RMI: Rivermead Mobility Index

Yes, clinician should document which items were attempted and which were declined. Declining due to fatigue or pain is common late in assessment (patient may fatigue after items 1-10). Score obtained items; do not assume refusal means unable (patient might achieve item if rested). Report total RMI from completed items with notation of missing items. If <10 items completed, reliability is reduced; document circumstances and retest when patient more alert.

RMI assesses basic mobility (sit, stand, transfer, walk) through direct observation; Barthel Index assesses activities of daily living (toileting, dressing, eating) through patient report or observation. RMI focuses on physical capacity; Barthel Index includes cognition and self-care. RMI applicable acutely; Barthel often used at discharge. They correlate (r=0.7-0.8) but measure different constructs. RMI preferred for predicting early rehabilitation progress; Barthel preferred for functional outcome at discharge or home assessment.

RMI is less commonly used in progressive diseases but can be applied. In Parkinson's disease, RMI captures mobility decline related to rigidity/bradykinesia/postural instability. In MS, RMI reflects functional impairment from various disease phenotypes (motor, ataxic, cognitive). However, EDSS (MS) and MDS-UPDRS (Parkinson's) are more sensitive and widely used in these populations. RMI useful in progressive disease rehabilitation units to track functional change; less sensitive than disease-specific scales.

RMI is binary observational checklist (yes/no capable of 15 tasks); TUG is single timed test (rise from chair, walk 3 meters, turn, walk back, sit). Both assess mobility but RMI broader (bed mobility, sitting balance, standing, transfers, stairs, outdoor); TUG narrower (functional mobility in real-time). RMI requires 10-15 minutes; TUG requires 2-3 minutes. RMI useful in rehabilitation with complex mobility deficits; TUG useful for fall risk screening in community-dwelling older adults. They are complementary; many settings use both.

Literature suggests RMI ≥11 associated with independent or supervised home discharge; RMI 8-10 requires assistance for ambulation and transfers; RMI <8 typically necessitates facility placement or 24-hour home care. However, individual variation is substantial: some RMI 9 patients achieve home discharge with community support and family help; some RMI 13 patients unable to access home due to architectural barriers. Use RMI as prognostic guide, not determinant; integrate with caregiver availability, home environment, and patient preference.