Brighton Mobility Score
Service evaluation • Frailty

Brighton Mobility Score pilot

Pilot evaluation of the Brighton Mobility Score in older people admitted to frailty wards, assessing whether serial BMS measurement is feasible, reproducible and clinically useful in routine hospital care.

We are recruiting early adopters to the BMS pilot. If you work in a frailty, acute medicine, rehabilitation, perioperative or related clinical service and would be interested in trying the Brighton Mobility Score, we would welcome your involvement and feedback.

Why pilot the BMS?

Mobility in frail inpatients is often documented narratively and inconsistently. Small but clinically important changes — for example moving from a two-person standing transfer to one-person assistance, or from assisted to independent frame walking — can be difficult to identify over time.

The BMS is designed to provide a simple, granular bedside description of current mobility and a common language for nursing, medical and therapy teams.

Admission→Deterioration→Stabilisation→Rehabilitation→Discharge
6–12 months Proposed initial pilot duration.
B8 & C8 Frailty wards, Royal Sussex County Hospital, Brighton.
Admission + weekly Baseline BMS followed by clinically appropriate serial scoring, usually on Mobility Mondays.
Development status: the Brighton Mobility Score is still being developed. The purpose of the pilot is to obtain practical clinical feedback, identify ambiguities, test usability and fine-tune the score before formal validation. Individual score definitions, wording or presentation may therefore change as feedback is received and the pilot develops.

Aims of the pilot

Primary aim

Determine whether the BMS can be incorporated into routine care on frailty wards as a simple and reproducible measure of patient mobility.

Detect change

  • Establish a clear mobility baseline.
  • Detect deterioration during acute illness.
  • Identify hospital-associated deconditioning.
  • Demonstrate recovery with treatment and rehabilitation.

Improve communication

  • Provide a longitudinal mobility measure.
  • Improve MDT communication.
  • Reduce reliance on lengthy narrative descriptions.
  • Support earlier clinical or therapy review when mobility falls.

Who is included?

The pilot is intended to reflect normal clinical practice rather than a narrowly selected research population.

Frailty

Older people receiving care on participating frailty wards.

Acute illness or injury

Including patients at risk of loss of mobility during an acute admission.

Deconditioning & recovery

Patients recovering from falls, undergoing rehabilitation or experiencing prolonged hospital admission.

How the BMS will be used

Baseline

A BMS is recorded following admission to establish the patient's current functional mobility.

Serial measurement

The score is repeated at clinically appropriate intervals, usually weekly, allowing the mobility trajectory to become visible.

Act on change

A change in BMS should prompt clinicians to consider why mobility has changed. The score is a signal, not a diagnosis.

What might a falling BMS mean?

Acute illness

Infection, pain, delirium or another acute medical problem.

Physiological or treatment effects

Hypotension, medication effects, weakness or reduced confidence.

Hospital-associated decline

Prolonged bed rest, deconditioning or a palliative trajectory.

Role of physiotherapy and occupational therapy

The BMS does not replace professional physiotherapy or occupational therapy assessment. Specialist therapy assessment addresses gait, balance, strength, endurance, cognition, equipment, rehabilitation potential and discharge requirements. The BMS asks a simpler longitudinal question: “How mobile is this patient now, and how has that changed?”

What will the pilot evaluate?

Feasibility

  • How frequently is the BMS completed?
  • How long does scoring take?
  • Can staff determine a score easily?
  • Are particular levels difficult to distinguish?

Reliability & responsiveness

  • Exploratory agreement between observers.
  • Does the score fall with illness or deconditioning?
  • Does it rise with mobilisation, rehabilitation and recovery?

Clinical usefulness

  • Communication and handover.
  • Recognition of deterioration.
  • Multidisciplinary discussion.
  • Rehabilitation goal setting.
  • Reduction in unnecessary narrative documentation.

Proposed outcome measures

  • Percentage of eligible patients with a BMS recorded.
  • Frequency of repeat measurement.
  • Time required to complete the score.
  • Distribution of scores.
  • Change between admission and discharge BMS.
  • Frequency of deterioration or improvement.
  • Agreement between observers.
  • Staff-reported ease of use and usefulness.

Exploratory relationships may include length of stay, discharge destination, therapy intervention, new or increased package of care, readmission and inpatient falls.

These exploratory associations should not be interpreted as formal validation.

Success criteria

The pilot will be considered successful if the BMS is quick to complete, understandable with minimal training, consistently used, sufficiently reproducible, responsive to recognised changes in mobility, useful to the multidisciplinary team and able to add value without creating a significant documentation burden.

Early adopters and pilot sites

Who can take part?

We are interested in hearing from clinical teams who would like to use the BMS in routine care and contribute feedback during its development.

Early adopters may include frailty, acute medicine, rehabilitation, perioperative, silver trauma and other services where changes in patient mobility are clinically important.

What we are looking for

  • Is the score quick and intuitive to use?
  • Are any levels difficult to distinguish?
  • Does it reflect clinically meaningful change?
  • Does it help communication between professions?
  • What wording or thresholds need refinement?

The score may evolve

The current BMS should be regarded as the pilot version. Feedback from participating clinicians and services will be used to refine and fine-tune the score before subsequent formal validation.

Interested in taking part?

Contact the BMS pilot

If you would like to become an early adopter, discuss piloting the BMS in your service, or provide feedback on the score, please get in touch.

Email: declan.okane@nhs.net

Governance and next steps

Service evaluation

The project is intended for local registration as an appropriate service-evaluation / quality-improvement pilot, subject to the Trust's usual governance processes.

Clinical safeguards

No clinical decision should be made solely on the basis of a BMS score. Existing nursing, medical and therapy assessments continue unchanged.

Formal validation

If the pilot is favourable, subsequent work may assess inter-rater reliability, construct validity, responsiveness, comparison with established measures and associations with clinically relevant outcomes.

Longer-term vision: to make change in mobility as visible and routinely communicated as other bedside observations — so deterioration in functional mobility in frail older people is measured, followed and acted upon rather than simply described.