Evaluation of the (modified) John Hopkins Highest Level of Mobility scale in surgical patients: a retrospective cohort study

Abstract

Background: The John Hopkins Highest Level of Mobility (JH-HLM) scale is developed to promote early mobility, however, in daily practice a ceiling effect in postoperative care is experienced. This study aimed to investigate whether the experienced ceiling effect of the JH-HLM scale actually exists and to evaluate if a modified version, the AMsterdam UMC Extension of the JOhn HOpkins Highest Level of mObility (AMEXO) scale is more sensitive to detect changes in mobility in hospitalized surgical patients. Method: All patients who underwent gastrointestinal surgery were included and measured with the JH-HLM scale or AMEXO scale in two different periods. Primary outcomes were the percentage of patients with the highest possible mobility score on the first postoperative day and the percentage of patients who showed a change in mobility score between the first three consecutive postoperative days. Results: In total, 373 patients were included (JH-HLM; n=135; AMEXO; n=238). On the first postoperative day, 61 (45.2%) patients scored the highest possible mobility score on the JH-HLM scale compared to 4 (1.7%) patients using the AMEXO scale (p-value < 0.001). During the first three consecutive postoperative days, 88 (65.2%) patients showed a change in mobility score with the JH-HLM scale compared to 225 (94.5%) patients with the AMEXO scale (p-value < 0.001). Conclusion and implications of key findings: Almost half of the patients scored the highest possible mobility score when using the JH-HLM scale which indicates a ceiling effect. The AMEXO scale appeared to be more sensitive to detect changes in mobility in hospitalized surgical patients and is therefore recommended instead of the JH-HLM scale. Future research should focus on how healthcare professionals can use the AMEXO scale to involve surgical patients to improve mobilization during hospital admission.