This study supports the validity of the DEMMI for measuring the mobility of patients making the transition from hospital to the community. Currently it is required that the Modified Barthel Index is administered
in this patient cohort. However, the DEMMI has been identified in this study as more responsive to change than the Modified Barthel Index and is a unidimensional measure of mobility – a construct of particular interest to physiotherapists. The Modified Barthel Index and the DEMMI serve different purposes and this is reflected in the moderate correlation between instrument scores in this study. The Modified Barthel Index is a measure of independence in activities of daily SCH-900776 living and the DEMMI is a unidimensional measure of mobility. Consequently, for physiotherapists, the Modified Barthel Index could be a relatively ‘blunt’ measure of EGFR inhibition effectiveness as changes in other domains such as continence can confound changes in the targeted area of interest – mobility. This may be why the DEMMI was identified as more responsive to change than the Modified Barthel Index in this study. Neither the DEMMI nor the Modified Barthel Index had floor or ceiling effects.
This is often a limitation of instruments that are applied in heterogeneous populations who range from bed-bound to high levels of independent mobility. Both the DEMMI and Modified Barthel Index have the scale width required to measure and monitor changes, both improvement and deterioration, for patients in the Transition Care Program. A greater proportion of patients scored the highest possible Tolmetin score of 100 at discharge on the Modified Barthel Index than with the DEMMI. This finding may indicate that the DEMMI has a broader scale width than the Modified Barthel Index and demonstrate its potential to measure improvement after discharge from the Transition Care Program and return to independence in activities of daily living. Rasch analysis identified that the DEMMI items
performed consistently regardless of whether a physiotherapist or an allied health assistant administered the assessment. This finding has important workforce implications as allied health staff recruitment and retention is a challenge for Transition Care Programs. Three of the programs across Victoria were unable to participate in this research due to staff shortages. In response to these findings, the physiotherapy profession could review the boundaries of the scope of inhibitors practice of allied health assistants and physiotherapists. Our findings increase the potential for physiotherapists to work more as a consultant for all appropriate patients, with the allied health assistant able to administer the prescribed assessments and therapy as directed by the physiotherapist. Such a shift in the allied health assistant/physiotherapist scope of practice would potentially allow for aspects of workforce shortages in physiotherapists to be explored.