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    Careplan

    IRF Mobility Impairment, Adult IRF

    May.05.2021

    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
    • 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

    • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • (2019). Lazaro, R. T.; Reina-Guerra, S. G.; Quiben, M (Eds.), Umphred's Neurological Rehabilitation. St. Louis: Elsevier. [Expert/Committee Opinion]
    • 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]
    • Centers for Medicare & Medicaid Services. (2019). NQF 2634. Inpatient rehabilitation facility (IRF) functional outcome measure: Change in mobility score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
    • Centers for Medicare & Medicaid Services. (2019). NQF 2636. Inpatient rehabilitation facility (IRF) functional outcome measure: Discharge mobility score for medical rehabilitation patients. Source[Quality Measures,Clinical Practice Guidelines]
    • Corregidor-Sánchez, A. I.; Segura-Fragoso, A.; Rodríguez-Hernández, M.; Criado-Alvarez, J. J.; Jaime, G. G.; Polonio-López, B. Can Exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis. Maturitas. 2020;132, 40-48. doi:10.1016/j.maturitas.2019.12.006 [Meta-analysis,Systematic Review]
    • 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]
    • Lin, T. C.; Yen, M.; Liao, Y. C. Hearing loss is a risk factor of disability in older adults: A systematic review. Archives of Gerontology and Geriatrics. 2019;85, 1-9. doi:10.1016/j.archger.2019.103907. [Systematic Review]
    • Menezes, K. V. R. S.; Auger, C.; de Souza Menezes, W. R.; Guerra, R. O. Instruments to evaluate mobility capacity of older adults during hospitalization: A systematic review. Archives of Gerontology and Geriatrics. 2017;72, 67-79. doi:10.1016/j.archger.2017.05.009. Source[Systematic Review]
    • Papa, E. V.; Dong, X.; Hassan, M. Resistance training for activity limitations in older adults with skeletal muscle function deficits. Clinical Interventions in Aging. 2017;12, 955-961. doi:10.2147/CIA.S104674 [Systematic Review]
    • 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]
    • Porras, D. C., Siemonsma, P., Inzelberg, R., Zellig, G., Plotnik, M. Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology. 2018;90(22), 1017-1025. [Metasynthesis,Meta-analysis,Systematic Review]
    • Registered Nurses' Association of Ontario. (2017). Preventing falls and reducing injury from falls. Source[Quality Measures,Clinical Practice Guidelines]
    • Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc and its successor in interest, UDSMR, LLC. (2015). NQF 2287. Functional change: Change in motor score. Source[Quality Measures,Clinical Practice Guidelines]
    • Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc and its successor in interest, UDSMR, LLC. (2019). NQF 2321. Functional change: Change in mobility score. Source[Quality Measures,Clinical Practice Guidelines]
    • 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]
    • Youkhana, S.; Dean, C. M.; Wolff, M.; Sherrington, C.; Tiedemann, A. Yoga-based exercise improves balance and mobility in people aged 60 and over: A systematic review and meta-analysis. Age and Ageing. 2015;45(1), 21-29. doi:10.1093/ageing/afv175 [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.

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