The Hierarchical Assessment of Balance and Mobility (HABAM) tool

Purpose

Impaired mobility and balance correlate strongly with an individual's function and overall state of health. The Hierarchical Assessment of Balance and Mobility (HABAM) is a graphic and rapid assessment of balance and mobility originally designed for use within the hospitalised elderly. The measure has been used predominantly within frail elderly populations; however the aims of this study were to assess the utility of the HABAM to an elective orthopaedic population.

Approach

Prior to implementation of the measure, physiotherapists were asked to consider a hypothetical, uncomplicated patient undergoing THR or TKR and identify the HABAM score that would represent their interpretation of acceptable physical function at discharge. Physiotherapists completed this individually, without discussion and were blinded as to the aim of the task in an attempt to assess how the HABAM relates to physiotherapists interpretation of readiness for discharge.

Data were then collected on a consecutive cohort of 131 patients undergoing Total Hip Replacement (THR) and 60 undergoing Total Knee Replacement (TKR) between October and December 2017. HABAM scores were collected by a physiotherapist at each routine post-operative treatment session. Regression analyses were performed to investigate the relationships between length of stay (LOS) and other independent variables.

Outcomes

Seven of the eight physiotherapists questioned reported that a HABAM score of 50 would satisfy their interpretation of safe physical function at discharge, with a mean score of 50.4 (SD; 0.7). Patients had a mean HABAM score of 51.4 (SD; 3.8) at discharge, with 87.5% of patients reaching a score in excess of 50 by this point. Lower HABAM score on day 1 significantly contributed to the regression model (p< 0.001) and was related to a longer than mean LOS.

Implications

When utilised in an elective orthopaedic population, patients achieve a HABAM score in excess of 50 at discharge, which corresponds to pre-existing functional discharge criteria. The HABAM offers a practical way to quantify and objectively track patients' physical function, and may help identify patients early on in their hospital stay who are at risk of an increased LOS.

This study has shown that after a short initial data collection period, results can be obtained and implemented clinically to track functional recovery. Although the HABAM has been used almost exclusively within the literature for the elderly and frail, it has good reliability which does not vary with setting or level of frailty. With this, and the HABAM's ability to quickly assess and quantify patients' physical function, we think it has a larger scope of utility than currently defined in the literature. This study goes some of the way in expanding this scope; however, future research should focus on the use of the HABAM to track physical function and recovery in populations other than the frail elderly.

Fund acknowledgements

This service development project was funded by: Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust.

Additional notes

This work was presented at Physiotherapy UK 2018.