Inter-rater reliability of the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) in the intensive care unit

Braz J Phys Ther. 2021 May-Jun;25(3):352-355. doi: 10.1016/j.bjpt.2020.07.010. Epub 2020 Aug 8.


Background: The Johns Hopkins Highest Level of Mobility (JH-HLM) scale is used to document the observed mobility of hospitalized patients, including those patients in the intensive care unit (ICU) setting.

Objective: To evaluate the inter-rater reliability of the JH-HLM, completed by physical therapists, across medical, surgical, and neurological adult ICUs at a single large academic hospital.

Methods: The JH-HLM is an ordinal scale for documenting a patient's highest observed level of activity, ranging from lying in bed (score = 1) to ambulating >250 feet (score = 8). Eighty-one rehabilitation sessions were conducted by eight physical therapists, with 1 of 2 reference physical therapist rater simultaneously observing the session and independently scoring the JH-HLM. The intraclass correlation coefficient was used to determine the inter-rater reliability.

Results: A total of 77 (95%) of 81 assessments had perfect agreement. The overall intraclass correlation coefficient for inter-rater reliability was 0.98 (95% confidence interval: 0.96, 0.99), with similar scores in the medical, surgical, and neurological ICUs. A Bland-Altman plot revealed a mean difference in JH-HLM scoring of 0 (limits of agreement: -0.54 to 0.61).

Conclusion: The JH-HLM has excellent inter-rater reliability as part of routine physical therapy practice, across different types of adult ICUs.

Keywords: Critical illness; Intensive care unit; Mobility limitations; Physical function; Rehabilitation.

MeSH terms

  • Adult
  • Humans
  • Intensive Care Units*
  • Physical Therapists*
  • Reproducibility of Results