McWilliams DJ, Atkins G, Hodson J, Boyers M, Lea T, Snelson C Is the Manchester Mobility Score a valid and reliable measure of physical function within the Intensive Care Unit McWilliams DJ, Atkins G, Hodson J, Boyers M, Lea T, Snelson C

Introduction Early and structured rehabilitation programmes have been shown to decrease both intensive care and hospital length of stay (LOS) [1], as well as improve functional ability at the point of intensive care discharge [2]. At present there is no general or universally accepted method for measuring mobility within the intensive care unit or to track rehabilitation progress [3]. Our aim was to test the validity and reliability of the Manchester Mobility Score (MMS) as a quick and simple tool for monitoring rehabilitation within critical care. 1. McWilliams et al (2014) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit. JCC 2. Schweickert et al. (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients. Lancet. 3. Elliott et al (2011) Assessing physical function and activity for survivors of a critical illness. Aust Crit Care

Manchester Mobility Score 1 – Passive Movements, Active exercise, chair position in bed 2 – Sit on edge of bed 3 – Hoisted to chair (incl. standing Hoist) 4 – Standing practice 5 – Step transfers with assistance 6 – Mobilising with or without assistance 7 – Mobilising > 30m A – Agitated U – Unwell R - Refused

Method Prospective observational study was performed within a large 75 bed, UK based mixed dependency critical care unit. The study was divided into 2 stages: Stage 1 - Inter–rater reliability testing of the MMS for all patients in critical care (Senior PT, Junior PT, Bedside nurse) Stage 2 - to assess for correlation with another validated measure of function within critical care (Barthel Index) for patients ventilated ≥5 days.

Stage 1 Results Patient Demographics (Stage 1) n=111 Age in years - mean (SD) 56 (18) Male (%) 71 (64%) SOFA score – mean (SD) 5 (3.9) PF ratio - median (IQR) 300 (222-400) Admission speciality (%): Surgical Medical Trauma and neurosurg Cardiothoracic   23 (21%) 15 (13%) 40 (36%) 33 (30%) Mechanically ventilated (%) 49 (44%) Tracheostomy (%) 28 (25%) Ventilator days - median (IQR) 2.0 (0.0-7.8) The inter-rater reliability was excellent with all 3 assessors assigning the same MMS score for every patient

Stage 2 Results Patient Demographics (Stage 2) n=53 Age in years - mean (SD) 53 (18) Male (%) 35 (66%) APACHE II – mean (SD) 15 (6.3) Charlson co morbidity index - median (IQR) 1 (0-2) Admission speciality (%): Surgical Medical Neurosurgical Trauma   6 (11%) 10 (19%) 26 (49%) 11 (21%) Mechanically ventilated (%) 53 (100%) Ventilator days - median (IQR) 10 (6 - 15) The correlation between the MMS and the Barthel Index on ICU discharge was found to be strong (p<0.001),

(p<0.001) The MMS also had a significantly negative association with post critical care length of stay

Conclusion The Manchester mobility score is a feasible measure for tracking rehabilitation within critical care It was quick and easy to complete with no prior training required for use. There was excellent inter-rater reliability across the entire critical care population with perfect agreement across different staff grades and professions. The negative association with critical care length of stay may offer some predictive value to long term outcome and would warrant further investigation.