Parker & Palmer (1993) prospectively evaluated 882 hip fracture patients on admission using a new nine-point pre-injury mobility score and the established abbreviated mental test score. The study asked which tool better predicts one-year mortality after proximal femoral fracture. Both were significant predictors, but the mobility score outperformed the mental test score and is simpler to administer.
Every hip fracture patient needs a one-year mortality estimate for family counseling and to frame decisions about surgical aggressiveness. The abbreviated mental test score was the leading predictor before this paper, but it performs poorly on acute admission because hospital-induced confusion artificially depresses scores in patients who were cognitively intact at home.
The Parker Mobility Score fixes this by asking about pre-injury function. Three questions about indoor walking, outdoor walking, and shopping can be answered by a family member in under two minutes, regardless of the patient's acute mental state.
Apply it on admission: score each domain 0-3, total 0-9. When the score is < 5, flag for elevated mortality risk and counsel accordingly. When both mobility < 5 and mental test < 8 are present together, one-year mortality is 59% — a number worth sharing during the consent conversation.
For individualized counseling, use the formula: % survival = 100 / [1 + exp(1.3 − 0.3×mobility − 0.07×mental test)]. This is why the Parker Mobility Score became a mandatory data field in the UK National Hip Fracture Database and a standard covariate in hip fracture outcomes research.
Parker & Palmer (1993) prospectively evaluated 882 hip fracture patients on admission using a new nine-point pre-injury mobility score and the established abbreviated mental test score. The study asked which tool better predicts one-year mortality after proximal femoral fracture. Both were significant predictors, but the mobility score outperformed the mental test score and is simpler to administer.
Every hip fracture patient needs a one-year mortality estimate for family counseling and to frame decisions about surgical aggressiveness. The abbreviated mental test score was the leading predictor before this paper, but it performs poorly on acute admission because hospital-induced confusion artificially depresses scores in patients who were cognitively intact at home.
The Parker Mobility Score fixes this by asking about pre-injury function. Three questions about indoor walking, outdoor walking, and shopping can be answered by a family member in under two minutes, regardless of the patient's acute mental state.
Apply it on admission: score each domain 0-3, total 0-9. When the score is < 5, flag for elevated mortality risk and counsel accordingly. When both mobility < 5 and mental test < 8 are present together, one-year mortality is 59% — a number worth sharing during the consent conversation.
For individualized counseling, use the formula: % survival = 100 / [1 + exp(1.3 − 0.3×mobility − 0.07×mental test)]. This is why the Parker Mobility Score became a mandatory data field in the UK National Hip Fracture Database and a standard covariate in hip fracture outcomes research.