Identifying, implementing and evaluating a physical performance outcome measure for the hospitalised older adult population

Introduction 

Data analysis within the Older Person’s Unit (OPU) identified increasingly complex and physically dependent patients. Elderly Mobility Scale (EMS) lacks sensitivity in highly dependent patients, with a pronounced floor effect obscuring functional gains in those requiring two‑person assistance. We aim to identify a more accurate outcome measure (OM) for functional change in hospitalised older adults.

Method 

This iterative project comprised:

• Scoping: 
  • benchmarking with 11 acute older adult wards nationally
  • Medline-based literature search, yielding 1298 articles: 5 were reviewed 
• Identification and implementation of “Hierarchical Assessment of Balance and Mobility” (HABAM) on OPU.
• Training with OPU physiotherapists ensuring standardised usage.
• Data collection for eligible patients (December 2025 - February 2026):  
  • Admission and discharge OM (EMS, HABAM, functional status) 
  • Age, gender, Clinical Frailty Scale 
• Data analysis using Cohen’s d for effect size.
• Feasibility assessment via OPU physiotherapist focus group. 

Results 

Benchmarking and literature review revealed no clearly recommended OM for this population; HABAM was identified as the most appropriate, responsive measure for trial on OPU. 88 data sets were analysed. Mean age was 83 years (60% female). Mean EMS change was 1.5 (SD 3.7, d=0.4), compared to 6.3 (SD 10.8, d=0.6) for HABAM. For the sub-group of patients requiring two-person assistance at admission and discharge, mean EMS change was 0.8 (SD 1.2, d=0.7), and HABAM was 7 (SD 7.0, d=1.0). Physiotherapists reported HABAM to be patient population-appropriate, noting ease and speed of use.

Conclusion

This data shows HABAM was more sensitive to change than EMS in OPU patients, particularly those still physically dependent at discharge. It was also deemed feasible for hospitalised older adults due to its quick, easy use. Further research is advised to evaluate the appropriateness of HABAM use at scale.