997, the EMS was further validated with the Barthel
index in another study, with a concurrent validity of
r = 0.79. In addition, the EMS reveals excellent
validity with modified Rivermead mobility index
The author has no conflict of interest and no source of funding to
declare.
DOI: 10.1097/JAT.0000000000000016
JACPT ■ Volume 7 ■ Number 1 ■ 2016
JACPT-D-14-00027.indd 3
LETTER TO
(Spearman P = 0.887). The MEMS demonstrated a
high correlation with gold standard functional inde-
pendence measure (r = 0.71). The interrater and test-
retest reliability of the MEMS was 0.931 to 1 and
0.87 to 0.99, respectively.1-6
COMMENTARY
The EMS and the MEMS are reliable and valid
tools that can be administered easily without any
special equipment in 5 minutes. They can be used
to assess the mobility of older patients (>55 years)
in an acute care with varying conditions. Unlike
other mobility scales that require patients to stand
or walk independently, the EMS and the MEMS can
be used for patients who are unable to move from
bed as they assess the mobility in a hierarchical pat-
tern from lying to stair climbing. Also, they may be
used to analyze the effectiveness of physiotherapy
interventions such as bed mobility exercise, balance
training, walking, and stair training. Effectiveness
of intervention can be determined in comparison
to the 10% minimal clinically important difference.
The physiotherapist may select the MEMS to assess
the mobility of elder patients in an acute care setting
as it covers higher level of functional task such as
stair climbing.
Limitations
The EMS and the MEMS have the mobility com-
ponent that alone does not predict the possible dis-
charge destination. The discharge destination of older
patients strongly depends on cognition, the body sys-
tems involved, and the patients living situation and/or
family support. The patient who scores more than 14
with cognitive impairments cannot be the safely dis-
charged to home, whereas the patient who scores less
than 6 with strong family support can be discharged
to home safely; therefore, this may not be a good
screening tool to predict the discharge destinations
for patients with cognitive impairments. In addition,
the EMS and the MEMS neither assess the quality of
movements and balance nor assess the basic activities
of daily living and, therefore, may be less useful than
other scales, to assess balance and activities of daily
living.
3
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 The Elderly Mobility Scale
Venkadesan Rajendran, BPT, MPT, (PhD)
Registered Physiotherapist, Medicine, Oncology
and Palliative care unit, Health Sciences North
Sudbury, Ontario, Canada
Email: venkadphysio@gmail.com
Deepa Jeevanantham, BPT, MPT
Health and Rehabilitation Science, Western
University, London, Ontario, Canada
REFERENCES
1. Smith R. Validation and reliability of the elderly mobil-
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2. Prosser L, Canby A. Further validation of the elderly mo-
bility scale for measurement of mobility of hospitalized
elderly people. Clin Rehabil. 1997;11(4):338-343.
3. Kuys SS, Brauer GS. Validation and reliability of the
modified elderly mobility scale. Australas J Ageing.
2006;25(3):140-144.
4. Chiu AYY, Au-Yeung SSY, Lo SK. A comparison of four
functional tests in discriminating fallers from non-fallers
in older people. Disabil Rehabil. 2003;25:45-50.
5. Yu MS, Chan CC, Tsim RK. Usefulness of the elderly
mobility scale for classifying residential placements.
Clin Rehabil. 2007;21(12):1114-1120.
6. Nolan JS, Remilton LE, Green MM. The reliability and va-
lidity of the elderly mobility scale in the acute hospital
setting. Internet J Allied Health Sci Pract. 2008;6(4):1-7.
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