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Standard Neuromuscular Examination or Direct Assessment?

Mary E. Tinetti, MD; Sandra F. Ginter, RN

JAMA. 1988;259(8):1190-1193.

Abstract
The need to assess functions such as mobility in elderly patients is increasingly recognized. Lacking other methods, clinicians may rely on the standard neuromuscular examination to evaluate mobility. Therefore, we checked the sensitivity of the neuromuscular examination for identifying mobility problems by comparing relevant neuromuscular findings with performance during four routine mobility maneuvers: (1) getting up from a chair, (2) sitting down, (3) turning while walking, and (4) raising the feet while walking. The subjects investigated were 336 elderly persons living in the community. Many subjects who performed poorly during mobility maneuvers did not have the corresponding neuromuscular abnormalities. For example, although hip and knee flexion are needed to sit down safely, abnormal hip flexion was found in only 15% and abnormal knee flexion in only 30% of the subjects who had difficulty sitting down. The relationship between neuromuscular findings and functional mobility was not predictable enough to rely on neuromuscular findings for identifying mobility problems. Therefore, a simple assessment that reproduces routine daily mobility maneuvers should be developed for use in the clinical care of elderly patients.

(JAMA 1988;259:1190-1193)

Author Affiliations
From the Department of Medicine, Yale University School of Medicine, New Haven, Conn.

Footnotes
Reprint requests to Department of Medicine, Yale University School of Medicine, Box 3333, 333 Cedar St, New Haven, CT06510-8056 (Dr Tinetti).

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