Rivermead Mobility Index (RMI)

Purpose of the measure

The Rivermead Mobility Index (RMI) was developed from the Rivermead Motor Assessment Gross
Function subscale as a means to quantify mobility disability in clients with stroke. The RMI
is clinically relevant in testing functional abilities such as gait, balance, and transfers
(Forlander & Bohannon, 1999).

Available versions

The RMI was published in 1991 by Collen, Wade, Robb and Bradshaw and is based on the
gross function section of the Rivermead Motor Assessment.

Features of the measure

Items:

The RMI includes fifteen mobility items: 14 self-reported and 1 direct observation (standing unsupported). The 15 items are hierarchically arranged and fulfill Guttmann scaling criteria, suggesting all items are ordered according to ascending difficulty. To clarify, if the client succeeds in completing the most difficult item, this suggests he/she will succeed in easier items. Similarly, failure on an item suggests the client will be unable to complete the remaining more challenging items (Hsieh, Hsueh, & Mao, 2000). However, Franchignoni et al. (2003) identified potential difficulties in the order of the first three scale items. They reported that more patients could perform the third task (sitting balance) than either of the preceding two items (turning over in bed and lying to sitting). Given this, the authors suggested caution in interpreting the RMI as a true hierarchical scale.

The RMI can be administered using self-report or proxy report. It consists of the following 15 questions: (Forlander & Bohannon, 1999; Franchignoni et al. 2003).

  1. Turning over in bed: Do you turn over from your back to your side without help?
  2. Lying to sitting: From lying in bed, do you get up to sit on the edge of the bed on
    your own?
  3. Sitting balance: Do you sit on the edge of the bed without holding on for 10
    seconds?
  4. Sitting to standing: Do you stand up from any chair in less than 15 seconds and
    stand there for 15 seconds, using hands and/or an aid, if necessary?
  5. Standing unsupported: ask client to stand without aid and observe standing for 10
    seconds without any aid.
  6. Transfer: Do you manage to move from bed to chair and back without any help?
  7. Walking inside (with an aid if necessary): Do you walk 10 meters, with an aid if
    necessary, but with no standby help?
  8. Stairs: Do you manage a flight of stairs without help?
  9. Walking outside (even ground): Do you walk around outside, on pavements, without
    help?
  10. Walking inside, with no aid: Do you walk 10 meters inside, with no caliper, splint,
    or other aid (including furniture or walls) without help?
  11. Picking up off floor: Do you manage to walk five meters, pick something up from the
    floor, and then walk back without help?
  12. Walking outside (uneven ground): Do you walk over uneven ground (grass, gravel,
    snow, ice, etc) without help?
  13. Bathing: Do you get into/out of a bath or shower to wash yourself unsupervised and
    without help?
  14. Up and down four steps: Do you manage to go up and down four steps with no rail, but
    using an aid if necessary?
  15. Running: Do you run 10 meters without limping in four seconds (fast walk, not
    limping, is acceptable)?

Scoring:
Each item is coded 0 or 1, depending on whether the client can complete the task according to specific instructions. A score of 0 = a ‘no’ response; a score of 1 = a ‘yes’ response. A total score is determined by summing the points allocated for all items. A maximum score of 15 is possible: higher scores indicate better mobility performance. (Franchignoni et al., 2003; Hsueh, Wang, Sheu & Hsieh, 2003).

Time:
The RMI takes 3 to 5 minutes to administer (Hsieh et al., 2000).

Subscales:
None.

Equipment:
Only a pencil and the test are needed.

Training:
None typically reported.

Alternative forms of the RMI

Modified Rivermead Mobility Index (MRMI): In 1996, Lennon and Hastings proposed the MRMI
to increase the sensitivity of the RMI. The MRMI includes 8 items on which patients are
scored by rater’s direct observation. Scores are based on a 6-point scale and ranges from
0 to 40, where higher scores indicate better performance.

Client suitability

Can be used with:

  • Clients with stroke, including those with poor mobility status.
  • Clients with head injury or multiple sclerosis.

Should not be used in: The RMI should not be administered to clients with severe cognitive impairments due to the 14 self-reported items.

In what languages is the measure available?

English, Italian and Dutch (Franchignoni et al., 2003; Roorda, Green, De Kluis, Molenaar,
Bagley, Smith et al. (2008).