A physical therapy mobility checkup for older adults: feasibility and participant preferences from a discrete choice experiment

Key points

1. 015 of 6 pre-specified feasibility criteria were met; only visit duration fell short (42% of visits exceeded 60 minutes)
2. 0268% of participants were identified as having preclinical or mobility disability, far exceeding the 25% feasibility threshold
3. 03Transitions (sit-to-stand and getting up from the floor) identified the most participants below age-referenced norms (16 of 21 with any impairment)
4. 04In the discrete choice experiment, no out-of-pocket cost was the dominant preference by a wide margin over $25 or $129 co-pays
5. 0597% of DCE participants said they would use a Mobility Checkup if one were available

How it was conducted

Design

Two-phase pilot: Phase 1 feasibility study + Phase 2 discrete choice experiment (DCE)

Participants

31 adults aged 55+ per phase (62 total); recruited from assisted living, libraries, and an academic institution

Feasibility criteria

6 a priori criteria: preclinical disability identification rate, cancellation rate, visit duration, satisfaction, education usefulness, adverse events

Mobility measures

Five Times Sit to Stand, Timed Up From Floor, 10-metre walk test, 6-minute walk test, Functional Gait Assessment, Activities-specific Balance Confidence scale

DCE attributes

Out-of-pocket cost ($0/$25/$129), visit duration (30/60 min), education topic (fall risk/walking/transitions), graphic style (bar vs. line)

Analysis

Descriptive statistics for feasibility; conjoint choice modelling (conditional logistic regression) for DCE; false discovery rate correction applied

What they found

• 21 of 31 feasibility participants (68%) were identified as having preclinical or mobility disability (below 50th percentile on at least one measure)
• 16 of 21 impaired participants had below-normal transitions (Five Times Sit to Stand or Timed Up From Floor)
• 13 of 31 visits (42%) exceeded 60 minutes, failing the duration criterion
• Mean satisfaction score was 91% of the maximum (range 71-100%)
• 98% of participants rated the education as useful (range 80-100%)
• No adverse events occurred
• Preference for no out-of-pocket cost: utility 1.205 (95% CI 0.972-1.462, FDR P<0.001); $25 utility 0.163 (95% CI -0.041-0.372); $129 utility -1.369
• Preference for 30-minute visit: utility 0.168 (95% CI 0.022-0.318, FDR P=0.022)
• Preference for education about fall risk over other topics: utility 0.293 (95% CI 0.079-0.517, FDR P=0.019)
• Preference for bar graph (positive framing): utility 0.320 (95% CI 0.033-0.619, FDR P=0.007)
• 97% of DCE participants said they would attend a Mobility Checkup if available; 52% preferred annual frequency
• DCE completion rate: 31/31 (100%); mean time to complete 40 minutes

Limitations

• Small, homogeneous samples in both phases (n=31 each); feasibility phase was predominantly white, well-educated, and female
• Pre-specified 50th percentile cutoff for preclinical disability is not a validated clinical threshold, likely inflating the identification rate
• DCE data collection was cut short by the COVID-19 pandemic, preventing the originally planned sample of 40 per survey
• Study did not measure whether the education actually changed participant behaviour or physical activity levels

Why it matters

For patients

Older adults who are concerned about their mobility can expect a brief, safe, and satisfying physical therapy assessment that tells them how their walking speed, balance, and ability to rise from a chair or the floor compare to people their age.

For clinicians

Physical therapists can feasibly deliver a standardised Mobility Checkup in community or clinic settings; transitions (sit-to-stand and floor rise) appear to be the highest-yield tests for catching early mobility decline.

For readers

This pilot supports developing a preventive PT model for older adults, but the small sample, non-validated disability cutoffs, and lack of behaviour-change outcomes mean a larger RCT is needed before widespread adoption.