PMI Supplementary Materials
PAIN and MOBILITY INDEX (PMI)
Name: Score
Date:
BED MOBILITY Rolling
Requires greater than 50% assistance to either side or unable 3
Requires less than 50% assistance to both sides 2
Able to roll to one side without assistance but requires assistance to roll to other side 1 Able to roll to each side with controlled motion without assistance 0 Lying to sit
Requires greater than 50 % assistance or unable 3
Requires less than 50% assistance 2
Able, but motion is uncontrolled OR requires > 1 push with arms to come to sitting 1
Performs task with a single controlled motion 0
Sit to lying
Requires greater than 50% assistance or unable 3
Requires less than 50% assistance 2
Able, but motion is uncontrolled OR requires > 1 attempt to lift legs onto bed 1
Performs task with a single controlled motion 0
TRANSFERS Sit to Stand
Requires greater than 50% assistance or unable 3
Requires less than 50% assistance 2
Requires more than 1 attempt or unsteady 1
Able to rise with controlled motion on first attempt 0
Stand to sit
Requires greater than 50% assistance or unable 3
Requires less than 50% assistance 2
Uncontrolled motion, but no assistance required 1
Sits with controlled motion 0
Initial standing balance (10 seconds)
Requires greater than 50% assistance or unable 3
Requires less than 50% assistance 2
Unsteady but self corrects and no assistance 1
Steady 0
GAIT
Assistive Device
Requires any assistance with assistive device or unable 2
Uses assistive device 1
Able to ambulate safely without assistive device 0
Right Stepping
Right step does not pass left stance AND right foot does not clear floor or unable 2 Either right step does not pass left stance OR right foot does not clear floor 1
Right step passes left stance AND right foot clears floor 0
Left Stepping
Left step does not pass right stance AND left foot does not clear floor or unable 2 Either left step does not pass right stance OR left foot does not clear floor 1
Left step passes right stance AND left foot clears floor 0
Walking Distance
Less than or equal to 150 feet without rest or unable 2
Greater than 150 feet but less than or equal to 1000 feet 1
Greater than 1000 feet without rest 0
Gait Speed
< .6 m/s (< 2 ft/s) or unable 2
.6 – 1.0 m/s (2 – 3.25 ft/s) 1
>1.0 m/s (3.25 ft/s) 0
STAIRS (at least 3 steps and may use one handrail with one hand) Ascending
Requires assistance or unable 2
Ascends with step-to pattern OR requires use of 2 handrails or other assistive device 1
Ascends with reciprocal pattern 0
Descending
Requires assistance or unable 2
Descends with step-to pattern OR requires use of 2 handrails or other assistive device 1
Descends with reciprocal pattern 0
BALANCE
Turning 180° and return in opposite direction
Requires any assistance or unable 2
Unsteady 1
Steady 0
Forward Reach
0 to 7 inches OR requires any assistance or unable 2
7 to 10 inches 1
> 10 inches 0
Eyes Closed, Feet Together (30 seconds)
Requires any assistance or unable 2
unsteady, but no assistance required 1
Steady 0
Single Leg Stand
Less than or equal to 5 seconds or unable 2
Greater than 5 seconds but less than or equal to 10 seconds 1
Greater than 10 seconds 0
PAIN
The patients subjective pain rating 0-10
9 to 10 5
7 to 8 4
5 to 6 3
3 to 4 2
1 to 2 1
0 = no pain 0
Grimacing with movement
Yes 1
No 0
Grimacing when still
Yes 1
No 0
Vocalizes pain without someone asking
Yes 1
No 0
Quick, jerky, unanticipated movements
Yes 1
No 0
Bracing or hesitancy to move
Yes 1
No 0
TOTAL
Pain and Mobility Index (PMI) Guidelines DEFINITIONS
“Assistive device” = any external device used to aid in ambulation or for stability.
“Greater than 50% assistance” = the patient requires greater than 50% assistance from the therapist to complete the task or any mechanical assistance is required.
“Less than 50% assistance” = the patient requires less than 50% assistance from the therapist to complete the task. This would include any contact assistance but not stand-by assistance.
“Steady” = the patient shows no signs of fear of falling and the practitioner notes no unstable movements.
“Unsteady” = the patient shows signs of fear of falling, or practitioner notes unstable movements that could be concerning for potential of future falls.
“Walking distance” = the length of distance a patient is able to ambulate without requiring a sitting rest break. Standing rest is acceptable.
“Without assistance” = no physical, contact assistance needed.
“> 1 push with arms” = more than just one smooth pushing motion. Multiple staggered small pushes would be an example of “>1 push with arms.”
“> 1 attempt to lift legs onto bed” = each leg may be lifted separately, but both legs must only require 1 smooth lifting motion from the floor to the top of the bed.
Attention:
If precautions or contraindications limit the patient’s ability to perform any item, score that item with the highest achievable score without compromising precautions or
contraindications. If a safety concern prohibits the patient’s ability to perform the item, score as “unable.” Guard the patient using standard of care practices, and use clinical judgement for resting or terminating the testing.
CLARIFYING INSTRUCTIONS Bed mobility
Rolling:
Ask the patient to “roll completely onto one side, then roll completely to the other side.”
The patient should obtain a fully side-lying position, assist the patient as needed to be able to obtain this position.
Supine to sit and sit to supine:
The patient should not use assistive devices or bed rails for this task, or have the head of the bed raised. If these are used, this item should be scored as “unable.”
Transfers Sit to stand:
The patient should have arms folded across chest, if arms are used to assist, it should be
scored as “requires less than 50% assistance.”
Stand to sit:
The patient may reach back with one arm to grab or feel chair.
Initial standing balance:
The patient should be free of assistance and not have the back of lower extremities touching chair.
Gait
Explain to the patient that their gait speed will first be timed, then they will walk as far as they safely can. The distance walked during timed trials may be included in the distance walked if there are no seated rest breaks.
Gait speed:1
Have predetermined marks on the floor or the wall to indicate a 2 meter acceleration zone, 4 meter timed zone, and a 2 meter deceleration zone.
Timing will begin and end when the midsagittal line of the trunk crosses the start and finish lines, respectively.
If the patient is able to perform this task 3 times, take the average of the 3 times as the
scored time. If the patient is only able to perform this task 1 time, score that time. If only 2 attempts were possible, score the average of those times.
Instruct the patient “walk at your usual speed through the finish line, do not stop at the finish line.”
Walking distance:2
Instruct the patient to “walk as far as you can without a seated rest.”
If the patient needs a standing rest, the distance measured can be continued once the patient begins walking again.
If the patient needs to sit to rest, the distance should be totaled and scored.
Be sure to identify the patient’s right and left stepping and score as appropriate on the PMI.
Stairs
Stairs should be available with at least 3 steps (including the platform at the top of the stairs).
Instruct the patient to “go up the steps using one handrail and one hand, turn around at
the top of the steps and come back down using one handrail and one hand.” Instruct the patient that they may use 2 handrails and alternate stepping patterns if needed. Assist the patient as needed.
Balance
Turning 180° and return in opposite direction:3
Instruct the patient to “turn around in a half circle and return to this starting point,” or
“turn around and face the opposite wall and return to this starting point.”
Forward reach:4
A yardstick should be affixed on a wall at the patient’s acromion height and parallel to the floor.
The patient should be positioned close to, but not touching the wall.
The patient should reach alongside the yardstick with one upper extremity, but not
touch the wall. The therapist should note the starting position of an anatomical landmark on the patient’s upper extremity (such as an individual MCP joint) on the yardstick and use this same landmark to determine the final reaching distance.
Instruct the patient to “reach forward as far as you can without taking a step or losing your balance.” The patient may use any reaching strategies during this task.
The patient is given one practice trial then the measured trial. If they move their feet,
touch the wall, or lose their balance, that trial cannot be counted; if any of these occur twice, score as “unable.”
Eyes closed, feet together:5
The patient is asked to “place your feet together (or as close as anatomically possible) and close your eyes for 30 seconds.”
Single leg stand:6
Instruct the patient to “stand on one foot, either foot is fine, for as long as you can up to 30 seconds with your arms across your chest or on your hips.”
If the patient requires any assistance to maintain balance during or immediately after this task, this item should be marked as “unable.”
Timing ends if the patient displaces the weight bearing foot, the raised foot touches the ground or touches the weight bearing leg, or arms come off their chest or hips.
Pain:
The patient should be asked about their pain before any of these items are assessed and after all mobility items are completed.
The higher of the patient’s subjective pain ratings should be the pain rating noted and scored.
Throughout the administration of this PMI, the therapist should be watching for all other
pain observations listed in this PMI and score them accordingly. Even one brief instance of any one of the pain observation items merits a “1” on that particular item.
REFERENCES:
1. Studenski S, Perera S, Wallace D, et al. Physical Performance Measures in the Clinical Setting.
J Am Geriatr Soc. 2003. 51:314-322.
2. Bohannon RW, Gorack W. Measurement of Distance Walked by Older Adults Participating in Subacute Rehabilitation. PM R. 2015. 7(2):130-134.
3. Kobayashi M, Usada S. Development of a Clinical Assessment Test of 180-degree Standing Turn Stratagy (CAT-STS) and Investigation of its Reliability and Validity. J Phys Ther Sci. 2016.
28(2):646-653.
4. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional Reach: A New Clinical Measure of Balance. J Gerontol. 1990. 45(6):192-197.
5. Cohen H, Blatchly CA, Gombash LL. A Study of the Clinical Test of Sensory Interaction and Balance. Phys Ther. 1993. 73(6):346-351.
6. Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative Values for the Unipedal Stance Test with Eyes Open and Closed. J Geriatric Phys Ther. 2007. 30(1):8-15.