Scoping Review Maps Gaps in Qualitative Mobility Assessment

A scoping review published in the European Review of Aging and Physical Activity has identified a critical gap in how clinicians and researchers assess mobility in older adults. The study, led by Natalie Lander and colleagues, systematically mapped the literature on process-oriented behavioural criteria used to qualitatively evaluate functional movement. The authors argue that while most clinical assessments focus on performance outcomes such as time or repetitions, these measures often overlook early qualitative signs of mobility deterioration that could signal impending decline.

The review was conducted following the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews, known as PRISMA-ScR. The team searched six major databases, including MEDLINE Complete, APA PsycInfo, CINAHL, SPORT Discus, Embase, and Web of Science, from their inception until September 2025. This comprehensive search strategy was designed to capture the breadth of existing evidence on how movement quality is evaluated in populations aged 65 and older.

From an initial pool of 811 records, the researchers identified 24 studies that met the strict inclusion criteria for the review. These studies were geographically diverse, with contributions from the United States, Germany, Brazil, India, and numerous other countries. The settings varied significantly, encompassing clinical environments, community-based programs, home-based assessments, and aged-care facilities. The sample sizes in these included studies ranged widely, from as few as 9 participants to as many as 11,251, reflecting the varied nature of the research conducted in this field.

The core concept of the review was the evaluation of process-oriented behavioural criteria. Unlike product-oriented measures that quantify the result of a movement, such as how fast a person can walk or how many times they can stand up, process-oriented criteria assess how the movement is performed. This includes observable characteristics such as postural control, coordination, balance, movement efficiency, and joint and limb control. The authors posit that these qualitative aspects reflect underlying motor competence and neuromuscular function, offering a more sensitive early marker of functional deterioration.

The included studies utilized a wide array of assessment tools, including the Mini-BEST, the Berg Balance Scale, the Tinetti Performance-Oriented Mobility Assessment, and the Dynamic Gait Index. Technology-based assessments, such as Posturography and the NeuroCom system, were also represented. Scoring approaches varied between these instruments, ranging from ordinal scales used in most clinical tests to continuous instrumented measures. In most studies, raters were trained in the administration of the respective assessment tools, although some did not report specific training requirements, highlighting a potential source of variability in data collection.

Psychometric properties of these assessments were inconsistently reported across the included studies. Several tools, such as the Berg Balance Scale and the Dynamic Gait Index, demonstrated high reliability and validity in the studies that evaluated them. In contrast, other tools like the Mini-BEST and the Performance-Oriented Mobility Assessment showed moderate properties. Some technology-based studies did not report test psychometric properties at all, which limits the ability to compare their effectiveness against traditional observational methods. This inconsistency in reporting makes it difficult to establish a clear hierarchy of tool performance.

Feasibility and acceptability were also variably described in the literature. Where reported, most process-oriented mobility tools were described as relatively quick to administer, typically requiring 10 to 20 minutes per person. The Berg Balance Scale was noted as being widely accepted in clinical practice due to its simplicity, low cost, and clear protocol. However, other tools imposed a moderate burden on clinicians and participants, particularly those requiring real-time supervision or manual scoring. The reliance on trained raters and specific equipment further constrains the broader uptake of these assessments in routine clinical practice.

The review identified several recurring domains in the process-oriented criteria, most notably postural control, coordination, balance and weight transfer, and the overall efficiency of movement execution. Broader clinical measures generally evaluated multiple aspects of movement performance across various tasks, while more task-specific tools focused on discrete components of mobility, such as gait adaptability and turning. Instrumented assessments provided a complementary perspective by quantifying underlying balance-related processes, such as centre of pressure displacement and sway characteristics, which may not be readily discernible through observational assessment alone.

Despite the breadth of tools identified, the review highlights a lack of standardisation across instruments. Many tools assess only narrow and isolated components of movement, which reduces comparability across studies and hinders implementation in practice. The absence of a unified conceptualisation of movement quality means that tools often operationalise mobility through differing theoretical lenses rather than a shared framework. This fragmentation limits the capacity to detect early, qualitative changes in mobility that may precede overt decline, potentially delaying targeted interventions.

The authors suggest that the current use of process-oriented assessments remains largely descriptive rather than decision-oriented. Most instruments were applied primarily for screening or to measure intervention effectiveness, with only a small subset used for detailed assessment or personalised feedback. This narrow application constrains their translational value, limiting the ability to provide individualised feedback or guide tailored interventions. The review argues that there is a missed opportunity to embed movement quality metrics within personalised and preventative models of care, which could help mitigate further deterioration and prevent related adverse outcomes.

Emerging digital technologies, such as wearable sensors, video analytics, and artificial intelligence, offer promising opportunities to enhance the objectivity and scalability of mobility assessment. However, the review notes that many existing digital assessments still emphasise performance outcomes rather than movement process or quality. Furthermore, there is a lack of reported psychometric properties for many technology-based tools, which constrains their interpretability and limits broader clinical adoption. Addressing these gaps through validation studies and user-focused implementation strategies is essential to maximise the translational potential of these technologies.

The study has several limitations that must be acknowledged. The review was limited to English-language publications and excluded grey literature and conference proceedings, which may have introduced publication and retrieval biases. The exclusion of qualitative studies and case series likely omitted nuanced descriptions of process-oriented criteria that could have informed framework development. Moreover, the considerable heterogeneity in study design, populations, and reporting prevented a cohesive synthesis of the included studies, and psychometric data were inconsistently reported.

The findings of this scoping review underscore the need for a feasible, reliable, and standardised framework of movement quality that integrates multiple domains of mobility for clinical application. By consolidating key movement quality domains, the field can enhance comparability across tools and improve clinical decision-making. Such an approach would also enable the integration of emerging digital technologies, supporting a shift toward more precise, personalised, and preventive models of care in mobility assessment for ageing populations.

The impetus behind refining qualitative movement analysis stems from urgent global demographic shifts and clinical realities. Projections indicate that by 2050, adults aged 60 and older will represent 22 percent of the worldwide population, surpassing 2.1 billion individuals. In countries such as Australia, roughly 52 percent of adults aged 65 and older currently experience physical disabilities or functional limitations driven by neuromuscular deterioration, including losses in strength, balance, coordination, and power. These impairments are strongly associated with hospitalisation, chronic disease, and fractures. Furthermore, nearly two-thirds of older adults develop kinesiophobia, an acute fear of movement that triggers severe reductions in physical activity and accelerates functional decline. Within the World Health Organization’s Integrated Care for Older People framework, mobility is classified as a foundational element of intrinsic capacity, requiring routine screening followed by comprehensive assessments of balance, gait, and strength when risks emerge. However, widespread clinical metrics such as the Timed Up and Go test and the Short Physical Performance Battery track only product outcomes like seconds elapsed or repetitions completed, failing to register early compensatory adaptations or subtle postural instability.

Methodologically, the review catalogued diverse research structures across its twenty-four analyzed publications, encompassing nine randomised controlled trials, five cross-sectional investigations, four prospective studies, three experimental works, two retrospective evaluations, and one quasi-experimental trial. The participant groups, ranging in mean age from 65 to 85 years, presented both with and without comorbidities across clinical, community, home-based, and residential aged-care environments. Through inductive analysis, the researchers distilled the diverse functional criteria into seven higher-order conceptual domains: postural control and stability; coordination, timing, and sequencing; gait adaptability and dynamic balance; strategy selection and sensory integration; trunk and segmental control; task-specific functional performance; and cognitive-motor integration. Among these constructs, cognitive-motor integration was notably underrepresented across existing assessment instruments, illustrating how current measures frequently omit crucial neurological intersections governing movement execution.

Specific evaluative instruments demonstrated notable practical trade-offs and structural limitations. The Berg Balance Scale, while widespread and inexpensive, exhibited ceiling and floor effects alongside an inability to evaluate gait speed or disease-specific balance traits. Instrumented posturography and sensory interaction testing captured continuous sway dynamics and sensorimotor reweighting via centre-of-pressure measurements, yet remained heavily confined to specialised laboratory setups with minimal real-world feasibility data. To address these operational constraints, the authors highlighted the promise of device-agnostic, video-based machine learning systems capable of mapping three-dimensional movement trajectories, body positioning, and velocity. While such automated approaches have shown initial success in paediatric populations, evidence for remote digital assessment in older adults remains sparse, particularly regarding the precise capture of gait speed and spatiotemporal parameters.

Subject of Research: Scoping review of process-oriented behavioural criteria for qualitative mobility assessment in older adults

Article Title: Qualitative assessment of mobility in older adults: a scoping review of process-oriented behavioural criteria

Article References: Lander, N., Glavas, C., Gandham, A., Contardo Ayala, A. M., Cofré Lizama, L. E., Zhang, Y., Fyfe, J., Zhou, T., Scott, D., & Daly, R. M. (2026). Qualitative assessment of mobility in older adults: a scoping review of process-oriented behavioural criteria. European Review of Aging and Physical Activity, 23(1), Article 26. https://doi.org/10.1186/s11556-026-00408-y

Image Credits: AI Generated

DOI: 10.1186/s11556-026-00408-y

Keywords: mobility assessment, older adults, scoping review, process-oriented criteria, geriatric medicine, clinical assessment, functional movement, digital health, balance, gait analysis, Qualitative, assessment