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Measuring disability in older adults: The International Classification System of Functioning, Disability and Health (ICF) framework
Abstract
Despite the importance of disability to geriatric medicine, no large scale study has validated the activity and participation domains of the International Classification System of Functioning, Disability, and Health (ICF) in older adults. The current project was designed to conduct such as analysis, and then to examine the psychometric properties of a measure that is based on this conceptual structure.
This was an archival analysis of older adults (n = 1388) who had participated in studies within our Claude D Pepper Older Americans Independence Center. Assessments included demographics and chronic disease status, a 23-item Pepper Assessment Tool for Disability (PAT-D) and 6-min walk performance.
Analysis of the PAT-D produced a three-factor structure that was consistent across several datasets: activities of daily living disability, mobility disability and instrumental activities of daily living disability. The first two factors are activities in the ICF framework, whereas the final factor falls into the participation domain. All factors had acceptable internal consistency reliability (>0.70) and test-retest (>0.70) reliability coefficients. Fast walkers self-reported better function on the PAT-D scales than slow walkers: effect sizes ranged from moderate to large (0.41-0.95); individuals with cardiovascular disease had poorer scores on all scales than those free of cardiovascular disease. In an 18-month randomized clinical trial, individuals who received a lifestyle intervention for weight loss had greater improvements in their mobility disability scores than those in a control condition.
The ICF is a useful model for conceptualizing disability in aging research, and the PAT-D has acceptable psychometric properties as a measure for use in clinical research.
... For the assessment of the health condition of the home dweller(s), the intervention of clinicians is required to ll in the ICF-based module. e clinical personnel have to assess all the user's impairments through standard tests and clinical scales speci cally dedicated to investigate a precise domain (vision, hearing [63], motor or cognitive de cits) or the general health status in elderlies [64,65]. e evaluation of the CRF occurs in a second phase and can be performed in di erent ways. ...
... Of course, immersive (e.g., head-mounted displays and CAVE) or semi-immersive (e.g., semicylindrical projected screens) experiences constitute the most promising means to validate di erent scenarios and to learn how the Smart Home services work, because of the higher sense of presence they elicit and the more natural interaction they often provide [66]. However, when choosing the VR technologies, particular attention must be paid on the target user: for frail elderlies or severe cognitive impaired subjects, the risks of adverse events and sickness while using head-mounted displays are not deniable [65]. erefore, other solutions should be preferred, even in exchange of a reduced sense of presence. ...
This paper introduces the Smart Home Simulator, one of the main outcomes of the D4All project. This application takes into account the variety of issues involved in the development of Ambient Assisted Living (AAL) solutions, such as the peculiarity of each end-users, appliances, and technologies with their deployment and data-sharing issues. The Smart Home Simulator—a mixed reality application able to support the configuration and customization of domestic environments in AAL systems—leverages on integration capabilities of Semantic Web technologies and the possibility to model relevant knowledge (about both the dwellers and the domestic environment) into formal models. It also exploits Virtual Reality technologies as an efficient means to simplify the configuration of customized AAL environments. The application and the underlying framework will be validated through two different use cases, each one foreseeing the customized configuration of a domestic environment for specific segments of users.
... Definitions originally derived from the disability framework established by Nagi (1). models have been developed in humans to characterize the physical domain of the individual and the possible transitions across the spectrum of function (17)(18)(19)(20). Multiple instruments are available for measuring each of the different phases of the conceptual framework proposed by Nagi (1), starting from the active pathology or underlying mechanisms, through physical impairment (ie, loss or abnormality of an anatomical, physiological, mental, or emotional nature) and limitation (ie, when the functional issue involves the organism as a whole), and ending with the disability condition (ie, the incapacity to interact with the surrounding environment and/or to function socially) ( Figure 1). ...
... Disability is defined in terms of restrictions in the ability to perform functional activities, including limitation in performance of socially defined roles or tasks (2,23). Common disability selfreports or proxy reports, such as index of ADLs (17), Instrumental ADLs (24), and the Pepper Assessment Tool for Disability (20), characterize the degree of difficulties the person faces in performing typical activities related to home or work life, including "typical" ADLs and Instrumental ADLs such as ambulatory ability, meal preparation, dressing, and managing medications and money. Such measures assess ability-disability and present environment-and subject-specific limitations in the heterogeneous contextualization of the condition of interest. ...
Despite dedicated efforts to identify interventions to delay aging, most promising interventions yielding dramatic life-span extension in animal models of aging are often ineffective when translated to clinical trials. This may be due to differences in primary outcomes between species and difficulties in determining the optimal clinical trial paradigms for translation. Measures of physical function, including brief standardized testing batteries, are currently being proposed as biomarkers of aging in humans, are predictive of adverse health events, disability, and mortality, and are commonly used as functional outcomes for clinical trials. Motor outcomes are now being incorporated into preclinical testing, a positive step toward enhancing our ability to translate aging interventions to clinical trials. To further these efforts, we begin a discussion of physical function and disability assessment across species, with special emphasis on mice, rats, monkeys, and man. By understanding how physical function is assessed in humans, we can tailor measurements in animals to better model those outcomes to establish effective, standardized translational functional assessments with aging.
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... The schedule of assessments is summarized in Table 3. Participant's baseline physical function will be assessed with objective tests (i.e., Grip Strength [26] and Chair stand [27]) and subjective instruments (i.e., Pepper Assessment Tool for Disability [28] and Clinical Frailty Scale [29]). Data will be collected prospectively through monthly review of electronic medical records for events documented at outpatient dialysis units, outpatient clinics, outpatient or inpatient interventional nephrology/ interventional nephrology, and inpatient charts. ...
Background
Treatment of end-stage kidney disease (ESKD) with hemodialysis requires surgical creation of an arteriovenous (AV) vascular access—fistula (AVF) or graft (AVG)—to avoid (or limit) the use of a central venous catheter (CVC). AVFs have long been considered the first-line vascular access option, with AVGs as second best. Recent studies have suggested that, in older adults, AVGs may be a better strategy than AVFs. Lacking evidence from well-powered randomized clinical trials, integration of these results into clinical decision making is challenging. The main objective of the AV Access Study is to compare, between the two types of AV access, clinical outcomes that are important to patients, physicians, and policy makers.
Methods
This is a prospective, multicenter, randomized controlled trial in adults ≥ 60 years old receiving chronic hemodialysis via a CVC. Eligible participants must have co-existing cardiovascular disease, peripheral arterial disease, and/or diabetes mellitus; and vascular anatomy suitable for placement of either type of AV access. Participants are randomized, in a 1:1 ratio, to a strategy of AVG or AVF creation. An estimated 262 participants will be recruited across 7 healthcare systems, with average follow-up of 2 years. Questionnaires will be administered at baseline and semi-annually. The primary outcome is the rate of CVC-free days per 100 patient-days. The primary safety outcome is the cumulative incidence of vascular access (CVC or AV access)-related severe infections—defined as access infections that lead to hospitalization or death. Secondary outcomes include access-related healthcare costs and patients’ experiences with vascular access care between the two treatment groups.
Discussion
In the absence of studies using robust and unbiased research methodology to address vascular access care for hemodialysis patients, clinical decisions are limited to inferences from observational studies. The goal of the AV Access Study is to generate evidence to optimize vascular access care, based on objective, age-specific criteria, while incorporating goals of care and patient preference for vascular access type in clinical decision-making.
Trial registration
: This study is being conducted in accordance with the tenets of the Helsinki Declaration, and has been approved by the central institutional review board (IRB) of Wake Forest University Health Sciences (approval number: 00069593) and local IRB of each participating clinical center; and was registered on Nov 27, 2020, at ClinicalTrials.gov (NCT04646226).
... 10 The benefits of PA increase with age; specifically, older adults who are physically active can mitigate losses in muscular strength, 18 and improve physical function 19 and participation in important daily life activities. 20 They can move better, have lower risk of falls, and are better able to live independently compared with their inactive counterparts. 21 For example, using data from 16,741 women with a mean age of 72 years, Lee and colleagues reported those who took approximately 4400 steps/ day had significantly lower risk for all-cause mortality compared with those who took < 2700 steps/day. ...
Physical Activity (PA) is recommended to mitigate the symptoms of osteoarthritis (OA), however this modality remains an unfamiliar construct for many patients and clinicians. Moreover, there can be confusion over the nuanced differences in terminology, such as such as exercise, sedentary behavior, and moderate intensity. The purpose of this scoping review is to provide a basic overview of PA including terminology, summarize the importance of PA for adults with OA, and discuss current gaps in the literature. Broadly, PA is defined as "any bodily movement produced by skeletal muscles that results in energy expenditure", and exercise is considered a type of PA that is planned, structured, and repetitive. Robust literature shows that PA has a modest protective effect on pain, functional limitation, and disability for OA, which is in addition to positive effects on a broad range of outcomes from mood and affect to mortality and morbidity in the general population. Recommendations are provided for which measurement instruments can be used clinically and from a research perspective to record PA, as well as metrics to employ to summarize daily activity.
... Different categories of older adults' functioning have been studied [98,99], and some relevant ones have been proposed [100,101]. However, each domain has been assessed independently and, therefore, the integration of the ICF domains into single measures is needed [102]. The usage of technologies in the different instruments to evaluate disability, such as wearables [86] or optoelectronic systems [34], for assessing ICF domains could improve the objectivity of the measures, be cost-effective and decrease assessment time. ...
The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults’ disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults’ disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.
... Prior to each performance test, assessments of Mobility-Related Self-Efficacy (MRSE) assessed participants' confidence in their ability to complete incrementally more challenging amounts of each of the 400MWT, ST, and LCT performance tests [35,36]. Self-reported functional limitations were measured with the Pepper Assessment Tool for Disability (PAT-D) [37]. ...
Being overweight or obese is a primary modifiable risk factor that exacerbates disease progression and mobility disability in older knee osteoarthritis (OA) patients. Lifestyle interventions combining exercise with dietary weight loss (EX+DWL) yield meaningful improvements in mobility and weight loss that are superior to EX or DWL alone. Unfortunately, community access to practical, sustainable weight management interventions remains limited and places knee OA patients at increased risk of mobility disability. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis patients (CLIP-OA), was a two-arm, 18 month randomized-controlled, comparative effectiveness trial designed to contrast the effects of an evidence-based, theory-driven EX+DWL intervention, personalized to patient needs and delivered by our community partners, with those of the Arthritis Foundation's Walk With Ease (WWE) standard of care self-management program in the treatment of knee OA patients with overweight or obesity. The primary outcome of the CLIP-OA trial was mobility performance assessed using the 400-m walk test (400MWT). Secondary outcomes included weight loss, pain, select quality of life and social cognitive variables, and cost-effectiveness of intervention delivery. Findings from the CLIP-OA trial will determine the comparative and cost-effectiveness of the EX+DWL and WWE interventions on key clinical outcomes and has the potential to offer a sustainable medium for intervention delivery that can promote widely accessible weight management among knee OA patients with overweight or obesity. Trial Registration: NCT02835326.
... Exercise was defined as per the American College of Sports Medicine as: "a type of PA that is planned, structured and repetitive bodily movement to advance or maintain physical fitness" (Haskell et al., 2007). PA was defined as per the World Health Organization as: "bodily movement that is produced by the contraction of skeletal muscle and increases energy expenditure" (Rejeski, Ip, Marsh, Miller, & Farmer, 2008). (b) Experimental studies could be randomized controlled trials (RCTs), nonrandomized controlled trials, uncontrolled trials (UCTs), or prospective or retrospective case-control studies. ...
... The kits will be returned by mail, and the camera footage will be used for test scoring. We will also gather self-reported disability using the Pepper Assessment Tool for Disability [35]. ...
Background:
Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults' chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program's scalability and potential efficacy.
Objective:
The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial.
Methods:
The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory-based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools.
Results:
Recruitment is ongoing as of January 2021.
Conclusions:
Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain.
Trial registration:
ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001.
International registered report identifier (irrid):
PRR1-10.2196/29013.
... Consequently, the demand for rehabilitation and social interventions together with medical treatment is greater. As Rejeski pointed the likelihood of experiencing functional decline is greater as BMI increases (Rejeski et al.,2008). ...
Obesity is a serious health problem of 21st century and is an important cause of morbidity and mortality in adults as well as adolescents and children. The prevalence of obesity has reached epidemic proportions in many countries around the World including in both developed and developing countries, and recent statistics from the World Health Organization indicate that in 2016, more than 1.9 billion adults were defined as overweight, of which 650 million were obese. Results: The review examined the published empirical evidence for the influence of the environmental factors on the risk of obesity. These environmental factors were further specified into four types including Physical , Economic ,Socio-cultural and Political environmental factors according to The Analysis Grid for Environments Linked to Obesity (ANGELO) framework .The Association of different work conditions with obesity was also discussed in this article including: Work stress, Shift work, Long Working hours, Sedentary behavior and Unemployment. In addition, this review summarizes existing empirical research related to the impact of obesity on working life, with issues related to decreased work productivity, absenteeism, presenteeism and obesity stigma in occupational setting. The review also pointed to the role of obesity or excess body weight in the modification of risk of some occupational diseases and conditions such as: Vibration-Induced Injury, work-related musculoskeletal disorders (WMSD), Work-Related Asthma and neurotoxicity. Lastly, in this review; a summary of the recommendations for worksite obesity prevention program and the effective strategies used in Prevention of Global Obesity Epidemic based on the most recent CDC and WHO Guidelines was also discussed.
... Information collected will include age, sex, race, ethnicity, marital status, education, income, body mass index, alcohol use, smoking history, depression symptoms, fall history, current health status, medication use, and medical history. Several measures of physical function and disability will be assessed including the SPPB (Guralnik et al., 1994), Pepper Assessment Tool for Disability (Rejeski et al., 2008), CHAMPS physical activity questionnaire (Stewart et al., 2001), Activities Specific Balance Confidence Scale (Powell and Myers, 1995), FACIT Fatigue Scale (Webster et al., 2003), and Pittsburgh Fatigability Scale (Glynn et al., 2015). Cognitive function will be assessed with the Montreal Cognitive Assessment (Nasreddine et al., 2005), NIH Toolbox cognitive/executive function tests (Weintraub et al., 2013), and an n-back spatial working memory test. ...
Age-related brain changes likely contribute to mobility impairments, but the specific mechanisms are poorly understood. Current brain measurement approaches (e.g., functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), PET) are limited by inability to measure activity from the whole brain during walking. The Mind in Motion Study will use cutting edge, mobile, high-density electroencephalography (EEG). This approach relies upon innovative hardware and software to deliver three-dimensional localization of active cortical and subcortical regions with good spatial and temporal resolution during walking. Our overarching objective is to determine age-related changes in the central neural control of walking and correlate these findings with a comprehensive set of mobility outcomes (clinic-based, complex walking, and community mobility measures). Our hypothesis is that age-related walking deficits are explained in part by the Compensation Related Utilization of Neural Circuits Hypothesis (CRUNCH). CRUNCH is a well-supported model that describes the over-recruitment of brain regions exhibited by older adults in comparison to young adults, even at low levels of task complexity. CRUNCH also describes the limited brain reserve resources available with aging. These factors cause older adults to quickly reach a ceiling in brain resources when performing tasks of increasing complexity, leading to poor performance. Two hundred older adults and twenty young adults will undergo extensive baseline neuroimaging and walking assessments. Older adults will subsequently be followed for up to 3 years. Aim 1 will evaluate whether brain activity during actual walking explains mobility decline. Cross sectional and longitudinal designs will be used to study whether poorer walking performance and steeper trajectories of decline are associated with CRUNCH indices. Aim 2 is to harmonize high-density EEG during walking with fNIRS (during actual and imagined walking) and fMRI (during imagined walking). This will allow integration of CRUNCH-related hallmarks of brain activity across neuroimaging modalities, which is expected to lead to more widespread application of study findings. Aim 3 will study central and peripheral mechanisms (e.g., cerebral blood flow, brain regional volumes, and connectivity, sensory function) to explain differences in CRUNCH indices during walking. Research performed in the Mind in Motion Study will comprehensively characterize the aging brain during walking for developing new intervention targets.
... The dominant leg was defined as the preferred leg used to kick a ball (Jafarnezhadgero, Shad, & Majlesi, 2017). The Pepper Assessment Tool for Disability (Rejeski, Ip, Marsh, Miller, & Farmer, 2008) was used for quantifying disability during preintervention (Table 1) and postintervention. The Pepper Assessment Tool for Disability self-administered questionnaire consists of 23 items that include a range of activities that assess mobility, activities of daily living, and instrumental activities of daily living. ...
Human lower limbs contribute to locomotion in multiple
ways; acting as springs, as force absorbing dampers, or as actuators
(Brown, O’Donovan, Hasselquist, Corner, & Schiffman, 2016;
Raynor, Yi, Abernethy, & Jong, 2002). The progression of ground
reaction forces (GRF) through the lower limbs during landing from
a drop occurs in a distal to the proximal manner, suggesting that
malalignment of the lower extremities might result in aberrant
loading patterns to more proximal structures (Weidenhielm,
Svensson, & Broström, 1995). Specifically, frontal plane tibiofemoral joint alignment may affect injury mechanisms by selectively
preloading or unloading specific tissues (Lerner, DeMers, Delp, &
Browning, 2015).
... The PAT-D is a 19-item questionnaire used to assess whether functional limitations impact disability across 3 domains-mobility, activities of daily living, and instrumental activities of daily living [27]. Responses are recorded on a 5-point Likert scale. ...
Background:
People aging with HIV are living with increased risk for functional decline compared with uninfected adults of the same age. Early preclinical changes in biomarkers in middle-aged individuals at risk for mobility and functional decline are needed.
Objective:
This pilot study aims to compare measures of free-living activity with lab-based measures. In addition, we aim to examine differences in the activity level and patterns by HIV status.
Methods:
Forty-six men (23 HIV+, 23 HIV-) currently in the MATCH (Muscle and Aging Treated Chronic HIV) cohort study wore a consumer-grade wristband accelerometer continuously for 3 weeks. We used free-living activity to calculate the gait speed and time spent at different activity intensities. Accelerometer data were compared with lab-based gait speed using the 6-minute walk test (6-MWT). Plasma biomarkers were measured and biobehavioral questionnaires were administered.
Results:
HIV+ men more often lived alone (P=.02), reported more pain (P=.02), and fatigue (P=.048). In addition, HIV+ men had lower blood CD4/CD8 ratios (P<.001) and higher Veterans Aging Cohort Study Index scores (P=.04) and T-cell activation (P<.001) but did not differ in levels of inflammation (P=.30) or testosterone (P=.83). For all participants, accelerometer-based gait speed was significantly lower than the lab-based 6-MWT gait speed (P<.001). Moreover, accelerometer-based gait speed was significantly lower in HIV+ participants (P=.04) despite the absence of differences in the lab-based 6-MWT (P=.39). HIV+ participants spent more time in the lowest quartile of activity compared with uninfected (P=.01), who spent more time in the middle quartiles of activity (P=.02).
Conclusions:
Accelerometer-based assessment of gait speed and activity patterns are lower for asymptomatic men living with HIV compared with uninfected controls and may be useful as preclinical digital biomarkers that precede differences captured in lab-based measures.
... Exercise was defined as per the American College of Sports Medicine as: "a type of PA that is planned, structured and repetitive bodily movement to advance or maintain physical fitness" (Haskell et al., 2007). PA was defined as per the World Health Organization as: "bodily movement that is produced by the contraction of skeletal muscle and increases energy expenditure" (Rejeski, Ip, Marsh, Miller, & Farmer, 2008). (b) Experimental studies could be randomized controlled trials (RCTs), nonrandomized controlled trials, uncontrolled trials (UCTs), or prospective or retrospective case-control studies. ...
Background: Variations in genotype may contribute to heterogeneity in functional adaptations to exercise. Methods: A systematic search of eight databases was conducted, and 9,696 citations were screened. Results: Eight citations from seven studies measuring 10 single-nucleotide polymorphisms and nine different functional performance test outcomes were included in the review. There was one observational study of physical activity and six experimental studies of aerobic or resistance training. The ACE (D) allele, ACTN3 (RR) genotype, UCP2 (GG) genotype, IL-6-174 (GG) genotype, TNF-α-308 (GG) genotype, and IL-10-1082 (GG) genotype all predicted significantly superior adaptations in at least one functional outcome in older men and women after prescribed exercise or in those with higher levels of physical activity. Conclusion: There is a small amount of evidence that older adults may have better functional outcomes after exercise/physical activity if they have specific alleles related to musculoskeletal function or inflammation. However, more robust trials are needed.
... Low levels of social participation 14,15 and support [16][17][18] are as- sociated with poor health outcomes. We calculated a social sup- port score from 0 to 4 using previously described methods 19 and dichotomized the variable to compare those with low (0-1) and high (2-4) levels of support. ...
Importance
Vision impairment (VI), including blindness, affects hundreds of millions globally, and 90% of those with VI live in low- and middle-income countries. Cross-national comparisons are important to elucidate the unique and shared factors associated with VI and receipt of eye care in different countries and to target those most in need.
Objective
To identify the characteristics associated with VI and receipt of eye care in a sample of low- and middle-income countries.
Design, Setting, and Participants
In this study of cross-sectional survey data from wave 1 of the World Health Organization Study on Global Aging and Adult Health, data on sociodemographic characteristics and health were collected from nationally representative samples in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010. Probability sampling with multistage, stratified, random-cluster samples was used to identify households and participants. The survey was completed by 34 159 adults 50 years and older. Data were analyzed from December 2017 to February 2018.
Main Outcomes and Measures
We analyzed associations of individual-level and household-level covariates with 3 primary outcomes: distance VI (visual acuity worse than 6/18 in the better-seeing eye), near VI (visual acuity worse than 6/18 in the better-seeing eye), and receipt of an eye examination within the previous 2 years.
Results
The study sample in China consisted of 13 350 participants (50.2% female; mean [SD] age, 62.6 [9.0] years); in Ghana, 4725 participants (50.4% female; mean [SD] age, 64.2 [10.8] years); in India, 7150 participants (48.9% female; mean [SD] age, 61.5 [9.0] years); in Mexico, 2103 participants (52.3% female; mean [SD] age, 69.2 [9.2] years); in Russia, 3763 participants (61.1% female; mean [SD] age, 63.9 [10.4] years); and in South Africa, 3838 participants (55.9% female; mean [SD] age 61.6 [9.5]) (all demographic characteristics weighted to reflect respective populations). The weighted proportion of the study sample with distance VI ranged from 9.9% (95% CI, 9.3-10.5) in China to 25.4% (95% CI, 22.0-29.2) in Russia; near VI, from 28.5% (95% CI, 26.9-30.1) in Ghana to 43.1% (95% CI, 41.1-45.1) in India; and receipt of a recent eye examination, from 15.0% (95% CI, 13.8-16.2) in Ghana to 53.1% (95% CI, 49.3-56.8) in Russia. Educational attainment, medical comorbidities, and memory were significantly associated with all outcomes across most low- and middle-income countries. Female sex, low household wealth, food insecurity, no health insurance, rurality, disability, being unmarried, and low social participation were significantly associated with adverse vision-related outcomes, though less consistently.
Conclusions and Relevance
There are both common and unique characteristics associated with VI and receipt of eye care across low- and middle-income countries. Our findings suggest that recognizing these factors is important to identify those most at risk and allocate resources optimally. Additional local epidemiological studies are needed.
... The dominant leg was defined as the preferred leg used to kick a ball (Jafarnezhadgero, Shad, & Majlesi, 2017). The Pepper Assessment Tool for Disability (PAT-D) (Rejeski, Ip, Marsh, Miller, & Farmer, 2008) was used for quantifying disability during pre (Table 1) and post-intervention. The PAT-D self-administered questionnaire consists of 23 items that include a range of activities that assess mobility, activities of daily living and instrumental activities of daily living. ...
The aim of this study was to identify the effects of a corrective exercise program on landing ground reaction force characteristics and lower limb kinematics in older adults with genu valgus. Twenty six older male adults with genu valgus were randomized into two groups. An experimental group conducted a 14- week corrective exercise program, while a control group did not perform any exercise. The experimental group displayed lower peak vertical, peak anterior and posterior, and peak medial ground reaction force components during the post-test compared to the pre-test. The vertical loading rate, impulses, and free moment amplitudes were not statistically different between groups. In the experimental group, the peak knee abduction during the post-test was significantly smaller and the peak hip flexion angle was significantly greater than during the pre-test. We suggest that this corrective exercise program may be a suitable intervention to improve landing ground reaction forces and lower limb kinematics in older male adults with genu valgus.
... Being part of the NHATS, Freedman (2009) puts into evidence the benefits that can be derived from the ICF language: the addition of the term "participation" to geriatrician vocabulary, the explicit and defined role for the environment, the availability of positive analogues for concepts that have traditionally been expressed in terms of loss in an advancement and the distinction between capacity to perform and the actual performance of a range of activities. Recently, new assessment instrument tools for disability based on the ICF perspective were proposed as an alternative to the classic ADL and IADL (Rejeski, Ip, Marsh, Miller, and Farmer, 2008). Another important step in order to enhance the applicability of the ICF in clinical practice and research is the ICF Core Set project created with the aim of selecting ICF domains that include "the least number of domains possible to be practical, but as many as required to be sufficiently comprehensive to cover the prototypical spectrum of limitations in functioning and health encountered in a specific condition" (Stucki, Ewert, and Cieza, 2002, p. 936). ...
Heterogeneity in the health status of elderly patients requires a particular care approach and geriatric medicine is the answer. In order to cope with frailty, disability, and diseases, the geriatric assessment approach guides the geriatrician into considering the interaction between functional status and cognitive, medical, affective, environmental, social support, economic, and spirituality dimensions. Rehabilitation is the goal of the geriatric assessment and the introduction of assistive solutions in geriatric rehabilitation makes possible a scenario in which the functioning of elderly people with physical or cognitive limitations is improved. This chapter provides an overview of the areas where technological systems may offer support to the everyday life of the elderly and their caregivers. The contribution of a geriatrician in a Centre for Technical Aid is described, linking the comprehensive geriatric assessment with the ICF model. The lack of implementation of the ICF and the requirement of training in assistive solutions for geriatricians and caregivers are discussed.
... Self-Reported Physical Function/Disability is assessed with a modified version of disability instrument that was used in LIFE-P, now called the Pepper Assessment Tool for Disability (PAT-D). [121][122][123] Based on factor analysis, 4 items were omitted from the original instrument (doing errands, preparing meals, feeding, and raising arms above head), leaving 19 items covering 3 domains: (1) basic ADLs (moving in and out of a chair, moving in and out of a bed, gripping with hands, using toilet, dressing, getting in and out of a car, and bathing); (2) mobility (walking several blocks, lifting heavy objects, walking 1 block, lifting/carrying 10 lbs, climbing several flights of stairs, and climbing 1 flight of stairs); and (3) instrumental ADLs (light housework, participating in community activities, managing money, visiting with relatives or friends, using the telephone, and taking care of a family member). ...
... The Pepper Assessment Tool for Disability (PAT-D) is a 19-item self-administered questionnaire to assess mobility, activities of daily living (ADL) and instrumental activities of daily living (IADL). Responses are made on a five-point Likert scale ranging from 1 ("usually did with no difficulty") to 5 ("unable to do"), or a box can be checked that reads "usually did not do for other reasons" (Rejeski, Ip, Marsh, Miller, & Farmer, 2008). The summary score, a mean of the three domain scores that ranges from 1 to 5, is an indication of a person's overall perceived disability. ...
Background
Lower muscle and higher fat mass are characteristics of older adults; their physical function is also characterized by slower gait speed and weaker strength. However, the association between specific body composition and physical function is unclear.
Methods
We examined the association between body composition and physical performance using combined cross-sectional data of 1,821 participants from 13 clinical studies at Wake Forest University that used a consistent battery of tests. All participants were ≥60 years old and had one of the following conditions: healthy, osteoarthritis, coronary artery disease, obesity, heart failure, at elevated risk for disability, renal transplantation candidates, heart failure with preserved ejection fraction, moderate self-reported disability, hypertension, diabetes, or coronary artery disease, at high risk for cardiovascular disease. Data at enrollment from each study using uniform tools including body mass index (BMI), dual energy x-ray absorptiometry, physical performance assessment using 4 m walk speed, five chair rise time, handgrip strength, short physical performance battery (17), and Pepper Assessment Tool for Disability were analyzed.
Results
Increased BMI was associated with slower walk speed, lower short physical performance battery, and higher Pepper Assessment Tool for Disability score. Increased percentage of body fat was associated with slower walk speed, lower hand grip strength, lower short physical performance battery scores, and higher Pepper Assessment Tool for Disability scores. Percent appendicular lean mass was associated with faster walk speed, higher handgrip strength, higher short physical performance battery, and lower Pepper Assessment Tool for Disability score. There were no significant discrepancies in relationship between body composition and physical function by gender except gender and BMI on chair-rise time.
Conclusions
Higher BMI and percent body fat were associated with poor physical function while percent appendicular lean mass was associated with better physical function. There was no significant discrepancy in the by gender.
... The PAT-D is a 19-item questionnaire designed to assess mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) [12,13]. Participants rate their level of difficulty performing each activity on a 5-point Likert scale ranging from 1 ("no difficulty") to 5 ("unable to do"). ...
Purpose
Aerobic exercise has been found to be neuroprotective in animal models of retinal degeneration. This study aims to report physical activity levels in patients with RP and investigate the relationship between physical activity and vision-related quality-of-life (QOL).
Materials and Methods
A retrospective study of adult patients with RP examined in 2005–2014. Physical activity levels were assessed using the Godin Exercise Questionnaire. The NEI-Visual Function Questionaire-25 (VFQ-25), SF-36 General Health survey, and Pepper Assessment Tool for Disability (PAT-D) were administered.
Results
143 patients participated. 81 (56.6%) patients were classified as “active” and 62 (43.4%) as “insufficiently active” by Godin score. VFQ-25 revealed statistically significant differences between the active and insufficiently active patients, including overall visual function (53.3 versus 45.1, p = 0.010), color vision (73.8 versus 52.9, p < 0.001), and peripheral vision (34.3 versus 23.8, p = 0.021). The physical component of the SF-36 and the PAT-D survey also demonstrated statistically significant differences (47.2 versus 52.9, p = 0.002; 24.3 versus 30.0, p = 0.010). Active patients had a higher initial Goldmann visual field (GVF) score (74.8 versus 60.1 degrees, p = 0.255) and final GVF score (78.7 versus 47.1 degrees, p = 0.069) but did not reach statistical significance.
Conclusions
In RP, increased physical activity is associated with greater self-reported visual function and QOL.
... Activities of daily living (ADL) disability was measured with the Pepper Assessment Tool for Disability (PAT-D) and the average level of difficulty (0-5, 0 = none and 5 = unable to do) for each of the seven ADL items was calculated. 24,32 These measures were repeated during follow-up at varied intervals. Details of these measures and their frequency are described elsewhere. ...
Background:
Physical activity (PA) reduces the rate of mobility disability, compared with health education (HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit.
Objective:
To evaluate intervention effects on tertiary physical performance outcomes.
Design:
The Lifestyle Interventions and Independence for Elders (LIFE) was a multi-centered, single-blind randomized trial of older adults.
Setting:
Eight field centers throughout the United States.
Participants:
1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10).
Interventions:
Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults.
Outcomes:
Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed.
Results:
Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component.
Conclusion:
Lower extremity performance (SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability.
... Self-reported physical function was assessed with the Pepper Assessment Tool for Disability (PAT-D) 16 at baseline and 6, 12, 24, and 36 months post-randomization. The PAT-D is a 23-item measure that assesses difficulty with an array of discrete functional tasks in three domains: basic activities of daily living (BADLs), instrumental activities of daily living (IADLs), and mobility. ...
Background/Objectives
To test the hypothesis that a long‐term structured, moderate intensity physical activity ( PA ) program is more effective than a health education ( HE ) program in reducing the risk of s elf‐reported dependency and disability in basic activities of daily living ( BADL s), disability in instrumental ADL s ( IADL ), and mobility disability.
Design
The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter, single‐blinded randomized trial.
Setting
University‐based research clinic.
Participants
Thousand six hundred and thirty five sedentary men and women aged 70–89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery.
Intervention
Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817).
Measurements
All outcomes were derived by self‐report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as “receiving assistance” or “unable” to do ≥1 activities. Disability was defined as having “a lot of difficulty” or “unable” doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities.
Results
Over an average follow‐up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants ( HR = 1.0, 95% CI = 0.78–0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability ( HR = 0.78, 95% CI = 0.64–0.96) and ratings of difficulty on mobility tasks were reduced in the PA group.
Conclusion
A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.
... Trial operations are also be supported by members of EFPIA (Sanofi-Aventis R&D, Novartis, GlaxoS-mithKline, and Servier). Table 1 Secondary outcomes of the SPRINTT clinical trial Physical performance Short physical performance battery (SPPB) [5] Handgrip strength Disability status Pepper Assessment Tool for Disability (PAT-D) [30] Activities of Daily Living (ADL) [31] and Instrumental Activities of Daily Living (IADL) [32] Incidence of persistent mobility disability (operationalized as failure of completing the 400-m walk test at two consecutive 6-month visits) Body composition [assessed using dual energy X-ray absorptiometry (DXA)] Anthropometric parameters (body mass index (BMI), mid-arm circumference, calf circumference) Nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF) [33] Cognitive function (assessed using the Mini Mental State Examination (MMSE) [34] and Trail Making Test (TMT) A and B [35]) Mood (assessed via the Center for Epidemiological Studies-Depression scale (CESD) [36]) Falls (assessed using self-reported questionnaire) and injurious falls Quality of life (measured using the EuroQoL-5D instrument) [37] Use of healthcare services (assessed through an ad hoc developed questionnaire) Cost-effectiveness analysis Mortality rate ...
The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity, frailty, and increased risk of functional impairment. Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society, novel strategies should be devised to preserve adequate levels of function and independence in late life. The development of mobility disability, an early event in the disablement process, precedes and predicts more severe forms of inability. Its prevention is, therefore, critical to impede the transition to overt disability. For this reason, the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) project is conducting a randomized controlled trial (RCT) to test a multicomponent intervention (MCI) specifically designed to prevent mobility disability in high-risk older persons. SPRINTT is a phase III, multicenter RCT aimed at comparing the efficacy of a MCI, based on long-term structured physical activity, nutritional counseling/dietary intervention, and an information and communication technology intervention, versus a healthy aging lifestyle education program designed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months. The primary outcome of the SPRINTT trial is mobility disability, operationalized as the inability to walk for 400 m within 15 min, without sitting, help of another person, or the use of a walker. Secondary outcomes include changes in muscle mass and strength, persistent mobility disability, falls and injurious falls, disability in activities of daily living, nutritional status, cognition, mood, the use of healthcare resources, cost-effectiveness analysis, quality of life, and mortality rate. SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives. The findings are also projected to pave the way for major investments in the field of disability prevention in old age.
... Participants rate how much difficulty they had performing each of the activities on a 5-point Likert scale ranging from 1 "no difficulty" to 5 "unable to do" the task, and items are averaged to yield the final score. This measure has been validated in four large samples of older adults and has demonstrated response to change in physical activity interventions (18). ...
Objectives:
The purpose of this study was to compare the effects of cognitive-behavioral therapy delivered by telephone (CBT-T) and telephone-delivered nondirective supportive therapy (NST-T) on sleep, health-related quality of life, and physical disability in rural older adults with generalized anxiety disorder.
Methods:
This was a secondary analysis of a randomized clinical trial on 141 rural-dwelling adults 60 years and older diagnosed with generalized anxiety disorder. Sleep was assessed with the Insomnia Severity Index. Health-related quality of life was assessed with the 36-item Short-Form Health Survey (SF-36). Physical disability was assessed with the Pepper Center Tool for Disability. Assessments occurred at baseline, 4 months, 9 months, and 15 months.
Results:
Insomnia declined in both groups from baseline to 4 months, with a significantly greater improvement among participants who received CBT-T. Similarly, Mental and Physical Component Summaries of the SF-36 declined in both groups, with a differential effect favoring CBT-T. Participants in both interventions reported declines in physical disability, although there were no significant differences between the two interventions. Improvements in insomnia were maintained at the 15-month assessment, whereas between-group differences shrank on the Mental and Physical Component Summaries of the SF-36 by the 15-month assessment.
Conclusion:
CBT-T was superior to NST-T in reducing insomnia and improving health-related quality of life. The effects of CBT-T on sleep were maintained 1 year after completing the treatment.
... On the other hand, frequent ailments with high impact on risk of ALRP were observed for stroke and dementia, a similar pattern to that seen for over-65-year-olds in Australia, where 96% of people with dementia had a severe or profound core-activity restriction, followed by schizophrenia (93%), speech problems (90%) and Parkinson's disease (82%). The relationship between diagnosis, function and participation has also been described in other samples, such as children with physical disabilities or special care needs [37,38], older adults [39] and people with specific chronic conditions [40,41]. ...
Objectives To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework.
Design A cross-sectional study.
Setting 2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza.
Participants 864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening.
Main outcome measures ICF Checklist—body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records.
Results Mild disability (WHODAS-36 level 5–24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores.
Conclusions Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over.
... We defined remission as having fewer than two IADL dependencies at any follow-up time point after incident impaired physical function, along with a statistically reliable decrease in number of dependencies. To calculate the RCI, we used SD and test-retest reliability estimates from previous studies (26,27). To have a statistically significant change, patients had to have a difference in number of dependencies of two or more. ...
... Self-reported physical function was assessed using the Pepper Assessment Tool for Disability (PAT-D), a 19-item questionnaire containing subscales assessing mobility, activities of daily living (ADLs), and instrumental ADLs (IADLs). 19 Participants answered questions on a Likert scale from 1 (usually do with no difficulty) to 5 (unable to do), and a summary score was calculated for each subscale (lower score indicating better functioning). A trained phlebotomist obtained nonfasting blood samples to assess liver and kidney function, vitamin D status (serum 25(OH)D; LIAISON, DiaSorin, Saluggia, Italy), and serum calcium (colorimetric assay) at an independent clinical laboratory (LabCorp, Greensboro, NC). ...
To assess the feasibility of a vitamin D intervention delivered through a Meals-on-Wheels (MOW) program to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce falls in homebound older adults.
Single-blind, cluster randomized trial.
MOW, Forsyth County, North Carolina.
Community-dwelling homebound adults aged 65 to 102 (N = 68).
MOW clients were randomized to vitamin D3 (100,000 IU/month; n = 38) or active placebo (400 IU vitamin E/month; n = 30) according to MOW delivery route.
Serum 25(OH)D was assessed at baseline and 5-month follow-up; proportions of participants in 25(OH)D categories were compared using Fisher exact test. Falls were assessed using monthly fall calendars, and rate of falls was estimated using negative binomial generalized estimating equation models.
Mean ± standard deviation 25(OH)D concentrations were 20.9 ± 11.5 ng/mL at baseline, with 57% having 25(OH)D concentrations less than 20 ng/mL. Retention and adherence were high (>90%). After the 5-month intervention, only one of 34 participants randomized to vitamin D3 had 25(OH)D concentrations less than 20 ng/mL, compared with 18 of 25 participants randomized to placebo (P < .001). In unadjusted analyses, the rate of falls over 5 months was not significantly different according to intervention group (risk ratio (RR) = 0.48, 95% confidence interval (CI) = 0.19-1.19), but after adjustment for sex, race, season of year, baseline 25(OH)D status, and history of falls, participants randomized to vitamin D3 had a lower rate of falling than those randomized to placebo (RR = 0.42, 95% CI = 0.21-0.87).
A vitamin D intervention delivered through MOW was feasible, resulting in improvements in 25(OH)D concentrations and a lower rate of falls in adjusted analyses. Further research is needed to validate the reduction in falls from this type of intervention.
© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
... Other widely used self-reported measures of physical function and behavior health typically display ICC's above 0.7. [16][17][18][19][20][21][22][23][24][25] The Physical Function scales demonstrated somewhat better reliability than the Behavioral Health scales particularly in the working age adult sample. Test-retest reliability estimates were more similar between the two samples for the Physical Function scales than the Behavioral Health scales. ...
The Work Disability Functional Assessment Battery (WD-FAB), developed for potential use by the US Social Security Administration to assess work-related function, currently consists of five multi-item scales assessing physical function and four multi-item scales assessing behavioral health function; the WD-FAB scales are administered as Computerized Adaptive Tests (CATs).
The goal of this study was to evaluate the test-retest reliability of the WD-FAB Physical Function and Behavioral Health CATs.
We administered the WD-FAB scales twice, 7-10 days apart, to a sample of 376 working age adults and 316 adults with work-disability. Intraclass correlation coefficients were calculated to measure the consistency of the scores between the two administrations. Standard error of measurement (SEM) and minimal detectable change (MDC90) were also calculated to measure the scales precision and sensitivity.
For the Physical Function CAT scales, the ICCs ranged from 0.76 to 0.89 in the working age adult sample, and 0.77-0.86 in the sample of adults with work-disability. ICCs for the Behavioral Health CAT scales ranged from 0.66 to 0.70 in the working age adult sample, and 0.77-0.80 in the adults with work-disability. The SEM ranged from 3.25 to 4.55 for the Physical Function scales and 5.27-6.97 for the Behavioral Health function scales. For all scales in both samples, the MDC90 ranged from 7.58 to 16.27.
Both the Physical Function and Behavioral Health CATs of the WD-FAB demonstrated good test-retest reliability in adults with work-disability and general adult samples, a critical requirement for assessing work related functioning in disability applicants and in other contexts.
Copyright © 2015 Elsevier Inc. All rights reserved.
... for mobility, and α = .82 for the summary score (24,25). ...
Performance-based and self-report instruments of physical function are frequently used and provide complementary information. Identifying older adults with a mismatch between actual and perceived function has utility in clinical settings and in the design of interventions. Using novel, video-animated technology, the objective of this study was to develop a self-report measure that parallels the domains of objective physical function assessed by the Short Physical Performance Battery (SPPB)-the virtual SPPB (vSPPB).
The SPPB, vSPPB, the self-report Pepper Assessment Tool for Disability, the Mobility Assessment Tool-short form, and a 400-m walk test were administered to 110 older adults (mean age = 80.6±5.2 years). One-week test-retest reliability of the vSPPB was examined in 30 participants.
The total SPPB (mean [±SD] = 7.7±2.8) and vSPPB (7.7±3.2) scores were virtually identical, yet moderately correlated (r = .601, p < .05). The component scores of the SPPB and vSPPB were also moderately correlated (all p values <.01). The vSPPB (intraclass correlation = .963, p < .05) was reliable; however, individuals with the lowest function overestimated their overall lower extremity function while participants of all functional levels overestimated their ability on chair stands, but accurately perceived their usual gait speed.
In spite of the similarity between the SPPB and vSPPB, the moderate strength of the association between the two suggests that they offer unique perspectives on an older adult's physical function.
© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Objectives
The objective of this systematic review was to synthesise the psychometric properties of measures of perceived mobility ability and related frameworks used to define and operationalise mobility in community-dwelling older adults.
Methods
We registered the review protocol with PROSPERO (CRD42022306689) and included studies that examined the psychometric properties of perceived mobility measures in community-dwelling older adults. Five databases were searched to identify potentially relevant primary studies. We qualitatively summarised psychometric property estimates and related operational frameworks. We conducted risk of bias and overall quality assessments, and meta-analyses when at least three studies were included for a particular outcome. The synthesised results were compared against the Consensus-based Standards for the Selection of Health Measurement Instruments criteria for good measurement properties.
Results
A total of 36 studies and 17 measures were included in the review. The Late-Life Function and Disability Index: function component (LLFDI-FC), lower extremity functional scale (LEFS), Mobility Assessment Tool (MAT)-short form (MAT-SF) or MAT-Walking, and Perceived Driving Abilities (PDA) Scale were identified with three or more eligible studies. Most measures showed sufficient test–retest reliability (moderate or high), while the PDA scale showed insufficient reliability (low). Most measures had sufficient or inconsistent convergent validity (low or moderate) or known-groups validity (low or very low), but their predictive validity and responsiveness were insufficient or inconsistent (low or very low). Few studies used a conceptual model.
Conclusion
The LLFDI-FC, LEFS, PDA and MAT-SF/Walking can be used in community-dwelling older adults by considering the summarised psychometric properties. No available comprehensive mobility measure was identified that covered all mobility domains.
Background: The quality of rehabilitation services plays an important role in the health and satisfaction of society, but it still has some significant deficiencies in different aspects at the same time. It is one of the main issues in the system of rehabilitation services in all countries. Objectives: This study aimed to investigate the rehabilitation service capacity for mildly disabled older adults in nursing homes. Methods: The data were used hierarchically and assigned entropy values, the final level of rehabilitation service capacity of mildly disabled older adults in nursing homes was derived, and hierarchical analysis and entropy power methods were combined. Results: In evaluating rehabilitation services for older adults with mild disabilities in nursing homes, the weight of the first-level risk indicators was 0.1454 for the rehabilitation environment, 0.3687 for the quality of rehabilitation services, and 0.4859 for the effectiveness of rehabilitation. Conclusions: Rehabilitation environment indicators for an elderly nursing home on their privacy and anti-slip design were ranked first, rehabilitation service quality indicators on the level of rehabilitation division, respectful treatment, and humanistic care, indicating that older people in nursing homes were more important physiological and psychological rehabilitation effect indicators analysis. Rehabilitation effect indicators, independent laundry, independent toileting, bathing, and independent dressing, are especially important in nursing homes for mildly disabled older adults who prefer the change the healthy physical effects.
Background: Existing literature suggests exercise has variable efficacy on gains in physiological performance which translate to improved functional outcomes. Methods: We analysed the Graded Resistance Exercise And Type 2 Diabetes in Older adults (GREAT2DO) participants to explore links between health status, physical characteristics, and functional performance outcomes. Then compared high-intensity power training (PT) vs. SHAM low intensity exercises analysing changes in muscle function and then the changes in functional performance associated with changes in muscle function. Lastly, we identified genetic contributants to functional performance before and after physical activity in older adults. Results: Muscle function, body composition and neuropsychological status, were significantly associated with the variance functional performance outcomes. Twelve months of PT resulted in significantly greater increases in muscle strength, peak power, and endurance total work, compared to the SHAM group. Surprisingly, no effect of group assignment on any changes over time nor any relationships between changes in strength or power and changes in any functional outcomes except for chest press power and static balance changes across both groups. A portion of this heterogeneity may be due to variations in genetic profile, ACE (D) allele, ACTN3 (RR) genotype, UCP2 (GG) genotype, IL6-174 (GG), TNFα-308 (GG) and IL10-1082 (GG) genotype all predicted significantly superior PPTs and self-reported physical function after prescribed exercise or in those with higher levels of PA. Conclusion: This should help design future exercise interventions, which may be needed to enhance adaptations. Our power training intervention significantly improved muscle function, this did not translate to functional benefits. Further research is needed to define optimal lifestyle approaches, identify those with genetic profiles predicting attenuated adaptation who may require individualised exercise prescriptions.
Objectives:
Among older women, the clinical presentation of urinary incontinence (UI) is heterogeneous; presenting as a pelvic floor condition or geriatric syndrome. We aimed to characterize the geriatric incontinence syndrome (GIS) to establish its foundation in clinical practice.
Design:
Prospective study.
Setting:
Geriatric Clinical Research Unit.
Participants:
Sixty-one community-dwelling women aged 70 and older with bothersome UI symptoms.
Measurements:
UI symptom type and severity were determined by 3-day bladder diary. UI severity was defined; moderate UI defined as <2 UI episodes/day and severe UI defined as ≥2 UI episodes/day. Subjective assessment of physical performance was determined using the Short Physical Performance Battery (SPPB) score. Total SPPB scores >9 define normal physical performance and scores ≤9 defined impaired physical performance.
Results:
The average age was 77.1 ± 5.8 (mean ± SD) years; 69% of women had severe UI and 31% had moderate UI. Demographic characteristics were similar between groups. Daytime voiding frequency was 7.1 ± 2.9 and nocturia was present equally between groups. The majority of women (59%) with severe UI had SPPB ≤9 compared with 26% among women with moderate UI (p = 0.02); featuring significantly slower chair stand scores (2.3 ± 1.4 vs 3.3 ± 0.9, p = 0.007) and gait speed (0.08 ± 0.2 m/s compared with 1.0 ± 0.2 in women with moderate UI).
Conclusions:
A multifactorial GIS may be present in older women evidenced by the co-existence of severe UI, physical disability, slower chair stand pace, and gait speed. Prospective studies are needed to understand how these clinical features may impact the clinical care of older incontinent women.
Background
Elevated Interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter-mile.
Methods
We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community dwelling high-functioning older adults (Health ABC) with two trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk.
Results
We found higher MMD risk per unit increase in log IL-6 [HR=1.26 (95% CI 1.13 to 1.41)]. IL-6 meeting pre-determined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD [HR=1.31 (95% CI: 1.12 to 1.54)]. Elevated CRP (CRP >3.0 mg/L) was also associated with increased MMD risk [HR=1.38 (95% CI: 1.10 to 1.74)]. The CRP effect was more pronounced among participants with elevated IL-6 [HR=1.62 (95% CI: 1.12 to 2.33)] compared to lower IL-6 levels [HR=1.19 (95% CI: 0.85 to 1.66)].
Conclusions
High baseline IL-6 and CRP were associated with increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.
Background:
Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools.
Objective:
Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications.
Design:
This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included.
Results:
The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies.
Conclusion:
FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
Objective: We investigated the mortality rates of three subtypes of disability and their specific explanatory factors in older adults. Methods: Our data come from NEDICES, a population-based longitudinal cohort study of Spanish older adults. We examined 3816 participants without dementia who completed the Pfeffer's Functional Activities Questionnaire (FAQ) and an assessment of self-perceived functional limitations (SFL) associated with health conditions. Subjects were classified into mutually exclusive subtypes of disability: subtype 1 (SFL), subtype 2 (impaired FAQ), and subtype 3 (impaired FAQ plus SFL). Factors related to all disability subtypes were analyzed using a multinomial logistic regression (MLR), whereas Cox regression (CR) models adjusted by covariates were applied to compare survival rates between groups at the 5-year follow up. Results: The CR models indicated that SFL and FAQ scores were associated with higher risk of mortality at 5-years. After stratifying by subtypes of disability, mortality was significantly higher in subtype 3 than in subtypes 1 and 2. All models were consistent after adjusting by different covariates. The MLR showed that subtype 1 was specifically associated with the number of comorbidities, whereas subtype 2 was associated with lower MMSE scores depression and living in nursing homes. Conclusions: Our results show that the combination of impaired FAQ plus SFL have an increased differential predictive utility for mortality than approaches based on unique measures. They also indicate that both measures of disability are associated with different explanatory factors.
Background:
Obesity compounds aging-related declines in cardiorespiratory fitness (CRF), with accompanying fatigue and disability. This study determined the effects of two different levels of caloric restriction (CR) during aerobic training on CRF, fatigue, physical function and cardiometabolic risk.
Methods:
The INFINITE study was a 20-week randomized trial in 180 older (65-79 years) men and women with obesity (BMI= 30-45 kg/m2). Participants were randomly assigned to aerobic training (EX; treadmill 4 days/week for 30 minutes at 65-70% of heart rate reserve), 2) EX with moderate (-250 kcal/d) CR (EX+Mod-CR), or 3) EX with more intensive (-600 kcal/d) CR (EX+High-CR). CRF (peak aerobic capacity, VO2peak, primary outcome) was determined during a graded exercise test.
Results:
155 participants returned for 20-week data collection (87% retention). VO2peak increased by 7.7% with EX, by 13.8% with EX+Mod-CR, and by 16.0% with EX+High-CR and there was a significant treatment effect (EX+High-CR= 21.5 ml/kg/min, 95%CI=19.8-23.2; EX+Mod-CR= 21.2 ml/kg/min, 95%CI=19.4-23.0; EX=20.1 ml/kg/min, 95%CI=18.4-21.9). Both CR groups exhibited significantly greater improvement in self-reported fatigue and disability, and in glucose control, compared to EX.
Conclusion:
Combining aerobic exercise with even moderate CR is more efficacious for improving CRF, fatigue and disability, and glucose control than exercise alone, and is as effective as higher dose CR.
White book on physical and rehabilitation Medicine (prM) in Europe. Chapter 7. The clinical field of competence: prM in practice European physical and rehabilitation Medicine bodies alliance a b s t r a c t in the context of the White book on physical and rehabilitation Medicine (prM) in Europe this paper deals with the scope and competencies of PRM starting from its definition as the "medicine of functioning." PRM uses the rehabilitative health strategy as its core strategy together with the curative strategy. according to the complexity of disabling health conditions, prM also refers to prevention and maintenance and provides information to the patients and other caregivers. The rehabilitation process according to the so-called rehabilitation cycle including an assessment and definition of the (individual) rehabilitation goals, assignment to the rehabilitation program evaluation of individual outcomes. prM physicians treat a wide spectrum of diseases and take a transversal across most of the medical specialties. they also focus on many functional problems such as immobilization, spasticity, pain syndromes, communication disorders, and others. The diagnosis in PRM is the interaction between the medical diagnosis and a PRM-specific functional assessment. The latter is based on the ICF conceptual framework, and obtained through functional evaluations and scales: these are classified according to their main focus on impairments, activity limitations or participation restrictions; environmental and personal factors are included as barriers or facilitators. interventions in prM are either provided directly by prM physicians or within the prM team. they include a wide range of treatments, including medicines, physical therapies, exercises, education and many others. standardized prM programs are available for many diseases and functional problems. in most cases rehabilitation is performed in multi-professional teams working in a collaborative way, as well as with other disciplines under the leadership of a prM physician and it is a patient-centered approach. outcomes of prM interventions and programs, showed reduction of impairments in body functions, activity limitations, and impacting on participation restrictions, and also reduction in costs as well as decrease in mortality for certain groups of patients. (Cite this article as: European physical and rehabilitation Medicine bodies alliance. White book on physical and rehabilitation Medicine (prM) in Europe. Chapter 7. The clinical field of competence: PRM in practice. Eur J Phys
Aims: Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.
Methods: In a scoping review, we investigated research published 2001–2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.
Results: The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.
Conclusion: The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes.
• Implications for Rehabilitation
• The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance.
• Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning.
• Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.
Background:
The Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.
Objective:
The aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.
Design:
This study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.
Participants/setting:
Community-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).
Main outcome measures:
DST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).
Statistical analyses performed:
Multiple analysis of variance and χ(2) analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.
Results:
Participants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).
Conclusions:
Older adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.
There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.
Objectives
To determine 1) age-adjusted transition probabilities to worsening physical/cognitive function states, reversal to normal cognition/physical function, or maintenance of normal state; 2) whether these transitions are modulated by sex, BMI, education, hypertension (HTN), health status, or APOE4; 3) whether worsening gait speed preceded cognition change, or vice versa. DesignAnalysis of 9-year prospective cohort data from the New Mexico Aging Process Study. Setting: Healthy independent-living adults. Participants: 60+ years of age (n= 598). MeasurementsGait speed, cognitive function (3MSE score), APOE4, HTN, BMI, education, health status. ResultsOver 9 years, 2129 one-year transitions were observed. 32.6% stayed in the same state, while gait speed and cognitive function (3MSE scores) improved for 38% and 43% of participants per year, respectively. Transitions to improved function decreased with age (P< 0.001), APOE4 status (P=0.02), BMI (P=0.009), and health status (P=0.009). Transitions to worse function were significantly increased for the same factors (all P<0.05). Times to lower gait speed and cognitive function did not precede each other (P=0.91). Conclusions
Transitions in gait speed and cognition were mutable with substantial likelihood of transition to improvement in physical and cognitive function even in oldest-old, which may have clinical implications for treatment interventions.
Det foreligger lite kunnskap om hvordan ICF anvendes innenfor de aktuelle
bruksområdene. En måte å få vite mer om ICFs bruksområder innen praksis og
forskning er gjennom tilgjengelig litteratur. Ved å se nærmere på ICF sin rolle i
vitenskapelige publikasjoner kan man utvikle ny kunnskap om aktuelle bruksområder
for ICF. Målet med denne studien var derfor å identifisere og presentere ICF litteratur
som er gitt ut i publiseringsåret 2008.
2 Mål
Målet med denne studien var å identifisere og presentere ICF litteraturen som er gitt ut i
2008, der ICF benyttes, omtales eller på en eller annen måte inngår i publikasjonen.
Background:
Existing instruments measuring participation may vary with respect to various aspects. This study aimed to examine the comparability of existing instruments measuring participation based on the International Classification of Functioning, Disability and Health (ICF) by considering aspects of content, the perspective adopted and the categorization of response options.
Methods:
A systematic literature review was conducted to identify instruments that have been commonly used to measure participation. Concepts of identified instruments were then linked to the ICF following the refined ICF Linking Rules. Aspects of content, perspective adopted and categorization of response options were documented.
Results:
Out of 315 instruments identified in the full-text screening, 41 instruments were included. Concepts of six instruments were linked entirely to the ICF component Activities and Participation; of 10 instruments still 80% of their concepts. A descriptive perspective was adopted in most items across instruments (75%), mostly in combination with an intensity rating. An appraisal perspective was found in 18% and questions from a need or dependency perspective were least frequent (7%).
Conclusion:
Accounting for aspects of content, perspective and categorization of responses in the linking of instruments to the ICF provides detailed information for the comparison of instruments and guidance on narrowing down the choices of suitable instruments from a content point of view. Implications for Rehabilitation For clinicians and researchers who need to identify a specific instrument for a given purpose, the findings of this review can serve as a screening tool for instruments measuring participation in terms of the following: • Their content covered based on the ICF. • The perspective adopted in the instrument (e.g., descriptive, need/dependency or appraisal). • The categorization of their response options (e.g., intensity or frequency).
Background:
Accelerometry has become the gold standard for evaluating physical activity in the health sciences. An important feature of using this technology is the cutpoint for determining moderate to vigorous physical activity (MVPA) because this is a key component of exercise prescription. This article focused on evaluating what cutpoint is appropriate for use with older adults 70-89 years who are physically compromised.
Methods:
The analyses are based on data collected from the Lifestyle Interventions and Independence for Elders (LIFE) study. Accelerometry data were collected during a 40-minute, overground, walking exercise session in a subset of participants at four sites; we also used 1-week baseline and 6-month accelerometry data collected in the main trial.
Results:
There was extreme variability in median counts per minute (CPM) achieved during a controlled bout of exercise (n = 140; median = 1,220 CPM (25th, 75th percentile = 715, 1,930 CPM). An equation combining age, age(2), and 400 m gait speed explained 61% of the variance in CPM achieved during this session. When applied to the LIFE accelerometry data (n = 1,448), the use of an individually tailored cutpoint based on this equation resulted in markedly different patterns of MVPA as compared with using standard fixed cutpoints.
Conclusions:
The findings of this study have important implications for the use and interpretations of accelerometry data and in the design/delivery of physical activity interventions with older adults.
Physical therapists expend a great deal of effort to assist older persons to regain the ability to walk independently. While we often use descriptors of gait patterns, assistive device use, level of assistance required, and distance traversed as part of our documentation, quantifying self-selected and fast walking speeds may be the most powerful measure to inform clinical decision making and to assess outcomes of intervention. In this article, we will consider why and how physical therapist should incorporate walking speed data into functional screening, development of plans of care (ie, setting appropriate goals), and assessing efficacy of interventions. We will explore the factors that determine an individual's self-selected walking speed and the importance of assessing if, and how much, an older person is able to increase walking speed for safe community function. We will then present current best evidence about how walking speed typically changes in the later years of life, highlight age- and gender-specific “norms” (ie, typical performance). We will review the converging evidence of key threshold values for walking speed, as they relate to community function, risk of frailty and morbidity, and risk of institutionalization and conclude with a discussion of how such information is used to determine physical therapy prognosis, setting measurable functional goals, documenting efficacy of intervention, and determining need for continued physical therapy care across delivery settings.
The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.
Age-related body-composition changes are associated with health-related outcomes in elders. This relation may be explained by inflammation and hemostatic abnormalities.
Our objectives were to evaluate the relation between body-composition measures [body mass index (BMI), total fat mass, and appendicular lean mass (aLM)] and C-reactive protein (CRP), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI-1) and to explore the effect of obesity and sarcopenia on CRP, IL-6, and PAI-1 concentrations.
The data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study baseline visit (n = 286; mean age = 66.0 y). Total fat mass and aLM were assessed with a dual-energy X-ray absorptiometry scan. Linear regressions were performed between body-composition measures and CRP, IL-6, or PAI-1 concentrations. The effect of sarcopenia and obesity (defined as the percentage of fat mass) on CRP, IL-6, and PAI-1 concentrations was evaluated with the use of analyses of covariance.
CRP and IL-6 were positively associated with both BMI [beta = 0.027 (P = 0.03) and beta = 0.048 (P < 0.001), respectively] and total fat mass [beta = 0.049 (P < 0.001) and beta = 0.055 (P < 0.001), respectively] and were inversely associated with fat-adjusted aLM [beta = -0.629 (P = 0.002) and beta = -0.467 (P = 0.02), respectively]. PAI-1 was positively associated with both BMI (beta = 0.038, P = 0.005) and total fat mass (beta = 0.032, P = 0.007). No significant interaction was found between either obesity or sarcopenia and CRP, IL-6, and PAI-1 concentrations. Obesity remained significantly associated with high CRP and IL-6 concentrations after adjustments for sarcopenia.
CRP and IL-6 are positively associated with total fat mass and negatively associated with aLM. Obesity-associated inflammation may play an important role in the age-related process that leads to sarcopenia. The relation of inflammation with sarcopenia was not independent of any of the considered obesity indexes.
Background: Age-related body-composition changes are associated with health-related outcomes in elders. This relation may be explained by inflammation and hemostatic abnormalities.
Objectives: Our objectives were to evaluate the relation between body-composition measures [body mass index (BMI), total fat mass, and appendicular lean mass (aLM)] and C-reactive protein (CRP), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI-1) and to explore the effect of obesity and sarcopenia on CRP, IL-6, and PAI-1 concentrations.
Design: The data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study baseline visit (n = 286; mean age = 66.0 y). Total fat mass and aLM were assessed with a dual-energy X-ray absorptiometry scan. Linear regressions were performed between body-composition measures and CRP, IL-6, or PAI-1 concentrations. The effect of sarcopenia and obesity (defined as the percentage of fat mass) on CRP, IL-6, and PAI-1 concentrations was evaluated with the use of analyses of covariance.
Results: CRP and IL-6 were positively associated with both BMI [β = 0.027 (P = 0.03) and β = 0.048 (P < 0.001), respectively] and total fat mass [β = 0.049 (P < 0.001) and β = 0.055 (P < 0.001), respectively] and were inversely associated with fat-adjusted aLM [β = −0.629 (P = 0.002) and β = −0.467 (P = 0.02), respectively]. PAI-1 was positively associated with both BMI (β = 0.038, P = 0.005) and total fat mass (β = 0.032, P = 0.007). No significant interaction was found between either obesity or sarcopenia and CRP, IL-6, and PAI-1 concentrations. Obesity remained significantly associated with high CRP and IL-6 concentrations after adjustments for sarcopenia.
Conclusions: CRP and IL-6 are positively associated with total fat mass and negatively associated with aLM. Obesity-associated inflammation may play an important role in the age-related process that leads to sarcopenia. The relation of inflammation with sarcopenia was not independent of any of the considered obesity indexes.
To ascertain predictors of decline in physical functioning among older adults reporting knee pain.
The International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization in 2001 to provide a standardized description of health and health-related states (WHO 2001). The ICF classifies functioning and disability associated with health conditions at the levels of body/body parts, the whole person and the person in their environmental context. The ICF is a multipurpose classification that can be used by different disciplines and sectors to provide a scientific basis and common language for the description of health and health related states, outcomes and determinants. ICF data enables comparison across countries, disciplines and time, and provides a coding system for health information (WHO 2001). The ICF is not a tool for assessment, but rather it provides the basis for such tools as well as a framework to which these tools can be related, thus building up a more complete picture of how a person lives. This paper will provide an overview of this international classification, give examples of its use in national data collections as well as detail its relevance to ergonomic research and practice.
Health status measures are being used with increasing frequency in clinical research. Up to now the emphasis has been on the reliability and validity of these measures. Less attention has been given to the sensitivity of these measures for detecting clinical change. As health status measures are applied more frequently in the clinical setting, we need a useful way to estimate and communicate whether particular changes in health status are clinically relevant. This report considers effect sizes as a useful way to interpret changes in health status. Effect sizes are defined as the mean change found in a variable divided by the standard deviation of that variable. Effect sizes are used to translate "the before and after changes" in a "one group" situation into a standard unit of measurement that will provide a clearer understanding of health status results. The utility of effect sizes is demonstrated from four different perspectives using three health status data sets derived from arthritis populations administered the Arthritis Impact Measurement Scales (AIMS). The first perspective shows how general and instrument-specific benchmarks can be developed and how they can be used to translate the meaning of clinical change. The second perspective shows how effect sizes can be used to compare traditional clinical measures with health status measures in a standard clinical drug trial. The third application demonstrates the use of effect sizes when comparing two drugs tested in separate drug trials and shows how they can facilitate this type of comparison. Finally, our health status results show how effect sizes can supplement standard statistical testing to give a more complete and clinically relevant picture of health status change. We conclude that effect sizes are an important tool that will facilitate the use and interpretation of health status measures in clinical research in arthritis and other chronic diseases.
Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.
It has been widely recognized that a gap in the series of existing classifications in health was the absence of one dealing with impairments, disabilities and resulting handicaps. The International Conference for the Ninth Revision of the International Classification of Diseases (ICD) which met in Geneva in 1975 considered draft proposals for a scheme to remedy this deficiency. In May 1976, the Twenty-ninth World Health Assembly in resolution WHA 29.35 accepted the recommendation that a classification of impairments and handicaps should be published for trial purposes as a supplement to the ICD. The manual is now available, and its potential implications for health and social policy development could be considerable. It provides a clarification of the concepts and terminology relating to the consequences of chronic and disabling conditions, and offers a medium for the better description of the different planes of experience that result from disease.
This study examined the relationship between self-efficacy beliefs and pain during the performance of stair climbing and lifting/carrying tasks on speed of movement, ratings of task difficulty, and perceived task ability in a group of patients with osteoarthritis (OA) of the knee. Seventy-nine patients with knee OA completed the tasks in a controlled laboratory setting. Before completing each task, patients' self-efficacy was assessed; following task performance they rated (a) the most intense knee pain experienced, (b) the difficulty of the task, and (c) their perceived ability as they performed each task. Results demonstrated that, even after controlling for physical function, self-efficacy, and knee pain during performance, each contributed significantly to understanding either speed of movement or self-reported ratings of task difficulty and perceived ability.
This investigation describes the development and validation of a test battery for evaluating physical activity restrictions (PAR) in patients with knee osteoarthritis (OA). The tasks on the final version of the PAR include (a) a 6-min walk; (b) a stair climb; (c) a lifting and carrying task; and (d) getting into and out of a car. Data from patients with knee OA revealed that the four tasks loaded highly on a single unrotated principal component yielding an alpha internal consistency reliability of 0.92. These data suggest that investigators may choose to use an aggregate score and/or responses from individual tasks. Two week test-retest reliabilities for the four tasks were all in excess of 0.85 and there was support for their concurrent and convergent validity. Specifically, performance on the tasks correlated with time on treadmill, difficulty with self-reported ADLs, and ratings of difficulty following the performance of each task. Additional research is needed on the predictive validity of the measure and its sensitivity to change.
To determine the extent to which patients with Stage I COPD experience improvements in physical performance and quality of life as a result of exercise training, and to compare these improvements with those seen in Stage I and II patients, 151 patients with COPD underwent a 12-wk exercise program. Outcomes were measured at baseline and follow-up. Physical performance was evaluated by means of a 6-min walk, treadmill time, an overhead task, and a stair climb. General health-related quality of life was assessed in terms of the domains of Social Function, Health Perceptions, and Life Satisfaction. Disease-specific health-related quality of life was assessed with the Chronic Respiratory Disease Questionnaire (CRQ). Six-minute walk distance increased significantly in Stage I (200.5 ft [95% CI: 165.4, 235.7]), Stage II (238.3 ft [143.3, 333.3]), and Stage III (112.1 ft [34.6, 189.6]) participants. Treadmill time increased significantly in Stage I (0.42 min [0.20, 0.64]) and Stage II (0.64 min [0.14, 1.4]) participants. Time to complete the overhead task decreased significantly in Stage I (0.91 s [1.72, 0. 11]) and Stage II (1.39 s [2.66, 0.13]) participants. None of the measures of general health-related quality of life improved in any of the three groups. Participants in Stages I, II, and III all experienced improvements in the CRQ domains of dyspnea (0.72 [0.53, 0.91], 0.47 [0.02, 0.91], and 0.46 [0.05, 0.87], respectively) and fatigue (0.49 [0.33, 0.66], 0.54 [0.20, 0.87], and 0.55 [0.05, 1.05], respectively). These results suggest that all patients with COPD will benefit from exercise rehabilitation. Berry MJ, Rejeski WJ, Adair NE, Zaccaro D. Exercise rehabilitation and chronic obstructive pulmonary disease stage.
To ascertain predictors of decline in physical functioning among older adults reporting knee pain.
The Observational Arthritis Study in Seniors was a longitudinal study of 480 adults over 65 years of age. Measurements of strength, sociodemographic characteristics, disease burden (including radiographic knee osteoarthritis [OA]), self-reported disability, and functional limitations were obtained on participants at baseline and at 15 and 30 months.
Radiographic evidence of OA at baseline was moderately associated with an increased decline in both transfer (P = 0.06) and ambulatory-based performance tasks (P = 0.04) but not in self-reported disability. This effect disappeared after accounting for baseline levels of knee pain intensity and knee strength.
Knee pain intensity and knee strength may mediate the relationship between radiographic evidence of knee OA and change in performance. Although it is not clear whether joint disease precedes or follows a decline in muscular strength, these results may help to identify subpopulations of older persons with knee OA who may benefit from interventions aimed at slowing the progression of disability related to transfer and ambulatory-based tasks.
Self-reported capability in physical functioning has long been considered an important focus of research for older persons. Current measures have been criticized, however, for conceptual confusion, lack of sensitivity to change, poor reproducibility, and inability to capture a wide range of upper and lower extremity functioning.
Using Nagi's disablement model, we wrote physical functioning questionnaire items that assessed difficulty in 48 common daily tasks. We constructed the instrument using factor analysis and Rasch analytic techniques and evaluated its validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 years and older who had a range of functional limitations.
Our analyses resulted in a 32-item function component with three dimensions--upper extremity, basic lower extremity, and advanced lower extremity functions. Expected differences in summary scores of known-functional limitation groups support its validity. Test-retest stability over a 1- to 3-week period was extremely high (intraclass correlation coefficients =.91 to.98).
The Late-Life Function and Disability Instrument has potential to assess activity concepts related to upper and lower extremity functioning across a wide variety of daily physical tasks and individual levels of physical functioning.
Efforts to evaluate the effectiveness of clinical and community-based interventions designed to impact late-life disability have been hindered significantly by limitations in current instrumentation. More conceptually sound and responsive measures of disability are needed.
Applying Nagi's disablement model, we wrote questionnaire items that assessed disability in terms of frequency and limitation in performance of 25 life tasks. We evaluated their validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 and older who had a range of functional limitations, using factor analysis and Rasch analytic techniques to examine and refine the instrument.
Our analyses resulted in a 16-item disability component with two dimensions, one focused on frequency of performance and the other addressing limitation in performance of life tasks, with two disability domains within each dimension. The frequency dimension consisted of a personal and a social role domain, and the limitation dimension consisted of an instrumental and a management role domain. Expected differences in summary scores of known-functional limitation groups support the validity of this instrument. Test-retest intraclass correlations of the reproducibility of each overall dimension summary score were moderate to high (intraclass correlation coefficients .68-.82).
The Late-Life Function and Disability Instrument has potential to assess meaningful concepts of disability across a wide variety of life tasks with relatively few items.
To determine the correlates of the total 6-min walk distance (6MWD) in a population sample of adults > or = 68 years old.
The standardized 6-min walk test (6MWT) was administered to the Cardiovascular Health Study cohort during their seventh annual examination.
Of the 3,333 participants with a clinic visit, 2,281 subjects (68%) performed the 6MWT. There were no untoward events. The mean 6MWD was 344 m (SD, 88 m). Independent general correlates of a shorter 6MWD in linear regression models in women and men included the following: older age, higher weight, larger waist, weaker grip strength, symptoms of depression, and decreased mental status. Independent disease or risk factor correlates of a shorter 6MWD included the following: a low ankle BP, use of angiotensin-converting enzyme inhibitors, and arthritis in men and women; higher C-reactive protein, diastolic hypertension, and lower FEV(1) in women; and the use of digitalis in men. Approximately 30% of the variance in 6MWD was explained by the linear regression models. Newly described bivariate associations of a shorter 6MWD included impaired activities of daily living; self-reported poor health; less education; nonwhite race; a history of coronary heart disease, transient ischemic attacks, stroke, or diabetes; and higher levels of C-reactive protein, fibrinogen, or WBC count.
Most community-dwelling elderly persons can quickly and safely perform this functional status test in the outpatient clinic setting. The test may be used clinically to measure the impact of multiple comorbidities, including cardiovascular disease, lung disease, arthritis, diabetes, and cognitive dysfunction and depression, on exercise capacity and endurance in older adults. Expected values should be adjusted for the patient's age, gender, height, and weight.
The present addresses concepts, definitions, and measurements of functional capacity. Further, distributions of functional capacity are assessed by such various indices as activities of daily living (ADL), instrumental ADL (IADL), the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, and active life expectancy in the Japanese elderly. Further, predictors of functional status are demonstrated, and the impact of functional decline on quality of life is investigated in elderly Japanese living in the community.
To test the hypothesis that distinct Activity and Participation dimensions of the International Classification of Functioning, Disability, and Health could be identified using physical functioning items drawn from the Late Life Function and Disability Instrument.
A cross-sectional, survey design was employed.
The sample comprised 150 community-dwelling adults aged 60 years and older.
Exploratory factor analysis was used to identify interpretable dimensions underlying 48 physical functioning questionnaire items.
Findings revealed that one conceptual dimension underlying these physical functioning items was not sufficient to adequately explain the data (X2 = 2383; p < 0.0001). A subsequent solution produced 3 distinct, interpretable factors that accounted for 61.1% of the variance; they were labeled: Mobility Activities (24.4%), Daily Activities (24.3%), and Social/Participation (12.4%). All 3 factors achieved high internal consistency with coefficient alphas of 0.90 or above.
Within physical functioning, distinct concepts were identified that conformed to the dimensions of Activity and Participation as proposed in the ICF. We believe this is the first empirical evidence of separate Activity and Participation dimensions within the International Classification of Functioning, Disability, and Health classification.
The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA).
Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older, with a body mass index of > or =28 kg/m(2), knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width.
Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in self-reported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups.
The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.
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