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Protocol - Physical Functioning - Objective

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Description:

This protocol is a brief series of tests used to evaluate a person’s balance, gait, strength, and endurance. A technician provides instructions and demonstrates how to perform each test. The tests include repeated chair stands, balance testing, and a measured walk. During each test, the technician uses a stopwatch to time the person and enters the result on an ordinal scale.

Protocol:

Study ID___________________ Date_____________ Tester Initials:____________

SHORT PHYSICAL PERFORMANCE BATTERY PROTOCOL AND SCORE SHEET

All of the tests should be performed in the same order as they are presented in this protocol. Instructions to the participants are shown in bold italic and should be given exactly as they are written in this script.

1. BALANCE TESTS

The participant must be able to stand unassisted without the use of a cane or walker. You may help the participant to get up.

Now let’s begin the evaluation. I would now like you to try to move your body in different movements. I will first describe and show each movement to you. Then I’d like you to try to do it. If you cannot do a particular movement, or if you feel it would be unsafe to try to do it, tell me and we’ll move on to the next one. Let me emphasize that I do not want you to try to do any exercise that you feel might be unsafe.

Do you have any questions before we begin?

A. Side-by-Side Stand

1. Now I will show you the first movement.

2. (Demonstrate) I want you to try to stand with your feet together, side-by-side, for about 10 seconds.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the side-by-side position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

9. If participant is unable to hold the position for 10 seconds, record result and go to the gait speed test.

B. Semi-Tandem Stand

1. Now I will show you the second movement.

2. (Demonstrate) Now I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the semi-tandem position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

9. If participant is unable to hold the position for 10 seconds, record result and go to the gait speed test.

C. Tandem Stand

1. Now I will show you the third movement.

2. (Demonstrate) Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the tandem position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

SCORING:

A. Side-by-Side Stand

[ ] 1 point Held for 10 sec

[ ] 0 points Not held for 10 sec

[ ] 0 points Not attempted

If 0 points, end Balance Tests

If participant did not attempt test or failed, mark why: [ ] 1 Tried but unable [ ] 2 Participant could not hold position unassisted [ ] 3 Not attempted, you felt unsafe [ ] 4 Not attempted, participant felt unsafe [ ] 5 Participant unable to understand instructions [ ] 6 Other (specify)______________________ [ ] 7 Participant refused

Number of seconds held if less than 10 sec: ___.__ __ sec

B. Semi-Tandem Stand

1 [ ] point Held for 10 sec

0 [ ] points Not held for 10 sec

0 [ ] points Not attempted (circle reason above)

If 0 points, end Balance Tests

Number of seconds held if less than 10 sec: ___.__ __ sec

C. Tandem Stand

2 [ ] points Held for 10 sec

1 [ ] point Not held for 3 to 9.99 sec

0 [ ] points Held for < than 3 sec

0 [ ] points Not attempted (circle reason above)

Number of seconds held if less than 10 sec: ___.__ __ sec

D. Total Balance Tests score _____________ (sum points)

Comments: _______________________________________________________________________

2. GAIT SPEED TEST

Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you need it to walk a short distance, then you may use it.

A. First Gait Speed Test

1. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking down the street to go to the store.

2. Demonstrate the walk for the participant.

3. Walk all the way past the other end of the tape before you stop. I will walk with you. Do you feel this would be safe?

4. Have the participant stand with both feet touching the starting line.

5. When I want you to start, I will say: "Ready, begin." When the participant acknowledges this instruction say: "Ready, begin."

6. Press the start/stop button to start the stopwatch as the participant begins walking.

7. Walk behind and to the side of the participant.

8. Stop timing when one of the participant’s feet is completely across the end line.

B. Second Gait Speed Test

1. Now I want you to repeat the walk. Remember to walk at your usual pace, and go all the way past the other end of the course.

2. Have the participant stand with both feet touching the starting line.

3. When I want you to start, I will say: "Ready, begin." When the participant acknowledges this instruction say: "Ready, begin."

4. Press the start/stop button to start the stopwatch as the participant begins walking.

5. Walk behind and to the side of the participant.

6. Stop timing when one of the participant’s feet is completely across the end line.

GAIT SPEED TEST SCORING:

Length of walk test course: [ ] Four meters [ ] Three meters

A. Time for First Gait Speed Test (sec)

1. Time for 3 or 4 meters __ __.__ __ sec

2. If participant did not attempt test or failed, mark why:

1 [ ] Tried but unable

2 [ ] Participant could not walk unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)__________________________

7 [ ] Participant refused

Complete score sheet and go to chair stand test

3. Aids for the first walk................... [ ] None [ ] Cane [ ] Other

Comments: _______________________________________________________________________________

B. Time for Second Gait Speed Test (sec)

1. Time for 3 or 4 meters __ __.__ __ sec

2. If participant did not attempt test or failed, circle why:

1 [ ] Tried but unable

2 [ ] Participant could not walk unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)__________________________

7 [ ] Participant refused

3. Aids for the second walk.............. [ ] None [ ] Cane [ ] Other

What is the time for the faster of the two walks?

Record the shorter of the two times __ __.__ __ sec

[If only 1 walk done, record that time] __ __.__ __ sec

If the participant was unable to do the walk: [ ] 0 points

For 4-Meter Walk:

[ ] 1 point If time is more than 8.70 sec

[ ] 2 points If time is 6.21 to 8.70 sec

[ ] 3 points If time is 4.82 to 6.20 sec

[ ] 4 points If time is less than 4.82 sec

For 3-Meter Walk:

[ ] 1 point If time is more than 6.52 sec

[ ] 2 points If time is 4.66 to 6.52 sec

[ ] 3 points If time is 3.62 to 4.65 sec

[ ] 4 points If time is less than 3.62 sec

3. CHAIR STAND TEST

Single Chair Stand

1. Let’s do the last movement test. Do you think it would be safe for you to try to stand up from a chair without using your arms?

2. The next test measures the strength in your legs.

3. (Demonstrate and explain the procedure.) First, fold your arms across your chest and sit so that your feet are on the floor; then stand up keeping your arms folded across your chest.

4. Please stand up keeping your arms folded across your chest. (Record results).

5. If participant cannot rise without using arms, say "Okay, try to stand up using your arms." This is the end of their test. Record result and go to the scoring page.

Repeated Chair Stands

1. Do you think it would be safe for you to try to stand up from a chair five times without using your arms?

2. (Demonstrate and explain the procedure.) Please stand up straight as QUICKLY as you can five times, without stopping in between. After standing up each time, sit down and then stand up again. Keep your arms folded across your chest. I’ll be timing you with a stopwatch.

3. When the participant is properly seated, say: "Ready? Stand" and begin timing.

4. Count out loud as the participant arises each time, up to five times.

5. Stop if participant becomes tired or short of breath during repeated chair stands.

6. Stop the stopwatch when he/she has straightened up completely for the fifth time.

7. Also stop:

• If participant uses his/her arms

• After 1 minute, if participant has not completed rises

• At your discretion, if concerned for participant’s safety

8. If the participant stops and appears to be fatigued before completing the five stands, confirm this by asking "Can you continue?"

9. If participant says "yes," continue timing. If participant says "No," stop and reset the stopwatch.

SCORING:

Single Chair Stand Test

A. Safe to stand without help

[ ] YES

[ ] NO

B. Results:

Participant stood without using arms

[ ] YES

[ ] NO → Go to Repeated Chair Stand Test

Participant used arms to stand

[ ] YES

[ ] NO → End test; score as 0 points

Test not completed

[ ] YES

[ ] NO → End test; score as 0 points

C. If participant did not attempt test or failed, mark why:

1 [ ] Tried but unable

2 [ ] Participant could not stand unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)________________________

7 [ ] Participant refused

Repeated Chair Stand Test

A. Safe to stand five times

[ ] YES

[ ] NO

B. If five stands done successfully, record time in seconds.

Time to complete five stands __ __.__ __ sec

C. If participant did not attempt test or failed, circle why:

1 [ ] Tried but unable

2 [ ] Participant could not stand unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)________________________

7 [ ] Participant refused

Scoring the Repeated Chair Test

0 [ ] points Participant unable to complete 5 chair stands or completes stands in >60 sec

1 [ ] point If chair stand time is 16.70 sec or more

2 [ ] points If chair stand time is 13.70 to 16.69 sec

3 [ ] points If chair stand time is 11.20 to 13.69 sec

4 [ ] points If chair stand time is 11.19 sec or less

Scoring for Complete Short Physical Performance Battery

Test Scores

_______ points

Gait Speed Test score

_______ points

Chair Stand Test score

_______ points

Total Score

_______ points

Test Scores

_______ points (sum of points above)

Protocol Name from Source:

Short Physical Performance Battery

Availability:

Publicly available

Personnel and Training Required

The individual who administers the tests should watch the video and familiarize themselves with each test. The test administrator should also be experienced with assisting the elderly.

Equipment Needs

Chair, stopwatch, tape measure

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Measurement

Life Stage:

Senior

Participants:

Originally validated for individuals aged 71 years or older and has been used with people in their 60s

Specific Instructions:

A video and specific protocols for the Short Physical Performance Battery are available at the National Institute on Aging website.

Selection Rationale

These tests were validated in a study of 5,000 elderly participants in three communities. The tests can be completed in a participant’s home and in fewer than 10 minutes.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Elderly Physical Function Objective Assessment Description Text 3061246 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Phys func objective proto 62825-5 LOINC
Process and Review

The Expert Review Panel #1 reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• Revised descriptions of measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive (link)

Source

Guralnik, J. M. (2013). Assessing physical performance in the older patient. National Institutes of Health, National Institute of Aging. Retrieved from http://www.grc.nia.nih.gov/branches/leps/sppb/

Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., . . . Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology: Medical Science, 49(2), M85-M94.

General References

None

Protocol ID:

150501

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX150501_Balance_Comments PX150501110000 Comments 4 N/A
PX150501_ChairStand_DidNot_Use_Arms PX150501270000 Participant stood without using arms 4 N/A
PX150501_ChairStand_Did_Use_Arms PX150501280000 Participant used arms to stand 4 N/A
PX150501_ChairStand_Not_Attempted PX150501300000 If participant did not attempt test or failed, mark why: 4 N/A
PX150501_ChairStand_Not_Attempted_Specify PX150501300100 If participant did not attempt test or failed, mark why 4 N/A
PX150501_ChairStand_Not_Completed PX150501290000 Test not completed 4 N/A
PX150501_ChairStand_Safe PX150501260000 Safe to stand without help 4 N/A
PX150501_RepeatedChairStand_Not_Attempted PX150501330000 If participant did not attempt test or failed, circle why 4 N/A
PX150501_RepeatedChairStand_Not_Attempted_Specify PX150501330100 If participant did not attempt test or failed, circle why 4 N/A
PX150501_RepeatedChairStand_Safe PX150501310000 Safe to stand five times 4 N/A
PX150501_RepeatedChairStand_Score PX150501340000 Scoring the Repeated Chair Test 4 N/A
PX150501_RepeatedChairStand_Time PX150501330200 Record the shorter of the two times 4 N/A
PX150501_SemiTandemStand PX150501040000 Semi-Tandem Stand 4 N/A
PX150501_SemiTandemStand_Not_Attempted PX150501050000 If participant did not attempt test or failed, mark why 4 N/A
PX150501_SemiTandemStand_Not_Attempted_Specify PX150501050100 If participant did not attempt test or failed, mark why 4 N/A
PX150501_SemiTandemStand_Number_Seconds PX150501060000 Number of seconds held if less than 10 sec 4 N/A
PX150501_Shorter_WalkTest_Time PX150501210000 Record the shorter of the two times 4 N/A
PX150501_SideBySide_Number_Seconds PX150501030000 Number of seconds held if less than 10 sec 4 N/A
PX150501_SideBySide_Stand PX150501010000 Side-by-Side Stand 4 N/A
PX150501_SideBySide_Stand_Not_Attempted PX150501020000 If participant did not attempt test or failed, mark why: 4 N/A
PX150501_SideBySide_Stand_Not_Attempted_Specify PX150501020100 If participant did not attempt test or failed, mark why: 4 N/A
PX150501_TandemStand PX150501070000 Tandem Stand 4 N/A
PX150501_TandemStand_Not_Attempted PX150501080000 If participant did not attempt test or failed, mark why 4 N/A
PX150501_TandemStand_Not_Attempted_Specify PX150501080100 If participant did not attempt test or failed, mark why 4 N/A
PX150501_TandemStand_Number_Seconds PX150501090000 Number of seconds held if less than 10 sec 4 N/A
PX150501_Total_Balance_Score PX150501100000 Total Balance Tests score (sum points) 4 N/A
PX150501_WalkTest_3Meter_Score PX150501250000 For 3-Meter Walk 4 N/A
PX150501_WalkTest_4Meter_Score PX150501240000 For 4-Meter Walk 4 N/A
PX150501_WalkTest_Course_Length PX150501120000 Length of walk test course 4 N/A
PX150501_WalkTest_One_Aids PX150501150000 Aids for the first walk 4 N/A
PX150501_WalkTest_One_Comments PX150501160000 Comments 4 N/A
PX150501_WalkTest_One_Not_Attempted PX150501140000 If participant did not attempt test or failed, mark why 4 N/A
PX150501_WalkTest_One_Not_Attempted_Specify PX150501140100 If participant did not attempt test or failed, mark why 4 N/A
PX150501_WalkTest_One_Time PX150501130000 Time for 3 or 4 meters 4 N/A
PX150501_WalkTest_Two_Not_Attempted PX150501180000 If participant did not attempt test or failed, mark why: 4 N/A
PX150501_WalkTest_Two_Not_Attempted_Specify PX150501180100 If participant did not attempt test or failed, mark why: 4 N/A
PX150501_WalkTest_Two_Time PX150501170000 Time for 3 or 4 meters 4 N/A
PX150501__WalkTest_Two_Aids PX150501190000 Aids for the second walk 4 N/A
Research Domain Information
Measure Name:

Physical Functioning - Objective

Release Date:

October 1, 2015

Definition

An objective tool used to measure lower extremity function in older adults

Purpose

This short battery of tests can be used to assess an older adult’s functional ability and to predict mortality and institutionalization.

Keywords

Physical Activity and Physical Fitness, gait, strength, exercise, balance, SPPB