The validity, reliability and responsiveness of the modified Iowa Level of Assistance scale in hospitalised older adults

Dr Sze-ee Soh1,2, Ms Melissa Raymond2, Ms Lara Kimmel1,2, Professor Anne Holland2,3

1Monash University, Frankson, Australia

2Alfred Health, Caulfield, Australia

3La Trobe University, Bundoora, Australia



To assess the psychometric properties of the modified Iowa Level of Assistance (mILOA) scale in hospitalised older adults.



Patients undergoing rehabilitation at a subacute rehabilitation hospital in metropolitan Melbourne were included if they were over 65 years, able to provide informed consent and medically stable to participate in two physiotherapy sessions within 24 hours. Interrater reliability was established by having two physiotherapists independently assess each participant within 24 hours of each other. Construct validity was established using ‘known-groups’ validity, whilst responsiveness was assessed by examining the difference in mILOA scores from admission to discharge.



The mean age of participants in the reliability phase of the study was 81.3 years (SD 7.8) with an average mILOA score of 12 points. The inter-rater reliability was excellent (intraclass correlation coefficient [2,1] 0.96; 95%CI 0.93, 0.98) with a mean difference between scores of 0.23 and limits of agreement of +4.96. The mILOA score displayed a mean difference between two known groups of 11.4 points (p<0.05). The scores also correlated significantly and negatively with the Elderly Mobility Scale (Spearman’s rho -0.90; p<0.01). Responsiveness was demonstrated with a minimal detectable change of 4.0 points.


Significance of the findings to allied health:

This study has provided an insight into the reliability, validity and responsiveness of the mILOA tool in the subacute care setting. This can help to provide invaluable information regarding patient outcomes and allow for benchmarking of services across departments and organisations.