Evidence of the use of the Perme Intensive Care Unit Mobility Score in hospitalized adults: a scoping review

Lenard, Maria Helena; Cechinel, Clovis; Zomer, Tissiane Bona; Rodrigues, João Alberto Martins; Binotto, Maria Angélica; Spoladore, Rossana

doi:10.1590/1518-8345.7491.4542

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Review Article • Rev. Latino-Am. Enfermagem 33 • 2025 • https://doi.org/10.1590/1518-8345.7491.4542 linkcopy

Evidence of the use of the Perme Intensive Care Unit Mobility Score in hospitalized adults: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to map the scientific literature regarding the use of the Perme Intensive Care Unit Mobility Score in hospitalized adults.

Method: scoping review, structured according to the methodological guidelines of the Joanna Briggs Institute - Evidence Synthesis Groups, with searches in seven databases and gray literature. The studies were selected by two reviewers, using an instrument for data extraction.

Results: the analysis of the 29 selected studies showed a predominance of longitudinal studies (34.48%), conducted in Brazil (48.27%) in Intensive Care Units (29%), and published between 2020 and 2021 (48.24%). The studies demonstrated the use of the Perme Score for description and reliability of the instrument, translation and cultural adaptation, association between functional mobility, clinical characteristics and outcomes, mobility assessment after interventions, mobility assessment and potential barriers to mobilization, and use of the score for validation of other instruments and various clinical profiles.

Conclusion: the Perme Score is an instrument capable of measuring physical mobility, including possible barriers to mobility, with potential for use in scenarios outside the Intensive Care Unit, in intervention studies for early mobilization and prediction of hospitalization outcomes.

Descriptors:
Mobility Limitation; Early Ambulation; Physical Therapy Modalities; Inpatients; Rehabilitation Nursing; Review

Highlights:

(1) The Perme Score demonstrates great potential for use in various settings. (2) Studies position nurses within the context of functional mobility assessment. (3) The Perme Score has been employed in intervention protocols for early mobility.

Author/ Year	Journal	Country of origin	Objectives	Results	Study design	Sample size
Perme, et al., 2014 ( ¹⁶ )	Methodist DeBakey Cardiovascular Journal	USA*	To describe a tool that assesses ICU ^† mobility and reliability, and to address clinical application.	- Perme Score ^‡ consisting of 15 items grouped into the following categories: mental status, potential mobility barriers, functional strength, bed mobility, transfers, gait, and endurance;	Methodological study	35
Perme, et al., 2014 ( ¹⁶ )	Methodist DeBakey Cardiovascular Journal	USA*		- Kappa agreement between evaluators: 94.29% (68.57%-100%). The Kappa values were: item 2 (mental status: patient can follow 2 out of 3 commands), no agreement (κ= 0); item 1 (alertness during initial contact), fair agreement (κ= 0.21-0.40); items 5, 10, 12 and 13, moderate agreement (κ= 0.41-0.60); items 4, 7, 9 and 11, substantial agreement (κ= 0.61-0.80); and items 3, 6, 8, 14 and 15, high agreement (κ= 0.81-1.00).	Methodological study	35
Nawa, et al., 2014 ( ¹⁷ )	Journal of Critical Care	USA*	To determine the inter-rater reliability of the Perme Score ^‡ in patients admitted to the Cardiovascular ICU ^† .	The 15 items of the score were analyzed individually. The inter-rater reliability was as follows: 1.0 for items 2, 3, 5, 6, 7, 8, 13 and 15; 0.82 for item 1; 0.80 for item 4; 0.60 for item 9; 0.72 for items 10 and 11; 0.78 for item 12; and 0.90 for item 14. The intraclass correlation coefficient was 0.98 (95% CI 0.97-0.99).	Methodological study	20
Kawaguchi, et al., 2016 ( ⁷ )	Jornal Brasileiro de Pneumologia	Brazil	To translate, adapt and validate the Perme Score ^‡ and IMS ^§ for Brazilian Portuguese.	The instruments showed excellent interobserver agreement (κ> 0.90) and reliability (α> 0.90) in all domains. There was a strong positive correlation between the two instruments (r= 0.941; p < 0.001).	Methodological study	103
Yang, et al., 2017 ( ²¹ )	American Journal of Respiratory and Critical Care Medicine	USA*	To identify the Perme Score ^‡ of patients at ICU ^† discharge and the final discharge destination.	The median Perme Score ^‡ for patients discharged home was 29; home care, 12; rehabilitation hospital, 26; skilled nursing facility, 13; and death, 7. Higher Perme Score ^‡ values were associated with home discharge ( p < 0.05).	Prospective longitudinal study	157
Nydahl, et al., 2018 ( ¹⁸ )	European Journal of Physiotherapy	Germany	To translate the Perme Score ^‡ into German and investigate the inter-rater reliability between physiotherapists and nurses.	The inter-rater reliability (nurses and physiotherapists) was nearly perfect: 0.96 (95%CI: 0.93-0.97). Two items were assessed with a reliability index lower than 0.8: ability to follow commands (0.73, 95%CI: 0.55-0.89) and pain (0.46, 95%CI: 0.09-0.68). The scale completion time was approximately 30 seconds. This is the first study comparing its application across different professionals.	Methodological study	58
Wilches Luna, et al., 2018 ( ¹⁹ )	Colombia M é dica	Colombia	To perform the translation, cultural adaptation and inter-rater reliability of the Spanish versions of the Perme Score ^‡ and IMS ^§ in ICU ^† patients.	The inter-rater reliability of the IMS ^§ ranged from 0.97 to 1.0, and for the Perme Score ^‡ it was between 0.99 and 1.0 at both measurement points, up to 24 hours after admission and ICU ^† discharge.	Methodological study	150
Moecke & Biscaro, 2019 ( ²² )	Fisioterapia Brasil	Brazil	To analyze the functional status of patients admitted to the ICU ^† and associate it with functional and clinical outcomes, and muscle strength.	- Perme Score ^‡: 8.18±3.99 upon awakening from sedation and 13.68±6 upon discharge from the ICU ^† ;	Prospective longitudinal study	40
				- Functional status and frailty are associated with clinical outcomes (discharge/transfer and death) ( p = 0.022 and p = 0.019);
				- MRC ^\|\| was associated with Perme Score ^‡ upon awakening ( p < 0.001) and at ICU ^† discharge ( p = 0.002);
				- Higher Perme Score ^‡ values are associated with MRC ^\|\| > 48.
Pereira, et al., 2019 ( ³⁶ )	Revista Brasileira de Terapia Intensiva	Brazil	To evaluate the predictive power of the Perme Score ^‡ for complications in the postoperative period of liver transplantation.	- Perme Score ^‡ at ICU ^† admission (5.5) and discharge (23.6), in the ward 28.2±5, and at hospital discharge 31.7±0.7;	Prospective observational study	30
				- When comparing the initial assessment in the ward and at hospital discharge, there was an improvement in functional status: Perme Score ^‡ 28.2 ± 5 to 31.7 ± 0.7, p < 0.001;
				- The duration of MV ^¶ was associated with the Perme Score ^‡ at ICU ^† discharge (r = -0.374; p = 0.042). The longer the MV ^¶ , the lower the Perme Score ^‡ at ICU ^† discharge;
				- The number of physiotherapy treatments was inversely associated with the Perme Score ^‡ at the IU ^** (r = -0.578; p = 0.001).
Ozcan, et al., 2020 ( ³¹ )	Disability and Rehabilitation	Turkey	To translate and cross-culturally adapt the FSS-ICU ^†† instrument into Turkish and evaluate its psychometric properties.	- Internal consistency was high (Cronbach’s α=0.949). Inter- and intra-rater reliability was excellent (α= 0.955-0.996);	Methodological study	50
Ozcan, et al., 2020 ( ³¹ )	Disability and Rehabilitation	Turkey		- FSS-ICU ^†† score showed moderate to high correlations with other functional measures, such as: Perme Score ^‡ (Spearman’s r= 0.92), Katz activities of daily living (r= 0.80) and handgrip strength (r= 0.76–0.77).	Methodological study	50
Cavalli, et al., 2020 ( ⁴⁰ )	Middle East Journal of Rehabilitation and Health Studies	Brazil	To analyze the discharge or mortality outcomes of ICU ^† patients considering age, sex, severity, reason for admission, comorbidities, and length of stay in the ICU ^† and hospital.	- The mean age was 54.91±19.7 years, with 62.5% male participants, a predominance of neurological conditions (34%), on MV ^¶ (63,9%), a mean ICU ^† stay of 5.76 days with an initial Perme Score ^‡ of 4.48 ± 7.17. The initial Perme Score ^‡ was lower in cases of death (0.57±1.98) compared to hospital discharge (7.27±8.16), p < 0.0001. Furthermore, the use of vasoactive and sedative drugs was higher in cases of death, p ≤ 0.0001;	Cross-sectional study	288
Cavalli, et al., 2020 ( ⁴⁰ )	Middle East Journal of Rehabilitation and Health Studies	Brazil		- There was a significant difference in the initial Perme Score ^‡ based on the type of admission: medical patients 4.15±7.30 and surgical patients 5.44±6.75, p <0.01.	Cross-sectional study	288
Ceron, et al., 2020 ( ³⁸ )	Respiratory Care	Brazil	To evaluate mobility performance changes with the use of speaking valves in tracheostomized individuals.	- Perme Score ^‡ increased from 11.3 (IQR ^‡‡ 10.1-12.0) to 18.2 (IQR ^‡‡ 16.2-20.1) immediately after the initiation of the speaking valve, p < 0.01.	Prospective cohort study	18
				- When evaluating the Perme Score ^‡ categories, changes were observed in the scores of the “transfer category” (“sitting to standing”, “static standing balance once the standing position is established” and “transferring from bed to chair or chair to bed”);
				- The use of speaking valves in tracheostomized patients improved mobility.
Gatty, et al., 2020 ( ²⁶ )	Physiotherapy Theory and Practice	India	To study the effectiveness of an early mobilization protocol on the mobility status of ICU ^† patients	- Perme Score ^‡ on the first ICU ^† day, median (IQR ^‡‡ ): intervention group 6 (2.2-8) and control group 6 (3-7); on the first day of rehabilitation, (IQR ^‡‡ ): intervention group 7 (5-9) and control group 5 (3-8); and on the last day of rehabilitation, (IQR ^‡‡ ): intervention group 18 (11-24.7) and control group 7 (5-11);	Non-randomized clinical trial	63
				- The difference in Perme Score ^‡ values between the first and last day of rehabilitation was 9 (3.2-17) in the intervention group and 2 (0-5) in the control group, p ≤ 0.001;
				- There was a significant increase in the median Perme Score ^‡ from the first day of ICU ^† admission to the last day of rehabilitation: 12.5 (6.2–7.7) in the intervention group and 2 (0–6) in the control group, p < 0.001;
				- The Perme Score ^‡ was compared between the first day of ICU ^† and the first day of rehabilitation, and no difference was observed in the intervention group ( p = 0.069) or the control group ( p = 0.124).
Lima, et al., 2020 ( ²³ )	Fisioterapia em Movimento	Brazil	To determine the relationship between functional mobility and clinical outcomes of patients admitted to the ICU ^† .	- Clinical outcomes (death/discharge) were associated with the Perme Score ^‡: mental status ( p = 0.040), mobility barriers ( p = 0.016), strength ( p = 0.01) and bed mobility ( p = 0.024). The total Perme Score ^‡ was 0 (0-10) for death and 10 (0-23) for discharge, ( p = 0.002);	Prospective longitudinal study	33
				- The use of MV ^¶ was associated with low scores on the scale, 2,40 ± 4,19, while its absence was associated with higher scores, 12,85±6,61, p = 0.000;
				- There was a positive correlation (R= 0.745) between Perme Score ^‡ and sedation level, and an inverse correlation between APACHE ^§§ and Perme Score ^‡ (R= -0.526), as well as between APACHE ^§§ and days of MV ^¶ (R= -0.602).
Perme, et al., 2020 ( ⁴¹ )	Journal of Acute Care Physical Therapy	USA*	To evaluate the association between the Perme Score ^‡ instruments, the MRC-SS ^\|\|\|\| and clinical outcome of patients admitted to the ICU ^† .	- The average Perme Score ^† was 23.56 (±7.09);	Prospective longitudinal study	250
				- The Perme Score ^† by discharge destination was: home 26.05±5.42, long-term care facilities 18.65±8.43, specialized nursing services 17.38±7.72, rehabilitation 20.3±7.48, and others 18±5.8;
				- The Perme Score ^‡ of discharged patients was different from those discharged to rehabilitation ( p < 0.001), specialized nursing service ( p < 0.001), long-term acute care ( p < 0.001) and palliative/hospice care or deceased ( p < 0.001);
				- There is a moderate correlation between the MRC-SS ^\|\|\|\| and the Perme Score ^‡ (r= 0.66; p < 0.001);
				- ICU ^† patients with a higher Perme Score ^‡ or MRC-SS ^\|\|\|\| at the time of physical therapist assessment were discharged home, while those with lower scores required post-acute care;
				- A higher Perme Score ^‡ or MRC-SS ^\|\|\|\| indicated a greater likelihood of discharge home.
Pinto, et al., 2020 ( ²⁹ )	Critical Reviews™ in Physical and Rehabilitation Medicine	India	To Identify PBM ^¶¶ and assess changes in mobility during ICU ^† stay in patients with organophosphate poisoning.	- The Perme Score ^‡ (2.50-6.0; p ≤ 0.01) improved in the subcomponents bed mobility (1.83±0.35 to 7.23±3.84), transfers (0.37±0.02 to 4.78±3.84) and gait (1.83±0.35 to 5.23±1.27) from day 2 to day 10 of hospital admission;	Cross-sectional study	37
Pinto, et al., 2020 ( ²⁹ )	Critical Reviews™ in Physical and Rehabilitation Medicine	India		- Endotracheal tube and continuous drug infusion were identified as PBM ^¶¶ (66.6%) by the Perme Score ^‡ .	Cross-sectional study	37
Wilches Luna, et al., 2021 ( ⁴² )	Physiotherapy Research International	Colombia	To determine MDC ^*** and responsiveness of the Perme Score ^‡ in adults admitted to the ICU ^† .	- The MDC ^*** value for the Perme Score ^‡ was 1.36, demonstrating that adults admitted to the ICU ^† who had a difference between the first and second scores greater than 1.36 points had a minimal detectable difference;	Prospective longitudinal study	142
				- MDC ^*** occurred in 80% of patients;
				- There was a significant difference in the duration of MV ^¶ (0.011) and in the ICU ^† length of stay ( p < 0.04).
Cordeiro, et al., 2021 ( ³⁷ )	Journal of Clinical and Translational Research	Brazil	To evaluate the association between early ambulation and functionality in patients undergoing heart valve replacement surgery.	- The walking group had a decrease of 11±2 in Perme Score ^‡ , while the non-walking group had a decrease of 13±2, p = 0.34.	Prospective cohort study	170
Da Rosa, et al., 2021 ( ²⁷ )	NeuroRehabilitation	Brazil	To verify the association between cycling aerobic training and lower limb muscle strength, walking speed, balance, mobility and functionality in individuals with CVA ^††† .	- Intervention: cycling aerobic training;	Randomized clinical trial	20
				- In the analysis of lower limb muscle strength, there was intergroup improvement between pre- and post-intervention. Significant improvement was observed in all muscle groups, including both the paretic and non-paretic sides, only in IG ^‡‡‡ ;
				- In the 10mWT ^§§§ and in the BBS ^\|\|\|\|\|\| there was an intragroup difference in IG ^‡‡‡ , p < 0.001, and an intergroup difference with a better result for IG ^‡‡‡ p < 0.001. It was observed that IG ^‡‡‡ showed improvement in balance (pre 0 ± 0, post 28.9 ± 7.45) and in gait speed (pre 0 ± 0, post 0.67 ± 0.78);
				- Regarding the Perme Score ^‡ , there was a difference between the results of the IG ^‡‡‡ (pre 14.3 ±3.10 and post 27.3 ± 2.91, p < 0.001) and the CG ^**** (pre 9.40±2.31 and post 12.30±3.40, p < 0.001).
				- Greater mobility was observed in individuals after an acute CVA ^††† who underwent cycle ergometer training.
Luna, Perme e Gastaldi, 2021 ( ³⁰ )	Canadian Journal of Respiratory Therapy	Colombia	To identify early PBM ^¶¶ in adults using the Perme Score ^‡ and association with days on MV ^¶ and ICU ^† length of stay.	- There were inverse correlations between the total number of days on MV ^¶ and the total PBM ^¶¶ score at ICU ^† admission (r = -0.773; p < 0.05) and discharge (r= -0.559; p < 0.05) as well as between ICU ^† length of stay and the total PBM ^¶¶ score at admission (r = -0.420; p < 0.05) and discharge (r= 0.283; p < 0.05);	Prospective observational study	142
Luna, Perme e Gastaldi, 2021 ( ³⁰ )	Canadian Journal of Respiratory Therapy	Colombia		- There was a correlation between the total score of the barriers item and the total Perme Score ^‡ (r= -0.91; p < 0.01).	Prospective observational study	142
Özsoy, et al., 2021 ( ³² )	Turkish Journal of Medical Sciences	Turkey	To translate and culturally adapt the IMS ^§ into Turkish and investigate its psychometric properties.	- The inter- and intra-rater reliability of the IMS ^§ was excellent, with a Kappa index of 0.87 (0.80-0.93) and 0.92 (0.87-0.96);	Methodological study	70
				- There are significant correlations between the IMS ^§ scale and the FSS-ICU ^†† , Perme Score ^‡ , Katz, right and left HGS ^†††† (rs ≥0.60; p < 0.05);
				- ICU ^† environment, mean age 69.65±10.73, 60% male, main diagnosis at admission was acute coronary syndrome 54.3%, Perme Score ^‡ 21.32±5.09.
Souza, et al., 2021 ( ²⁸ )	Revista Pesquisa em Fisioterapia	Brazil	To evaluate the energy and protein supply of critically ill patients undergoing conventional physiotherapy combined with an active cycle ergometer (IG ^‡‡‡ ) or conventional physiotherapy (CG ^**** ) and correlate with MRC ^\|\| , anthropometric data and Perme Score ^‡ .	- The level of caloric and protein adequacy in both groups was 73.9% and 69.5%, respectively. In CG ^**** caloric adequacy was 66.6% and protein adequacy was 58.3%, while in IG ^‡‡‡ the adequacy was 81.8% for both caloric and protein intake;	Interventional study	23
				- There was a significant reduction in calf circumference on day 9 compared to the baseline, p = 0,001. No difference was observed between the CG ^**** and the IG ^‡‡‡ , p= 0.053);
				- There was a significant reduction in arm circumference on day 9 compared to the baseline in both groups (CG ^**** p = 0.038 and IG ^‡‡‡ p = 0.041);
				- A moderate inverse correlation was found between energy deficit and the final Perme Score ^‡ in the CG ^**** (r= 0.59; p = 0.03).
Timenetsky, et al., 2021 ( ³⁴ )	PLoS One	Brazil	To describe the mobility level of COVID-19 patients admitted to the ICU ^† and address factors associated with the mobility level at the time of ICU ^† discharge.	- The Perme Score ^‡ improved when comparing discharge 20.0 (7-28) to admission 7.0 (0-16) in the ICU ^† , p < 0.001;	Retrospective cohort study	136
				- There was an improvement in mobility during ICU ^† admission in 64.7% of patients, and the median Perme Score ^‡ was 1.5 (0.6-3.4);
				- The improved group had a shorter duration of MV ^¶: 10 (5-14) vs. 15 (8-24) days, p = 0.021; shorter hospital stay: 25 (12-37) vs. 30 (11-48) days, p< 0.001; and lower ICU ^† and hospital mortality;
				- Independent predictors for mobility were younger age, lower Charlson Comorbidity Index, and not having received renal replacement therapy.
Reis, et al., 2021 ( ³³ )	Revista Brasileira de Terapia Intensiva	Brazil	To translate and cross-culturally adapt the Early Rehabilitation Index into Brazilian Portuguese and verify the psychometric properties of the tool (ERBI ^‡‡‡‡ ) at ICU ^† discharge.	- The ERBI ^‡‡‡‡ had adequate reliability, with a Cronbach’s alpha coefficient of 0.65;	Methodological study	122
				- Inter-rater reliability was excellent, with a coefficient of 0.94 (95%CI 0.92-0.96);
				- The validity of the ERBI ^‡‡‡‡ was observed through strong and significant correlations with the total Perme Score ^‡ (rô= 0.72);
				- ICU ^† characteristics: Perme Score ^‡ 25.5 (15-30), mean age 56 years (46.8-66), male 51%, reason for admission (23% sepsis, 19% elective postoperative, 14% cardiovascular disorder), 68% MV ^¶ , VM ^¶ duration 5 (3-8) days, and hospital discharge 88%.
Nawa, et al., 2022 ( ²⁰ )	Colombia M é dica	Brazil	To evaluate the influence of the Perme Score ^‡ on ICU ^† length of stay in the postoperative period of cardiac surgery and investigate the association of preoperative variables with postoperative mobility.	- The Perme Score ^‡ on days 2 and 3 was associated with ICU ^† length of stay: (β= -0.76; IC95% -1.19 to -0.33, p = 0.001) and (β= -2.67; IC95% -3.38 to -1.95, p <0.001), respectively.	Prospective longitudinal study	44
				- An increase of 4.6 points in the Perme Score ^‡ reduced ICU ^† length of stay by one day, regardless of the type of surgical procedure;
				- Preoperative pulmonary function was one of the main independent predictors of mobility status during the first three days of ICU ^† admission, as well as left ventricular ejection fraction and extracorporeal circulation time on day 1 ( p = 0.006), age and left ventricular ejection fraction on day 2 ( p = 0.002), and Maximum Expiratory Pressure on day 3 ( p < 0.001).
Nawa, et al., 2022 ( ³⁵ )	PLoS One	EUA*	To address variations in clinical characteristics, use of MV ^¶ , and risk factors associated with mobility level during ICU ^† stay in critically ill patients with COVID-19.	- The overall rate of patients out of bed was 63.3%, and those able to walk 30 meters was 20.5% at ICU ^† discharge;	Retrospective cohort study	949
				- The percentage of patients who were able to get out of bed during ICU ^† admission was lower in patients on MV ^¶\| (36.4% vs. 72%, p < 0.001), in the elderly (51.2% vs. 64.1%, p < 0.001) and in frail patients (41.2% vs. 56.5% in pre-frail vs. 65.7% in non-frail; p < 0.001);
				- After adjusting for confounding factors, the independent predictors of improvement in mobility level were frailty (OR 0.52; 95%CI: 0.29-0.94; p = 0.03) and higher Perme Score ^‡ at admission (OR 0.35; 95%CI 0.28-0.43, p < 0.001).
Yen, et al., 2022 ( ³⁹ )	NeuroRehabilitation	Taiwan	To investigate the effects of early progressive mobilization on functional mobility and the rate of out-of-bed mobility achieved by patients with moderate to severe traumatic brain injury.	- At ICU ^† discharge, IG ^‡‡‡ patients (progressive early mobilization) were at Level 1 (9.5%), Level 2 (33.3%) and Level 3 (52.4%), while CG ^**** patients remained at Level 0 on the Modified ICU ^† Mobility Scale;	Interventional study	86
				- Initial Perme Score ^‡ in the CG ^**** was 3.23±2.03 vs. 2.83±2.26 in the IG ^‡‡‡ ;
				- The IG ^‡‡‡ showed a significant increase in the total Perme Score ^‡ at ICU ^† discharge (IG ^‡‡‡ 6.62±4.33 vs. CG ^**** 3.64±1.66, p = 0.001, η2p= 0.995);
				- At ICU ^† discharge, only the subscore for the level of assistance required for mobility on the Perme Score ^‡ showed a difference (CG ^**** 3.64±1.66 vs. IG ^‡‡‡ 6.62±4.33, p = 0.001).
Nascimento, et al., 2023 ( ²⁴ )	Canadian Journal of Respiratory Therapy	Brazil	To assess the mobility of patients with COVID-19 using the Perme Score ^‡ outside the ICU ^† setting and correlate the score value with the length of hospital stay.	- An average increase of 7.3 points (95%CI 5.7-8.8, p < 0.001) between admission to the IU ^** and hospital discharge;	Retrospective cohort study	69
				- Average Perme Score ^‡ values on the IU ^** were 17.5 (15.8-19.3) and at hospital discharge were 24.8 (23.3-26.3);
				- There was no association between the Perme Score ^‡ values and length of hospital stay (0.929 95%CI; 0.861-1.002, p = 0.058);
				- It was observed that 17.9% of patients achieved the maximum score on the Perme Score ^‡ , of whom only one patient (1.4%) had the maximum score at both admission and discharge.
Rittel, et al., 2023 ( ⁴³ )	Dimensions of Critical Care Nursing	USA*	To assess mobility and self-care among elderly patients admitted to the ICU ^† and identify barriers to early intervention.	- Initial Perme Score ^‡ (IQR ^‡‡ 25-75) 23 (11.5-28) and final (IQR ^‡‡ 25-75) 27 (16-31);	Retrospective cohort study	43
				- Of the total number of patients, 76% showed improvement in the Perme Score ^‡ ;
				- Of the patients with improvement in the Perme Score ^‡ , the median was (IQR ^‡‡ 25-75) 9.4 (3,1-15.6);
				- Reasons for non-mobilization were: lack of staff or sufficient time 17%, mental inability to follow instructions 8%, being under active sedation 6%, being hemodynamically unstable 3%, and transition to comfort care/hospice 3%.
Tavares, et al., 2023 ( ²⁵ )	Heart & Lung - The Journal of Cardiopulmonary and Acute Care	Brazil	To evaluate strength, mobility, and ICU ^† acquired weakness among individuals with and without COVID-19 and determine the Perme Score ^‡ cutoff for ICUAW ^§§§§ .	- Perme Score ^‡ at ICU ^† discharge, COVID-19 Group 18.1 (15.5-20.7) vs. non-COVID-19 Group 18.3 (15-21.5), p = 0.20;	Cross-sectional study	48
				- Perme Score ^‡ at hospital discharge COVID-19 Group 27.2 (24.6-29.9) vs. non-COVID-19 Group 27.6 (24.4-30.8), p = 0.65;
				- A one-unit increase in the Perme Score ^‡ reduced the length of hospital stay by 1.04 days for other pathologies and 8.30 days for COVID-19;
				- The cutoff point with the highest sensitivity (0.82) and specificity (0.70) for detecting ICUAW ^§§§§ in the Perme Score ^‡ was 18 points.

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[1] *USA = United States of America; ^†ICU = Intensive Care Unit; ^‡Perme Score = Perme Intensive Care Unit Mobility Score; ^§IMS = ICU Mobility Scale; ^||MRC = Medical Research Council; ^¶MV = Mechanical Ventilation; **IU = Inpatient Unit; ^††FSS-ICU = Functional Status Score for the Intensive Care Unit; ^‡‡IQR = Interquartile range; ^§§APACHE = Acute Physiology and Chronic Health disease Classification System; ^||||MRC-SS = Medical Research Council Sum Score; ^¶¶PBM = Potential Barriers to Mobilization; ***MDC = Minimal Detectable Change; ^†††CVA = Cerebrovascular Accident; ^‡‡‡IG = Intervention Group; ^§§§10mWT = 10 meter Walk Test; ^||||||BBS = Berg Balance Scale; ****CG = Control Group; ^††††HGS = Handgrip Strength; ^‡‡‡‡ERBI = Early Rehabilitation Barthel Index; ^§§§§ICUAW = ICU-Acquired Weakness