Mobility as the 6th Vital Sign?

Will be fashioning this vision as we progress through the PMC project, so consider this just getting the thinking juices flowing.  Some readers will be aware of the American Pain Society's 'Pain as the 5th vital sign' initiative that was introduced in the mid-90s and ramped up in earnest in the early and mid-2000's.  The intention was to elevate pain and its management to the level of other vital body functions that are routinely assessed in medical contexts, along with temperature, heart rate, blood pressure and respiration rate.  It's hard to objectively say how well it actually worked, with evidence generally indicating that patients were having their pain assessed more frequently, but that pain management was still inadequate.  Of course, many of you will also know that there have been recent calls to remove the pain as the 5th vital sign owing to the ongoing public and political movements around the so-called 'opioid crisis'.  So, hard to say at this time what that initiative will end up looking like, but at least I would say the spirit of the initiative was in the right place.

So on to mobility.  I'll cop to the fact that I've often said that physical therapy doesn't save lives, but it gives lives back.  And I thought that was a very admirable and supportive thing to say about my profession.  But as we're traveling across Canada to better understand the concept of mobility, I'm realizing that I was very likely wrong - adequate mobility may well save lives.  I'm going to have to tiptoe slightly around the precise nature of the qualitative narratives I've been capturing as they are part of an ongoing research study, but I can say it has become clear that without adequate mobility (and the 'adequate' word is intentional here as it differs by person and context, more on that in a later post) the lives of many may well be at risk.  Consider the fishing villages in the Atlantic provinces, at which residents must work HARD during the summer months to ensure they have enough food and supplies to last what are often fairly harsh winters.  No one else is going to do it for them if they can't.  Consider our military personnel for whom mobility (defined broadly and in different ways) is what may save the lives of you, your squad mates and the people you're trying to protect in active combat zones.  Just today I see that the province of British Columbia has issued a state of emergency and has evacuated thousands from the province's interior due to raging wildfires.  Those who are immobile must rely on the aid of others or perish.  And then there were even more unexpected things that have emerged through these conversations, from more than one physio patient, who have stated that their mobility is such a key aspect of their personal identity that without it, they were in danger of losing the will to live.  

So, what would a 'mobility as the 6th vital sign' initiative look like?  Could we adequately argue for mobility as a basic function of human life?  What would that mean for nursing staff on inpatient wards - they were trained to assess pain better, could they be trained to conduct basic mobility assessment?  Does that then mean increased demand for physiotherapy services?  Would that mean mobility intervention would have to become a publicly funded service in our socialized health care system?  Does that then lead to more physios in primary care and preventative roles?  Would that mean physios are required on all inpatient wards in hospitals?  Long term care facilities?  Does the public then get an annual 'mobility check up' in the same vein as annual physicals or dental checkups?  Could there be any potential fallout, as per the pain as 5th sign initiative?  Is this all taking the concept too far?

I don't yet have a clear vision of what this can or should be, or if it's even worth pursuing, but one has a lot of time to think when driving for several hours at a stretch, so consider this little more than a musing at this time.  Would love to hear your comments though.