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IRF Mobility Impairment, Adult

Feb.28.2019

Mobility Impairment (Adult IRF)

Clinical Description

  • Care of the patient experiencing impairment in functional mobility, including bed mobility, transfers, ambulation and stairs.

Key Information

  • Mobility is a critical component of daily task engagement and overall level of functional independence.
  • A clear understanding and communication of mobility status is important to determine independence and safety, including the use of or need for assistive devices.
  • Nonambulatory patients may require additional supervision or intervention during transfers to minimize fall risk.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Optimal Mobility Independence and Safety

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management/Training
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Mobility Impairment

Signs/Symptoms/Presentation

  • abnormal gait pattern
  • ambulation impairment
  • balance impairment
  • bed mobility impairment
  • functional transfer impairment
  • inability to safely negotiate doors, curbs or obstacles
  • inability to transfer off floor
  • mobility activity intolerance
  • mobility assistance required
  • mobility safety impairment
  • stair-climbing impairment
  • unsteady gait

Problem Intervention

Support Mobility Independence and Safety

  • Assess mobility and encourage participation at maximally safe independent level.
  • Provide level of assistance and supervision needed for safety; involve caregiver in mobility training.
  • Ensure effective use of devices, such as cane, transfer board or orthosis.
  • Schedule mobility activities when pain and fatigue are at a minimum; pace activity to conserve energy.
  • Ensure proper body mechanics and positioning for optimal task performance.
  • Identify and address impairments or safety issues affecting performance, such as balance, strength or cognition.
  • Provide mobility and gait training with therapeutic interventions.

Associated Documentation

  • Mobility Safety Promotion

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management/Training

  • environmental modification

  • mobility aids/assistive devices

  • safety techniques

When to Seek Medical Attention

  • new or worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Agency for Healthcare Research and Quality (AHRQ). (2016). NQF 2636. Inpatient rehabilitation facility (IRF) functional outcome measure: Discharge mobility score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2287. Functional Change: Change in motor score. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2321. Functional change: Change in mobility score. Source[Quality Measures,Clinical Practice Guidelines]
  • Agency for Healthcare Research and Quality (AHRQ). (2017). NQF 2634. Inpatient rehabilitation facility (IRF) functional outcome measure: Change in mobility score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
  • Braddom, R. L.; Chan, L.; Harrast, M. A.; Kowalske, K. J.; Matthews, D. J.; Ragnarsson, K. T.; Stolp, K. A. (2011). Physical medicine and rehabilitation. Philadelphia: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Gulanick, M.; Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Lehman, C. (2015). The specialty practice of rehabilitation nursing: A core curriculum. Chicago: Association of Rehabilitation Nurses. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Plummer, P.; Zukowski, L. A.; Giuliani, C.; Hall, A. M.; Zurakowski, D. Effects of physical exercise interventions on gait-related dual-task interference in older adults: A systematic review and meta-analysis. Gerontology. 2016;62(1), 94-117. [Metasynthesis,Meta-analysis,Systematic Review]
  • Rice, L. A.; Ousley, C.; Sosnoff, J. J. A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults. Disability and Rehabilitation. 2015;37(19), 1697-1705. doi:10.3109/09638288.2014.976718 [Metasynthesis,Meta-analysis,Systematic Review]
  • Umphred, D. A.; Lazaro, R. T.; Roller, M. L.; Burton, G. U. (2013). Umphred's neurological rehabilitation. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Van Abbema, R.; De Greef, M.; Crajé, C.; Krijnen, W.; Hobbelen, H.; Van Der Schans, C. What type, or combination of exercise can improve preferred gait speed in older adults? A meta-analysis. BMC Geriatrics. 2015;15(1), 72. [Metasynthesis,Meta-analysis,Systematic Review]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.