Objective Measures Of Physical Function Research Articles

Association between self-reported and objectively assessed physical functioning in the general population

Knowledge about a patient’s physical fitness can aid in medical decision-making, but objective assessment can be challenging and time-consuming. We aimed to investigate the concordance of self-reported health status and physical functioning with the 6 minute walking distance (6MWD) as objective measure of physical performance. The prospective characteristics and course of heart failure stages A/B and determinants of progression (STAAB) cohort study iteratively follows a representative sample of residents of the city of Würzburg, Germany, aged 30–79 years, without a history of heart failure (HF). The 6MWD was measured in 2752 individuals (aged 58 ± 11 years, 51% women) from a population-based cohort under strictly standardized conditions. Self-reported health status and physical functioning were assessed from items of the short form 36 (SF-36). After the respective classification of self-reported health status and physical functioning into ‘good’, ‘moderate’, and ‘poor’, we determined the association of these categories with 6MWD by applying a generalized linear model adjusted for age and sex. Prevalence of self-reported good/moderate/poor general health and physical functioning was 41/52/7% and 45/48/7%, respectively. Mean 6MWD in the respective categories was 574 ± 70/534 ± 76/510 ± 87 m, and 574 ± 72/534 ± 73/490 ± 82 m, with significant sex-specific differences between all categories (all p < 0.001) as well as significant differences between the respective groups except for the categories ‘moderate’ and ‘poor’ health status in men. This cross-sectional analysis revealed a strong association between self-reported health status and physical functioning with the objective assessment of 6MWD, suggesting that physicians can rely on their patients’ respective answers. Nevertheless, sex-specific perception and attribution of general health and physical functioning deserve further in-depth investigation. Decision-making based on self-reported health requires prospective evaluation in population-based cohorts as well as adult inpatients.

Examining Sex Differences in Relationships Between Subjective and Objective Measures of Upper Extremity Motor Impairment in a Sample of Stroke Survivors.

Rehabilitation professionals use subjective and objective outcome measures to assess stroke-related impact and impairment. Understanding if subjective and objective findings correlate among stroke survivors, especially if these associations differ between females and males, can inform care decisions. A retrospective cross-sectional design was used, with data selected from subacute to chronic stroke survivors on age, time since stroke, the hand domain from the Stroke Impact Scale version 3.0 (SIS-H), and the Fugl-Meyer Upper Extremity (FMUE) Assessment. Group differences were assessed for all outcomes based on sex and time poststroke. Separate correlations for females and males were performed between the subjective (SIS-H) and objective measures (FMUE) of upper limb function and impairment. Data from 148 participants (44 females) were included in this study. SIS-H was significantly correlated with FMUE in both females and males ( P s ≤0.001). No significant differences were found between the groups' mean SIS-H or FMUE scores based on sex or time poststroke. Subjective and objective measures of physical functioning were correlated in both females and males. Although we found no sex differences in our primary outcomes, the sample size of females was disproportionately lower than the males. This is consistent with an ongoing problem in the stroke recovery research field, where females are often underrepresented and understudied, and where females who experience higher levels of impairment are less likely to participate in research.

The relationship between patient-reported and objective measures of physical function among cancer survivors receiving rehabilitation care: A correlation analysis.

Physical function is associated with cancer-related quality of life and survival. The correlation of patient-reported and objective measures of physical function has not been quantified previously in the cancer rehabilitation medicine setting. To correlate patient-reported physical function with objective measures of physical function. The secondary aim is to correlate fatigue and social participation levels with objective measures of physical function. Retrospective. Tertiary university cancer center. A total of 226 cancer survivors referred to an outpatient cancer rehabilitation medicine clinic. Not applicable. Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile domains with objective physical function measured by the 30-second sit-to-stand and hand grip strength. Pearson correlation analysis revealed a moderate correlation between patient-reported physical function and the 30-second sit-to-stand test (r = 0.57; p <.001), and a weak correlation of patient-reported physical function and handgrip strength (r = 0.27; p <.001). Multivariable regression modeling controlling for age, gender, and receipt of systemic therapy demonstrated a significant association between patient-reported physical function and the 30-second sit-to-stand test (estimated confidence interval 0.76 [0.60, 0.92], p < .01), in addition to patient-reported function and handgrip strength (estimated 0.22 [0.10, 0.34], p < .01). Multiple myeloma but no other cancer type was inversely associated with lower physical function. Patient-reported physical function correlated moderately with the 30-second sit-to-stand test, whereas hand grip strength demonstrated a weak correlation. The 30-second sit-to-stand test is a suitable substitute for patient-reported physical function. Further work evaluating how measures relate to each other across cancer populations is needed before recommending a standardized set of outcome measures.

Longitudinal Associations Between Optimism and Objective Measures of Physical Functioning in Women.

Identifying factors contributing to sustained physical functioning is critical for the health and well-being of the aging population, especially as physical functioning may precede and predict subsequent health outcomes. Prior work suggests optimism may protect health, but less is known about the association between optimism and objective physical functioning measures as individuals age. To evaluate the longitudinal association between optimism and 3 physical functioning measures. This was a prospective cohort study using data from the Women's Health Initiative (WHI) with participants recruited from 1993 to 1998 and followed up over 6 years. Data analysis was conducted from January 2022 to July 2022. Participants included postmenopausal women older than 65 years recruited from 40 clinical centers in the US. Optimism was assessed at baseline using the Life Orientation Test-Revised. Physical functioning was measured at 4 time points across 6 years by study staff evaluating performance in grip strength, timed walk, and chair stands. The final analytic sample included 5930 women (mean [SD] age, 70 [4] years). Linear mixed-effects models controlling for demographics, depression, health status, and health behaviors showed that higher optimism was associated with higher grip strength (β = 0.36; 95% CI, 0.21-0.50) and number of chair stands (β = 0.05; 95% CI, 0.01-0.10) but not timed walk at baseline. Higher optimism was also associated with slower rates of decline in timed walk (β = -0.09; 95% CI, -0.13 to -0.04) and number of chair stands (β = 0.01; 95% CI, 0-0.03) but not grip strength over time. Cox proportional hazards models showed that higher optimism was associated with lower hazards of reaching clinically defined thresholds of impairment for all 3 outcomes over 6 years of follow-up. For example, in fully adjusted models, for a 1-SD increase in optimism, hazard ratios for reaching impairment thresholds were 0.86 (95% CI, 0.80-0.92) for grip strength, 0.94 (95% CI, 0.88-1.01) for timed walk, and 0.91 (95% CI, 0.85-0.98) for chair stands. In this cohort study of postmenopausal women, at baseline, higher optimism was associated with higher grip strength and number of chair stands but not with the time it took to walk 6 m. Higher optimism at baseline was also associated with maintaining healthier functioning on 2 of the 3 performance measures over time, including less decline in walking speed and in number of chair stands women could perform over 6 years of follow-up. Given experimental studies suggesting that optimism is modifiable, it may be a promising target for interventions to slow age-related declines in physical functioning. Future work should explore associations of optimism with maintenance of physical functioning in diverse populations.

Cancer-related fatigue is associated with objective measures of physical function before and after a clinical exercise program: A retrospective analysis.

Background: Cancer-related fatigue (CRF) is a common symptom reported by survivors of cancer. CRF is associated with reduced self-reported physical function, but associations with objective measures of physical function are less robust. Exercise programs have been shown to improve both CRF and objective physical function, but the interaction of exercise, CRF, and function has not been explored. Methods: Retrospective data were collected from baseline (n = 420) and final assessments (n = 234) of survivors who participated in a 3-month clinical exercise program. Assessments included measures of CRF (Functional Assessment of Chronic Illness Therapy–Fatigue) and physical function (6-minute walk test, usual and fast gait speed, 30-second sit-to-stand test, and the Timed Up and Go test). Multiple regression analyses investigated associations between CRF and physical function before and after the program. CRF and functional changes following the program were calculated and associations investigated with multiple regressions. Results: All measures of CRF and physical function significantly improved following the program (P &lt; .01). CRF was associated with all functional measures at baseline (standardized β = −0.18 to 0.29, P &lt; .01) and final assessments (r = −0.27 to 0.26, P &lt; .01). Changes in CRF were associated with changes in function (standardized β = −0.12 to 0.23, P &lt; .05), except usual gait speed (P = .17). Conclusion: This investigation demonstrated associations between CRF and objective physical function before and after participation in an exercise program. The 3-way interaction between CRF, physical function, and exercise can be used clinically to personalize rehabilitation strategies. Future studies should investigate changes in CRF and function during an exercise program.

Accelerometer-assessed sleep and decline in physical function in older men

Assess the prospective association of actigraphically measured sleep with self-report and objective measures of physical function among community-dwelling older men. Participants were (n=1496) men aged ≥65 years from the Osteoporotic Fractures in Men Studyand ancillary sleep study who were followed up at 4 years for physical function outcomes. Sleep predictors included baseline total sleep time (<6, 6-8hours [reference], >8hours), sleep efficiency (<80% or ≥80% [reference]), wake after sleep onset (<90 [reference] or ≥90minutes), and sleep onset latency (<30 [reference] or ≥30minutes), measured by wrist actigraphy. Outcomes included self-reported difficulties in mobility and instrumental activities of daily livingand objective measures of physical performance (time to complete chair stands, gait speed, grip strength, best narrow walk pace). Multivariable regression models estimated associations between the sleep predictors and change in physical function at follow-up, adjusting for demographic and health-related variables. Participants with short average baseline total sleep time (<6hours) had significantly greater slowing in their walking speed from baseline to follow-up. Participants with long baseline sleep onset latency (≥30minutes) had significant increases in mobility difficulties and time to complete chair stands. Sleep efficiency and wake after sleep onset were not significantly associated with any outcomes. No sleep predictors were associated with change in instrumental activities of daily living. These findings add to the body of evidence showing links between poor sleep and subsequent declines in physical function. Further experimental research is needed to understand the mechanisms at play.

The Application of Gait Speed and Grip Strength As a Frailty Screening Tool in Elderly Patients with Mulitiple Myeloma

Introduction Gait speed and grip strength are easily obtainable objective measures of physical function, they are important diagnostic parameters for sarcopenia, and also representative geriatric index of frailty and function that performed well, even compared with more comprehensive frailty assessments. Brief screening tests for frailty that can easily fit into the clinic workflow and predict important clinical outcomes are needed. Geriatric assessment (GA) of the International Myeloma Working Group (IMWG) applying to the newly diagnosed MM, because of its subjectivity and relative complexity, obstructing widespread development in clinical. The purpose of our analysis was to examine the potential value of gait speed or grip strength as a screening test for frailty in elderly patients with MM. At the same time, efforts are ongoing to explore the significance of dynamic evaluation . Methods All 47 patients aged 60 years and older who presented for an initial consultation in our hospital were eligible for participation. Gait speed and grip strength and IMWG-GA were measured in all consented patients. Gait speed was obtained using the National Institutes of Health 4-m gait speed test, while grip strength was measured using a Hand Dynamometer. And the differences in SASP (Senescent Associated Secretory Phenotype) between different gait speed groups were compared. Results All enrolled patients underwent dynamic evaluation and completed 124 frequency IMWG-GA, 131 gait speed and 129 grip strength tests. IMWG-GA: fit group: 43.5%(54/124), intermediate fit: 7.3%(9/124), frail: 49.2%(61/124). Gait speed &amp;lt;0.8m/s: 53.4%(70/131), ≥0.8m/s：46.6%(61/131). Grip strength：Male group：&amp;lt;28kg group 51.5%(50/97), ≥28kg group 48.5%(47/97); Female group: &amp;lt;18kg group 59.4%(19/32), ≥18kg group 40.6%(13/32). Complete and analyzable data from all cases showed high consistency between gait speed and IMWG-GA (AUC=0.83), the “4-m gait speed test” can be used as an effective predictor for frailty. And between grip strength and IMWG-GA (AUC=0.68), “Grip strength ”can also be used as an effective predictor for frailty, but its performance seems to be slightly inferior to“ 4-m gait speed test ”. The combination of “4-m gait speed test” and “grip strength” can serve as an effective predictor for IMWG-GA(AUC=0.74), and its seems to be superior to using “4-m gait speed test” or “grip strength” alone. The incidence rate of sarcopenia is 49%(23/47). We further analyzed and found that, the differential expression of IL-6 (38.51±17.59 vs 8.09±3.97 pg/ml, p&amp;lt;0.05) and IFN-γ(2.0±0.49 vs 0.86±0.14 pg/ml, p&amp;lt;0.05) in SASP between the two groups with a gait speed of &amp;lt;0.8m/s and ≥0.8m/s. While there was no statistically significant difference in IL-8 and IL-1b between the two groups. We conducted a dynamic evaluation of IMWG-GA and gait speed and grip strength. As the number of treatment courses increases and the treatment effect becomes apparent, the proportion of patients with frail decreases and the proportion of patients with improved gait increases, while the difference in grip strength changes is not significant(Figure1-3). Conclusions In summary, gait speed and grip strength have strong diagnostic value in evaluating elderly frailty MM, and dynamic monitoring is simple and feasible in clinical practice. The relationship between sarcopenia and frailty, as well as the role of dynamic assessment, still needs further exploration.

Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study

Background: Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes. Purpose: To determine associations between demographic characteristics, objective measurements of physical function, patient-reported outcome measure scores, sports-related function assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale, and psychological readiness to RTS assessed with the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale at 1 year after ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: At a mean of 12.5 ± 2.0 months after ACLR, 143 participants (50.3% female), with a mean age of 25.0 ± 5.7 years, were assessed for demographic characteristics, physical factors (hop performance, muscle strength, ankle and hip range of motion), and psychological factors (KOOS Pain and Symptoms subscales, Perceived Stress Scale, fear of reinjury) as well as the KOOS Sport and Recreation subscale and ACL-RSI scale. Backward linear regression models were used to evaluate factors associated with sports function and psychological readiness to RTS. Results: Lower isokinetic knee extension peak torque (limb symmetry index) (B = 18.38 [95% CI, 3.01-33.75]), lower preinjury activity level (B = 2.00 [95% CI, 0.87-3.14]), greater knee pain (B = 0.90 [95% CI, 0.70-1.10]), shorter time between injury and reconstruction (B = 0.16 [95% CI, 0.05-0.26]), and greater fear of reinjury (B = 0.11 [95% CI, 0.01-0.20]) were associated with a worse KOOS Sport and Recreation subscore (R2 = 0.683). A shorter hop distance (B = 0.15 [95% CI, 0.00-0.29]) was associated with a lower ACL-RSI score (R2 = 0.245). Conclusion: A combination of knee muscle strength, activity level, knee pain, timing of surgery, and fear of reinjury accounted for approximately 70% of the variation in sports function at 1 year after ACLR. In contrast, there was only 1 weak association between physical function and psychological readiness to RTS at this time point. Thus, factors associated with current sports function are much better known than features related to psychological readiness to RTS.

Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series.

In cancer cachexia trials, measures of physical function are commonly used as endpoints. For drug trials to obtain regulatory approval, efficacy in physical function endpoints may be needed alongside other measures. However, it is not clear which physical function endpoints should be used. The aim of this systematic review was to assess the frequency and diversity of physical function endpoints in cancer cachexia trials. Following a comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990-2021), records were retrieved. Eligible trials met the following criteria: adults (≥18years), controlled design, more than 40 participants, use of a cachexia intervention for more than 14days and use of a physical function endpoint. Physical function measures were classified as an objective measure (hand grip strength [HGS], stair climb power [SCP], timed up and go [TUG] test, 6-min walking test [6MWT] and short physical performance battery [SPPB]), clinician assessment of function (Karnofsky Performance Status [KPS] or Eastern Cooperative Oncology Group-Performance Status [ECOG-PS]) or patient-reported outcomes (physical function subscale of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaires [EORTC QLQ-C30 or C15]). Data extraction was performed using Covidence and followed PRISMA guidance (PROSPERO registration: CRD42022276710). A total of 5975 potential studies were examined and 71 were eligible. Pharmacological interventions were assessed in 38 trials (54%). Of these, 11 (29%, n=1184) examined megestrol and 5 (13%, n=1928) examined anamorelin; nutritional interventions were assessed in 21 trials (30%); and exercise-based interventions were assessed in 6 trials (8%). The remaining six trials (8%) assessed multimodal interventions. Among the objective measures of physical function (assessed as primary or secondary endpoints), HGS was most commonly examined (33 trials, n=5081) and demonstrated a statistically significant finding in 12 (36%) trials (n=2091). The 6MWT was assessed in 12 trials (n=1074) and was statistically significant in 4 (33%) trials (n=403), whereas SCP, TUG and SPPB were each assessed in 3 trials. KPS was more commonly assessed than the newer ECOG-PS (16 vs. 9 trials), and patient-reported EORTC QLQ-C30 physical function was reported in 25 trials. HGS is the most commonly used physical function endpoint in cancer cachexia clinical trials. However, heterogeneity in study design, populations, intervention and endpoint selection make it difficult to comment on the optimal endpoint and how to measure this. We offer several recommendations/considerations to improve the design of future clinical trials in cancer cachexia.

Cancer-Related Fatigue Is Associated With Objective Measures of Physical Function in Survivors of Cancer

Purpose: Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer and may have a negative impact on functional activities. The purpose of this study was to investigate the relationships between CRF and objective measures of physical function in survivors. Methods: A retrospective analysis was performed on 428 survivors initiating a clinical exercise oncology program. A physical assessment was performed prior to program start and included a six-minute walk test (6MWT), handgrip strength assessment, and a 10 m walk test to measure both usual and fast gait speed. CRF was measured with the Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-Fatigue), a commonly used 13-item questionnaire, with scores ranging from 0–52. Lower scores indicate greater CRF. Participant demographics, cancer diagnosis, and treatment information were self-reported at program start. Four multiple linear regression analyses were performed, with 6MWT, handgrip strength, usual gait speed, and fast gait speed as the dependent variables. In each model, FACIT-Fatigue was entered as a predictor and covariates were age, gender, cancer diagnosis, and cancer treatment (currently receiving chemotherapy or radiation or not). Results: Participants were on average 55.2 (SD = 14.1) years old, majority women (64%) and breast cancer survivors (30.5%). Approximately half were currently receiving cancer treatment (48%). The means (SD) of measures of physical function were: 6MWT = 582 (120) m; grip strength = 32.7 (10.5) kg; usual gait speed = 1.36 (0.25) m/s; and fast gait speed = 1.9 (0.38) m/s. The mean (SD) FACIT-Fatigue score was 33.7 (10.8). All regression models were significant (P &amp;lt; 0.01). FACIT-Fatigue was significantly associated with 6MWT (Î2 = 3.39, P &amp;lt; 0.01), handgrip strength (Î2 = 0.13, P &amp;lt; 0.01), usual gait speed (Î2 = 0.005, P &amp;lt; 0.01), and fast gait speed (Î2 = 0.009, P &amp;lt; 0.01). Conclusions: Findings demonstrated that higher CRF was significantly associated with reduced performance on objective measures of physical function, providing insight on how CRF may contribute to limitations of functional day-to-day activities. Future studies should investigate whether reductions in CRF mediate the improvements in physical function seen after participation in exercise programs.

Impact of novel glucose-lowering therapies on physical function in people with type 2 diabetes: A systematic review and meta-analysis of randomised placebo-controlled trials.

We investigated evidence from randomised, placebo-controlled trials of novel glucose-lowering therapies; sodium-glucose co-transporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), on physical function in people with type 2 diabetes (T2D). PubMed, Medline, Embase and Cochrane library were searched from 1 April 2005 to 20 January 2022. The primary outcome was change in physical function in groups receiving a novel glucose-lowering therapy versus placebo at the trial end-point. Eleven studies met our criteria including nine for GLP-1RA and one each for SGLT2i and DPP4i. Eight studies included a self-reported measure of physical function, seven with GLP-1RA. Pooled meta-analysis showed an improvement of 0.12 (0.07, 017) points in favour of novel glucose-lowering therapies, mainly GLP-1RA. These findings were consistent when assessed individually for commonly used subjective assessments of physical function; namely the Short-Form 36 item-questionnaire (SF-36; all investigating GLP-1RA) and the Impact of Weight on Quality of Life-Lite (IWQOL-LITE; all, except one, exploring GLP-1RA) with estimated treatment differences (ETDs) of 0.86 (0.28, 1.45) and 3.72 (2.30, 5.15) respectively in favour of novel GLTs. For objective measures of physical function (VO2max and 6-minute walk test (6MWT)) no significant between-group differences between the intervention and the placebo were found. GLP-1RAs showed improvements in self-reported outcomes of physical function. However, there is limited evidence to draw definitive conclusions especially because of lack of studies exploring the impact of SGLT2i and DPP4i on physical function. There is a need for dedicated trials to establish the association between novel agents and physical function.

Physical Function Tests Are Potential Tools to Identify Low Physical Resilience in Women after Breast Cancer Treatment

Background: This study sought to investigate whether different physical function tests (objective measures of physical performance) may identify a low physical resilience in breast cancer survivors (BCS). Methods: This analytical cross-sectional study evaluated 146 BCS and 69 age-matched women without breast cancer history. The different times after the end of treatment were used as criteria for group division. Participants were divided into four groups: control (CT: n = 69–women without breast cancer history); &lt;1.0 years after the end of treatment (&lt;1 YAT: n = 60); 1–3.9 years after the end of treatment (1–3.9 YAT: n = 45); and ≥4 years after the end of treatment (&gt;4 YAT: n = 41). Physical function was evaluated by 4 m walk test (4-MWT), five-times-sit-to-stand test (FTSST), timed up and go test (TUG), and short physical performance battery (SPPB). Age, menopausal status, smoking, number of medications, level of physical activity, body mass index, and muscle strength were used as confounding variables in ANCOVA. Results: All groups that underwent cancer treatment (&lt;1 YAT, 1–3.9 YAT and ≥4 YAT) had lower physical performance (p &lt; 0.001) identified by 4 MWT, TUG, and FTSST when compared to the CT group. For the SPPB, the &lt;1 YAT and ≥4 YAT groups had lower performance (p = 0.005) when compared to the CT. Conclusions: The different physical function tests can be used to identify a low physical resilience in BCS.

What are small, medium and large effect sizes for exercise treatments of tendinopathy? A systematic review and meta-analysis

ObjectiveTo quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice through conducting a systematic review...

Objective Measurements of Physical Function to Predict Survival in Patients with Metastatic Cancer

Background/Objectives Physician-reported performance status (PS) constitutes the established method for stratifying oncologic patients in therapeutic decision-making. Objective measurements of physical function may further refine prognostication. Subjects/Methods In this prospective observational study, 103 patients with metastatic cancer who were referred for systemic therapy initiation were evaluated. PS was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and five objective physical function measurements (handgrip strength [HGS], chair stand test [CST], timed up and go [TUG] test, 4-m gait speed [GS] test, and short physical performance battery [SPPB] test). Overall survival and treatment complications were recorded from the medical records. Results Patients with low PS according to ECOG-PS (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.84, 7.80), HGS (HR: 2.37, 95% CI: 1.24, 4.55), SPPB (HR: 3.43, 95% CI: 1.55, 7.57), GS (HR: 3.03, 95% CI: 1.44, 6.38), and TUG (HR: 5.16, 95% CI: 2.19, 12.14) had shorter overall survival after adjustment for sex, age, symptomatology, comorbidity, percentage of weight loss, and tumor localization. Conclusions Among the studied objective physical function measurements, HGS, SPPB, GS, and TUG were independent predictors of survival in a sample of patients with metastatic cancer, with TUG showing the highest effect size.

Performance of the SARC-F in identifying low grip strength and physical performance in older adults with cancer

IntroductionRemote, online geriatric assessment (GA) is gaining attention in oncology. Most GA domains can be assessed remotely. However, there is limited evidence identifying reliable tools that can be used in lieu of objective measures of physical function, such as grip strength and physical performance during remote, online GA. In this prospective cohort study, we aimed to assess the performance of the SARC-F, a screening questionnaire for sarcopenia, in identifying low grip strength and the Short Physical Performance Battery (SPPB). Additionally, we assessed the satisfaction of clinical staff with using the SARC-F in the clinic. Materials and MethodsData were prospectively collected from older adults with cancer of any type and stage who underwent GA in the geriatric oncology clinic of a tertiary cancer centre. Following GA, patients were asked to complete the SARC-F tool. Spearman correlations were performed between objective measures of physical function, SARC-F domains, and SARC-F total score. Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value were assessed to evaluate the performance of SARC-F to detect low grip strength and SPPB. ResultsEighty (n = 80) older adults (mean age: 80 years) with cancer completed the SARC-F. A positive SARC-F was found in 31.3% of the cohort. Moderate correlations were found between the SPPB per point and Assistance in walking (r = −0.69), as well as the SPPB per point and total SARC-F score (r = −0.66). SARC-F exhibited moderate sensitivity in identifying low grip strength using the Foundation for the National Institutes of Health (FNIH) criteria (sensitivity: 64.3%) or the Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria (sensitivity: 40.4%). However, specificity was high (>75%) regardless of the criteria applied. Similarly, moderate sensitivity (52.2%), but excellent specificity (97.1%) was found for SPPB. When low grip strength per FNIH was combined with low SPPB, SARC-F demonstrated high sensitivity (80%) and specificity (75.7%). DiscussionSARC-F exhibited promising performance in identifying low grip strength per FNIH and low SPPB combined. To definitively assess the performance of the SARC-F in detecting low grip strength and SPPB, larger studies are warranted.

AWARENESS OF AGE-RELATED GAINS AND LOSSES AND THEIR ASSOCIATIONS WITH PHYSICAL AND COGNITIVE FUNCTION

Abstract Awareness of age-related change (AARC) refers to people’s recognition of how aging has affected their performance, behavior, and ways of experiencing life. Sometimes these age-related changes are perceived as losses (AARC-Losses), such as when people notice declines in their health. However, other times these age-related changes are perceived as gains (AARC-Gains), such as when people notice they have developed a better sense of what is important to them. Past research has shown that higher AARC-Losses (and to a lesser extent lower AARC-Gains) are associated with poorer self-rated health. However, no research has yet examined whether AARC also relates to an objective performance-based measure of health. To address this, we examined the cross-sectional relationships between AARC-Losses and AARC-Gains with gait speed (i.e., a measure of physical function) in 164 community-dwelling older adults. Participants in this study also completed health-related questionnaires and the NIH Toolbox Cognition Battery. Results showed that AARC-Losses were most strongly predicted by depression levels, but higher AARC-Losses were also predicted by slower gait speeds. A different pattern emerged for AARC-Gains. After controlling for demographic factors, depression, and other self-reported measures of health, we found that higher AARC-Gains were predicted by poorer cognition and slower gait speed. The counterintuitive relationship between AARC-Gains and objective cognition has previously been reported in the literature. However, this study is the first to document that AARC-Gains are also associated with poorer performance on an objective measure of physical function. We discuss features of the AARC questionnaire that may lead to these paradoxical effects.

THE VALUE OF BALANCE CONFIDENCE IN OLDER ADULT FALL RISK ASSESSMENT

Abstract Fall risk assessment traditionally focuses on objective physical performance. Balance confidence, a subjective measure of physical function, may provide important information to better predict fall risk and guide assessment and intervention strategies. This study examines the associations of balance confidence congruency with physical performance measures and fall occurrence. One-hundred-fifty-five community-dwelling adults aged 60 and over completed a comprehensive fall risk assessment including physical performance tests (timed up and go, 4-stage balance, 30-second chair stand, and 4-M gait speed), activities-specific balance confidence (ABC) scale, and self-reported falls in the past year. Four groups were created based on congruency between balance confidence (low vs. high) and each physical performance measure or overall fall risk category (at fall risk vs. not at fall risk, based on the STEADI tool kit). Poison regression analyses, adjusted for age and gender, tested the association between group membership and number of falls in the past year. Participants with high balance confidence and at fall risk based on 4-stage balance performance (Estimate=0.88, p &amp;lt; 0.001), or high balance confidence and at fall risk following the STEADI screening algorithm (Estimate=0.69, p = 0.003) were at increased risk of more falls compared to participants in the group with high balance confidence and not at fall risk. These results suggest that older adults who overestimate their balance relative to their physical performance may be at increased fall risk, and that participant subjective reporting of physical performance should be paired with objective physical performance measures to better identify older adults at fall risk.

Knowledge of Nutrition and Physical Activity Guidelines is Not Associated with Physical Function in Dutch Older Adults Attending a Healthy Ageing Public Engagement Event.

Evidence-based guidelines on nutrition and physical activity are used to increase knowledge in order to promote a healthy lifestyle. However, actual knowledge of guidelines is limited and whether it is associated with health outcomes is unclear. This inception cohort study aimed to investigate the association of knowledge of nutrition and physical activity guidelines with objective measures of physical function and physical activity in community-dwelling older adults attending a public engagement event in Amsterdam, The Netherlands. Knowledge of nutrition and physical activity according to Dutch guidelines was assessed using customized questionnaires. Gait speed and handgrip strength were proxies of physical function and the Minnesota Leisure Time Physical Activity Questionnaire was used to assess physical activity in minutes/week. Linear regression analysis, stratified by gender and adjusted for age, was used to study the association between continuous and categorical knowledge scores with outcomes. In 106 older adults (mean age=70.1 SD=6.6, years) who were highly educated, well-functioning, and generally healthy, there were distinct knowledge gaps in nutrition and physical activity which did not correlate with one another (R2=0.013, p=0.245). Knowledge of nutrition or physical activity guidelines was not associated with physical function or physical activity. However, before age-adjustment nutrition knowledge was positively associated with HGS in males (B= 0.64 (95% CI: 0.05, 1.22)) and having knowledge above the median was associated with faster gait speed in females (B=0.10 (95% CI: 0.01, 0.19)). Our findings may represent a ceiling effect of the impact knowledge has on physical function and activity in the this high performing and educated population and that there may be other determinants of behavior leading to health status such as attitude and perception to consider in future studies.

Young Adult Pain Rehabilitation: Interdisciplinary Development and Preliminary Outcomes of a Novel Treatment Program.

Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

PurposeStudy purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF.MethodsBalance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined.ResultsGait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment.ConclusionsDetermination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.