Did you take a shower today? Did you make your bed? Did you walk for 10 minutes? Every day we expend energy doing simple daily activities.
MET levels, or metabolic equivalencies, help us understand how much energy is used during these activities and provide a metric to understand physical performance.
ADLs or activities of daily living are the tasks we do on a daily basis (showering, bathing, dressing, and personal hygiene).
Why are Met levels and ADLs so important for discharge planning?
Met levels and ADLs can be used to better measure a patient‘s physical performance and ability to perform occupations to provide a more accurate recommendation for a safe discharge.
Today, I’ll discuss why MET levels and ADLs are so important for discharge planning and how therapists and physicians can use them to communicate better.
Using MET levels to determine discharge recommendations
When deciding on discharge, doctors use physical and occupational therapy notes to help determine if a patient is safe to go home, but they really should be focusing on MET levels and activities of daily living (ADL).
Met levels help us understand how much energy a person is able to tolerate. These levels can be used to measure equivalent activities in our daily life (i.e walking, biking, sitting, cooking, bathing).
Typically, doctors want to know how many feet a patient is able to walk in order to go home. It’s easy to say that a patient walked 250 feet, but a short walk is only about 2.5 METs or less.
That doesn’t give anyone a clear indicator that the patient is safe to go home.
It’s more important to know what MET levels the patient can achieve, and the level of assistance required for ADLs.
If a patient can achieve a MET level of 4 but is unable to get dressed or transfer from a low toilet seat, they may not be safe to go home.
ADL assistance levels and MET levels are equally important in discussing discharge.
When we know the patient’s MET level and ADL needs, we can know if the patient is safe for discharge.
Common MET Levels
Below is a list of common MET levels to better understand METs in relation to activities.
|Met Levels||Activities of Daily Living||IADLs|
|1-2.5||Sitting for meals, Feeding, Transfer from bed to chair, feeding, toileting, sponge bath.||Knitting, sewing|
|2.5-3.5||Full body dressing, walking household distances, Sex, seated bathing||Cooking, Fishing|
|3.5-4||Hot shower (standing)||Double Tennis, Housework, Golf|
Why Doctors and therapists should be documenting MET levels
Documenting Met levels can help other clinicians understand how much activity a patient is able to tolerate. Instead of documenting “the patient has poor activity tolerance”, PT and OT can document the Met level that was tolerated or acheived.
Documenting Met levels can be beneficial, but only if all clinician’s are on board.
PT and OT need to understand Met levels to know what the patient can tolerate. Doctors need to understand Met levels to know if the patient is safe to go home.
When all clinicians are documenting Met levels and ADLs, they provide better communication and provide a more accurate description of the patient’s physical performance.
How MET levels should be documented
Document the maximal Met level that was tolerated or achieved when writing goals. Here are a few examples:
1. The patient was only able to tolerate a MET level of 1 while sitting EOB.
2. Today the patient poorly tolerated a MET level of 4.5 after showering.
3. The patient walked 250 feet and reached her MET level goal of 2.5.
Include MET levels on PT and OT goals and describe the activity used to meet this level (Dressing, bathing, walking, etc).
How to implement MET levels in your practice
- Use a Met Calculator or find a chart. (Click here to see a list of MET levels for activities in your treatment session)
- Discuss the importance of using MET levels with other practitioners (PT, OT, MD, PA, NP, RNs).
- Share this article with others.
Its important to know MET levels in order to understand how well ADLs and IADLs can be achieved for a safe discharge.
When we know how much activity a patient can tolerate, we can know if they’re safe to go home.
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David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.