Remote assessment of physical function in older people: feasibility, safety and agreement with in-person administration

Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment

Timed up and go and 30-S chair-stand tests applied via video call are reliable and provide results similar to face-to-face assessment of older adults with different musculoskeletal conditions

Background The AAQ assesses activity limitations in individuals with hip/knee osteoarthritis (HKOA), and consists video animations of 17 basic daily activities performed with different levels of difficulty (www.myaaq.com). The individuals choose the animation that best matches their own performance. The AAQ was developed in the Netherlands, and showed a good overall cross-cultural validity in 6 other languages. Objectives The aims of this study were to assess the construct validity and reliability of the Portuguese version of the AAQ. Methods In Diamantina, Brazil, men and women (≥ 45 years) with clinical HKOA were included in the study. The exclusion criteria were: cognitive impairment, visual/auditory deficit, or any medical condition other than HKOA that could hamper activity. This study was approved by the UFVJM Ethics Committee. All participants completed the Portuguese version of the AAQ. Illiterate or functional illiterate participants were assisted by the researchers. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), to assesses pain, stiffness and function was administered to the participants. Performance-based tests were applied to a subgroup of 71 participants: Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB). The first 53 participants completed the AAQ twice. To validate the AAQ, Spearman’s rho coefficients were calculated between the AAQ score, each score of the WOMAC, the SPPB score, and TUG score. To evaluate the influence of education in completing the AAQ, the participants were divided in two groups, 0-3 years of education and ≥4 years of education. To evaluate internal consistency and test–retest reliability of the AAQ, we calculated the Cronbach’s alpha coefficient and the intraclass correlation coefficient (ICC), respectively. Results 200 individuals, 85% female, mean age of 64.4 (SD 11.2) years, and a mean of 5.8 (SD 4.4) years of education, participated in the study. 72% of the participants had knee OA, 9% had hip OA, and 19% had both joints affected. The mean values on the different measures were as follow: AAQ = 72.7 (SD 16.1), WOMAC pain = 36.5 (SD 19.3), WOMAC stiffness = 37.1 (SD 26.2), WOMAC function = 39.1 (SD 19.6), SPPB = 8.0 (SD 2.1), and TUG = 16.2 (SD 12.7) seconds. The AAQ showed high internal consistency (Cronbach’s alpha = 0.94) and good test-retest reliability was (ICC = 0.98). The AAQ showed a moderate correlation with WOMAC pain (rs = -0.51, 95%CI = -0.61 to -0.39), and WOMAC stiffness (rs = -0.46, 95%CI = -0.56 to -0.33), and a high correlation with WOMAC function (rs = -0.77, 95%CI = -0.82 to -0.71), SPPB (rs = 0.65, 95%CI = 0.48 to 0.77), and TUG (rs = -0.71, 95%CI = -0.81 to -0.56). Regarding the level of education, the correlations between the AAQ score and the three domains of the WOMAC were similar when the participants with 0-3 years of education (n = 62) were compared to the participants with ≥4 years of education (n=138) (pain: rs = - 0.51, 95%CI = -0.68 to -0.29 vs -0,52, 95%CI = -0.64 to -0.39; stiffness: rs = - 0.54, 95%CI = -0.70 to -0.32 vs -0,41, 95%CI = -0.54 to -0.25; function: rs = - 0.80, 95%CI = -0.88 to -0.68 vs -0,75, 95%CI = -0.82 to -0.66). Conclusion The Portuguese version of the AAQ showed good construct validity and reliability, and also seems to be applicable for patients with low literacy. Reference [1] Peter WF, et al. Cross-cultural and construct validity of the Animated Activity Questionnaire. Arthritis Care Res. 2016. Disclosure of Interests None declared

BackgroundThe Active Connected Engaged [ACE] study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial [RCT] with an internal pilot phase. The ACE study incorporates a multi-level mixed methods process evaluation including a systems mapping approach and an economic evaluation. ACE aims to test the effectiveness and cost-effectiveness of a peer-volunteer led active ageing intervention designed to support older adults at risk of mobility disability to become more physically and socially active within their communities and to reduce or reverse, the progression of functional limitations associated with ageing.Methods/designCommunity-dwelling, older adults aged 65 years and older (n = 515), at risk of mobility disability due to reduced lower limb physical functioning (Short Physical Performance Battery (SPPB) score of 4–9 inclusive) will be recruited. Participants will be randomised to receive either a minimal control intervention or ACE, a 6-month programme underpinned by behaviour change theory, whereby peer volunteers are paired with participants and offer them individually tailored support to engage them in local physical and social activities to improve lower limb mobility and increase their physical activity. Outcome data will be collected at baseline, 6, 12 and 18 months. The primary outcome analysis (difference in SPPB score at 18 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals.DiscussionACE is the largest, pragmatic, community-based randomised controlled trial in the UK to target this high-risk segment of the older population by mobilising community resources (peer volunteers). A programme that can successfully engage this population in sufficient activity to improve strength, coordination, balance and social connections would have a major impact on sustaining health and independence.ACE is also the first study of its kind to conduct a full economic and comprehensive process evaluation of this type of community-based intervention. If effective and cost-effective, the ACE intervention has strong potential to be implemented widely in the UK and elsewhere.Trial registrationISRCTN, ISRCTN17660493. Registered on 30 September 2021.Trial Sponsor: University of Birmingham, Contact: Dr Birgit Whitman, Head of Research Governance and Integrity; Email: researchgovernance@contacts.bham.ac.uk.Protocol Version 5 22/07/22.

Comorbid Conditions and Physical Function in Adults With Multiple Sclerosis

Physical function across the lifespan in adults with multiple sclerosis: An application of the Short Physical Performance Battery.

Androgen receptor inhibitors (ARIs) are approved for the treatment of advanced prostate cancer; however, some patients may experience symptoms and side effects that hinder their physical functioning. The Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests are used to assess physical functioning in older adults and are recommended assessments for patients with prostate cancer, despite lacking validation in this setting. DaroAct (NCT04157088) was an open-label, multicenter, phase 2b study designed to evaluate the effects of the ARI darolutamide (lead-in phase) and darolutamide vs enzalutamide (randomized phase) on physical functioning in men with castration-resistant prostate cancer (CRPC). Only the lead-in phase, in which participants received darolutamide 600mg twice daily, was completed. The TUG and SPPB tests were used to assess physical functioning. The lead-in phase enrolled 30 participants. During 24 weeks of treatment, 8 (32.0%) of 25 evaluable participants exhibited clinically meaningful worsening in TUG from baseline (primary endpoint). At the week 24 visit, 5 (21.7%) of 23 participants had worsening in TUG time, and 8 (33.3%) of 24 participants had worsening in SPPB score. Because only 48% of participants had the same outcome on the TUG and SPPB tests, the study was terminated without initiating the randomized comparison. Most participants showed no clinically meaningful worsening in physical functioning after 24 weeks of darolutamide treatment, but poor agreement between tests was observed. Tools to accurately and consistently measure the impact of ARIs on physical functioning in patients with CRPC are needed.

Vitamin D Supplementation and Muscle Power, Strength and Physical Performance in Older Adults: A Randomized Controlled Trial

Objective: The aim of this study was to assess the association between physical functioning and fall-related efficacy among community-dwelling elderly people.Method: Participants (n = 176) were 60 years old and older. Data were collected using physical functioning tests: hand grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), Falls Efficacy Scale – International (FES-I) and History of Falling Checklist (HoFC). Statistical analyses were used to determine group differences with respect to age, gender and fall history, as well as the correlation between the total scores of the FES-I and hand grip strength, TUG and SPPB.Results. Values of physical functioning measures were significantly higher in non-fallers than in fallers (p < 0.05). The FES-I total scores were positively correlated with TUG (rs = 0.615) and negatively correlated with hand grip strength (rs = –0.522) and SPPB scores (rs = –0.727). There were significant differences in the FES-I scores according to TUG and SPPB cut-off values (p < 0.001).Conclusion: Higher physical functioning values were associated with a lower incidence of falling and a lower level of fear of falling. Maintaining and improving physical functioning should be considered as an important factor that may influence fall-related efficacy and risk of falling among elderly people.

Gluteal muscle quality influences risk of falling and mobility limitation. We sought (1) to compare gluteal muscle fatty infiltration (FI) between groups of older women with urinary incontinence (UI) at risk for falling (at-risk group) and not at risk for falling (not-at-risk group), and (2) to determine correlation of gluteal FI with Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) performance. Prospective pilot study of gluteal FI on pelvis MRI for 19 women with UI, aged ≥ 70years. A musculoskeletal radiologist selected axial T1-weighted MR images; then, two blinded medical student research assistants analyzed gluteal FI by quantitative fuzzy C-means segmentation. TUG and SPPB tests were performed. TUG ≥ 12s defined participants as at risk for falling. Descriptive, correlation, and reliability analyses were performed. Mean age, 76.3 ± 4.8years; no difference for age or body mass index (BMI) between the at-risk (n = 5) versus not-at-risk (n = 14) groups. SPPB score (p = 0.013) was lower for the at-risk group (6.4 ± 3.1) than for the not-at-risk group (10.2 ± 1.9). Fuzzy C-means FI-%-estimate differed between the at-risk group and the not-at-risk group for bilateral gluteus medius/minimus (33.2% ± 15.6% versus 19.5% ± 4.1%, p = 0.037) and bilateral gluteus maximus (33.6% ± 15.6% versus 19.7% ± 6.9%, p = 0.047). Fuzzy C-means FI-%-estimate for bilateral gluteus maximus had significant (p < 0.050) moderate correlation with age (rho = - 0.64), BMI (rho = 0.65), and TUG performance (rho = 0.52). Fuzzy C-means FI-%-estimates showed excellent inter-observer and intra-observer reliability (intraclass correlation coefficient, ≥ 0.892). Older women with UI at risk for falling have greater levels of gluteal FI and mobility limitation as compared to those not at risk for falling.

Frailty, characterized by vulnerability, reduced reserves and increased susceptibility to severe events, is a significant concern in chronic haemodialysis (HD) patients. Sarcopenia, corresponding to the progressive loss of muscle mass and strength, may contribute to frailty by reducing functional capacity, mobility and autonomy. However, consensus lacks on the optimal bedside frailty index for chronic HD patients. This study investigated the influence of frailty on chronic HD patient survival and explored the associated factors. A total of 135 patients were enrolled from January to April 2019 and then followed up prospectively until April 2022. At inclusion, frailty was assessed by the Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests including gait speed, standing balance and lower limb muscle strength. From a total of 114 prevalent chronic HD patients (66% men, age 67.6±15.1years), 30 died during the follow-up period of 23.7months (range 16.8-34.3). Deceased patients were older, had more comorbidities and a higher sarcopenia prevalence (P<.05). The TUG and SPPB test scores were significantly reduced in patients who had died [SPPB total score: 7.2±3.3 versus 9.4±2.5; TUG time 8.7±5.8 versus 13.8±10.5 (P<.05)]. Multivariate analysis showed that a higher SPPB score (total value >9) was associated with a lower mortality risk [hazard ratio 0.83 (95% confidence interval 0.74-0.92); P<.03). Each component of the SPPB test was also associated with mortality in univariate analysis, but only the SPPB balance test remained protective against mortality in multivariate analysis. Older age, lower handgrip strength and lower protein catabolic rate were associated with SPPB total scores <9, SPPB balance score and TUG time >10s. Screening for frailty is crucial in chronic HD patients, and incorporating SPPB, especially the balance test, provides valuable insights. Diminished muscle strength and inadequate protein intake negatively influence the SPPB score and balance in chronic HD patients. Effective identification and management of frailty can therefore improve outcomes. NCT03845452.

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Protein-energy malnutrition is a major cause of functional decline in the elderly and is clearly an important component of frailty. However, limited evidence is available about how to select frail individuals most benefiting from protein-energy supplementation. 1) To investigate factors associated with stronger benefits from protein-energy supplementation, and 2) to test the hypothesis that the severity of frailty is associated with the efficacy of protein-energy supplementation. Secondary analysis of data from a pre-post-intervention study and a clinical trial. National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. 123 community-dwelling frail older adults [usual gait speed (UGS) <0.6m/sec and Mini Nutritional Assessment (MNA) <24]. Each participant was received with two 200 mL per day of commercial liquid formula (providing additional 400 kcal of energy and 25 g of protein per day) for 12 weeks. Relative change in the Physical Functioning (PF) and Short Physical Performance Battery (SPPB) score between the baseline and 12-week follow-up assessments were measured. Multilevel mixed-effect linear regression analysis showed that a lower level of baseline UGS was associated with a greater improvement in PF and SPPB score after adjustment for age, gender, education, living status, beneficiary of public assistance, number of chronic diseases, compliance, and type of dataset (p<0.001). A lower level of baseline MNA score was associated with greater change in PF and SPPB score after adjustment for multiple covariates (p≤0.045). Participants with severe frailty (UGS <0.3 m/sec + MNA <17) showed 52.4% and 44.6% more relevant improvements in PF and SPPB score, respectively, than those with mild frailty (UGS 0.3-0.6 m/sec + MNA 17-24) (p<0.001). Slower UGS and lower MNA score are independently associated with the greater efficacy of protein-energy supplementation on functional status.

The Short Physical Performance Battery (ASSESSMENT)

PURPOSE: The purpose of this study was to determine, in older adults at risk for mobility disability, whether a walking program supplemented by tasks designed to challenge multiple systems (WALK+: balance, coordination, cognition, and lower extremity function) could improve physical function more than a traditional walking program (WALK). METHODS: 37 older adults (M+SD age=75.4+5.9 yrs) with compromised lower extremity function (Short Physical Performance Battery (SPPB)=8.9+1.7) were recruited for this study. Participants were randomized to treatment. Both interventions were 6 wks in length (1hr, 3x/wk), were tailored to the individual ability of each participant, and were progressive in intensity and duration. Measures of physical function included the SPPB, lateral mobility (LM), one leg balance (OLB), functional reach (FR), 400m-Walk (400m-W), and timed-up and go (TUG). Data were analyzed with an analysis of covariance on change scores with the pretest score used as the covariate. RESULTS: Table 1 shows adjusted change scores for the WALK and WALK+ interventions. The WALK+ group improved their SPPB score more than the WALK group following the treatment (F=4.12, p=0.05). Although changes in the other outcomes did not reach statistical significance, trends in LM, OLB, 400m-W, and TUG were consistent with the SPPB data.TableCONCLUSION: These data suggest that a complex physical activity intervention that challenges multiple systems may be more effective for improving physical function than a traditional walking program. The WALK+ intervention produced a clinically meaningful change in the SPPB (Perera et al., JAGS, 54, 743–9, 2006), a measure that has been associated with institutionalization and mortality in older adults.