Mobility decline is a strong predictor of falls, fractures, and disability in older adults and is associated with sarcopenia, kinesiophobia, reduced physical activity, and poorer quality of life. Early identification is essential to mitigate deterioration. Yet, most clinical assessments emphasise performance outcomes (e.g., time, repetitions) and often overlook early qualitative signs of mobility deterioration. Process-oriented assessments evaluating movement quality may offer greater sensitivity but are seldom used given time, resource, and training constraints. Digital technologies could overcome barriers, but practical evidence-based tools remain limited. This review aimed to identify process-oriented behavioural criteria for qualitatively assessing functional mobility in older adults, establishing a foundation for digital mobility assessments. Following Joanna Briggs Institute and PRISMA-ScR guidelines, six databases (MEDLINE Complete, APA PsycInfo, CINAHL, Sport Discus, Embase, Web of Science) were searched from inception to September 2025. Six reviewers independently screened studies and extracted data. Inductive analysis identified behavioural criteria and tool characteristics. Twenty-four studies met inclusion criteria. Most assessed balance and gait using ordinal scales. Berg Balance Scale and Dynamic Gait Index showed high reliability and validity; Mini-BEST and POMA demonstrated moderate properties. Feasibility was inconsistently reported. Limitations included moderate clinical burden, ceiling/floor effects, reliance on trained raters, equipment requirements, and lack of a standardised framework. Process-oriented assessments are limited by inconsistent psychometric quality, feasibility constraints, and a lack of standardisation, highlighting a critical gap in qualitative assessment. Validated process-oriented criteria may enable scalable digital mobility assessment integration, allowing for earlier detection, tailored interventions, reduced falls risk, and streamlined clinical workflows without extensive training or specialised equipment.
Lander et al. (Thu,) studied this question.