Dalhousie University


Research / Projects
Hierarchical Assessment of Balance and Mobility


The Hierarchical Assessment of Balance and Mobility (HABAM) is an instrument that provides a clinical assessment of in-bed mobility, transfers and ambulation. The patient being assessed is asked to stand, transfer from the bed and walk as far as they are safely able to. Their performance is observed and recorded in a box for each of the three sections of the instrument.

Text Box: HABAM Example Case       Patients are encouraged to perform to the best of their ability, as they would usually do in the unobserved situations, to obtain the highest possible scores. Each patient is assessed with their usual aid: sticks, crutches, walkers or wheelchairs. The instrument is scaled in numerical scores. The highest number in the scaling marks the highest level of performance (e.g. unlimited, vigorous – Mobility). By contrast, the lowest number, which has a value of 0, is equal to the lowest or no performance (e.g. total lift – Mobility). These numbers are associated with wording which describes the subject’s ability.

The form here shows a patient who deteriorates over her first 3 days in hospital (example 1) and then steadily improves (example 2).

Previous work in the GMRU has shown that the HABAM is a reliable means of assessing mobility and balance in frail older people.

Current work

We are currently investigating the hypothesis that HABAM is a marker of disease progression for older patients admitted to hospital. Patterns of HABAM behaviour are being explored and related to outcomes. The frailty status of these patients has been measured by a Frailty Index© derived from Comprehensive Geriatric Assessment© and HABAM scores will enable us to investigate how frailty affects time to recovery and recovery potential.

Further Reading

MacKnight C, Rockwood K. A Hierarchical Assessment of Balance and Mobility. Age Ageing 1995:24:126-130.

MacKnight C, Rockwood K. Rasch analysis of the hierarchical assessment of balance and mobility. J Clin Epidemiol 2000; 53(12):1242-1247.

Rockwood K, Rockwood MRH, Andrew MK, Mitniski A. Reliability of the Hierarchical Assessment of Balance and Mobility in Frail Older Adults. J Am Geriatr Soc 2008; 56(7): 1213-1217.



Dalhousie University Faculty of Medicine