Self-report Measures Of Physical Function Research Articles

Clinician's Commentary on Wilhelm et al.(1.).

Clinician's Commentary on Wilhelm et al.(1.).

Physical Activity and Function in Adolescents With Chronic Pain: A Controlled Study Using Actigraphy

Physical functioning is often impaired in adolescents with chronic pain, which has largely been demonstrated through subjective self-report measures. Actigraphy uses motion monitoring as an objective means for assessing one dimension of physical functioning; physical activity level. This study used subjective and objective measures to assess multiple dimensions of physical functioning in a clinical sample of adolescents with chronic pain (n = 78) and a comparison group of healthy adolescents (n = 59). Individual and pain characteristics were also examined as predictors of actigraphy variables within the chronic pain sample. Results indicated that adolescents with chronic pain demonstrate significant impairment in subjective measures of physical functioning and evidence lower levels of physical activity. Actigraphic measures of physical activity were moderately correlated with self-report measures of physical functioning. Individual characteristics, including adolescent age, sex, and Body Mass Index percentile, were associated with physical activity levels among adolescents with chronic pain. Physical activity represents a distinct dimension of physical functioning. Assessing physical activity may provide additional description of physical functioning among adolescents with chronic pain, and may help identify targets for intervention in this population. PerspectiveThis study demonstrates that adolescents with chronic pain have lower physical activity levels, as measured objectively via actigraphy, as well as poorer subjective reports of physical functioning, compared to healthy adolescents. Actigraphic measurement of physical activity provides objective source data about one dimension of physical functioning.

The Influence of Body Mass Index on Self-report and Performance-based Measures of Physical Function in Adult Women

Little is known about limitations in physical function across BMI categories in middle aged women using both self-report and performance-based measures. Furthermore, the impact of BMI on the measurement of function has not been explored. The purpose of this study was to assess physical function in adult women across BMI categories using self-report and performance-based measures and determine the influence of BMI on the relationship between the measures. Fifty sedentary females (10 in each BMI category: normal weight, overweight, obese class I, II, and III) aged 51.2 ± 5.4 years participated. Assessments included demographics, past medical history, physical activity level, BMI, and self-report (Late Life Function and Disability Instrument) and performance-based measures of physical function (6-Minute Walk Test, timed chair rise, gait speed). Physical function was compared between BMI categories using analysis of variance. The influence of BMI on the relationship of self-report and performance-based measures was analyzed using linear regression. Compared to those that were normal weight or overweight, individuals with obesity scored lower on the self-report measure of physical function (LLFDI) for capability in participating in life tasks and ability to perform discrete functional activities. On the performance-based measures, the individuals with obesity had slower gait speed compared to the normal and overweight weight groups. For the 6-Minute Walk Test and timed chair stands, individuals with obesity had poorer performance compared to those who were normal weight. Linear regression analyses revealed that BMI attenuated the relationship between the self-report and performance-based measures by approximately 50%. While those with severe obesity were most impaired, adult women with less severe obesity also demonstrated significant decrements in physical function.

Discriminant Validity of the Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning Subscale in Community Samples With Hip Osteoarthritis

Pua Y-H, Cowan SM, Wrigley TV, Bennell KL. Discriminant validity of the Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning Subscale in community samples with hip osteoarthritis. Objective To evaluate, in a community hip osteoarthritis (OA) sample, the discriminant validity of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning (PF) subscale to differentiate between self-report measures of pain and physical function. Design Cross-sectional. Setting Human movement laboratory of a university. Participants Adults (N=100; 60 women, 40 men; age, 62.3±10.1y) with radiographically confirmed symptomatic hip OA. Interventions Not applicable. Main Outcome Measures Six self-report measures of pain and physical function—WOMAC-PF and WOMAC-Pain subscales, Lower Extremity Functional Scale, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) bodily pain and PF subscales, and 4-item pain intensity measure—were obtained. Confirmatory factor analysis was applied to a correlated 2-factor measurement model that assumed discriminant validity: self-report measures of pain were conceptualized to load uniquely on 1 factor; self-report measures of physical function were conceptualized to load uniquely on the other factor. Results Confirmatory factor analysis revealed that the initially proposed model did not achieve an acceptable fit to the data. Allowing a correlation between the error terms of the WOMAC-PF with those of the WOMAC-Pain and the SF-36 bodily pain subscales resulted in a viable model that provided adequate fit to the data (χ 2=7.5, P=.28). Conclusions The findings suggest that the discriminant validity of the WOMAC-PF subscale from self-report pain measures cannot be confirmed in community-dwelling adults with hip OA.

Hip flexion range of motion and physical function in hip osteoarthritis: Mediating effects of hip extensor strength and pain

Hip flexion range of motion (ROM), hip extensor strength (torque production), and hip pain are important correlates of physical function in individuals with hip osteoarthritis (OA). However, the relationships among these variables remain unclear. The purpose of this study was to examine whether hip extensor strength and hip pain mediate the association between hip flexion ROM and physical function. Participants were 100 adults (mean age 62 years) with radiographically confirmed hip OA. Passive hip flexion ROM was measured using a digital inclinometer, and isometric hip extensor strength was measured using a force transducer. Self-report measures of physical function and pain were assessed by the Short Form 36 (SF-36) questionnaire, and physical performance was assessed by the gait speed, step test, and stair climb test. Multiple mediation analyses, adjusted for demographic and anthropometric measures, revealed that the association between hip flexion ROM and SF-36 physical function scores was fully mediated by SF-36 bodily pain scores and hip extensor strength. Hip extensor strength mediated the hip flexion effects on gait speed and step test performance, while the SF-36 bodily pain scores mediated the hip flexion stair performance association. In individuals with symptomatic hip OA, hip pain and hip extensor strength mediated the influence of hip flexion ROM on physical function. These results suggest that interventions to improve the range of hip motion may be clinically indicated.

Self‐report and physical performance measures of physical function in hip osteoarthritis: Relationship to isometric quadriceps torque development

Quadriceps strength (knee extensor torque) is an important correlate of physical function in individuals with hip osteoarthritis (OA). However, it remains unclear whether the ability to rapidly generate quadriceps torque in the early phase of muscle contraction (maximal rate of torque development [MRTD]) is also associated with physical function. The purpose of this study was to quantify the independent impact of quadriceps strength and quadriceps MRTD on self-report and physical performance measures of physical function in community-dwelling adults with hip OA. Ninety-two adults with radiographically confirmed symptomatic hip OA (mean age 62 years) participated. Unilateral isometric quadriceps strength and MRTD were measured using a dynamometer. Self-report measure of physical function was assessed by the Short Form 36 (SF-36) questionnaire, and physical performance was assessed by the timed stair and step tests. In the hierarchical regression models, high maximal quadriceps strength and high quadriceps MRTD uniquely covaried with high SF-36 physical function scores after accounting for demographic, anthropometric, and pain measures. For the timed stair test, all else being equal, in 2 participants with low but identical levels of quadriceps strength, the one with a higher MRTD had better stair-climbing function. For the step test, quadriceps MRTD was not associated with step test performance over and above that of quadriceps strength. In individuals with hip OA, maximal quadriceps strength and quadriceps MRTD positively impact self-report and physical performance measures of physical function. These findings are of importance in developing intervention strategies, but they call for further study.

Self-report measures of physical function for children with spinal cord injury: A review of current tools and an option for the future

Objective: The purpose of this article is to provide paediatric rehabilitation providers with a review of self-report physical function outcome measures that have been used for children with spinal cord injury (SCI).Review process: A literature review was conducted to identify self-report physical function measures for children with SCI. Further searching of reference lists and textbooks was also completed.Outcomes: Eight measures were identified, but limitations exist in these current tools. There are few reports of psychometrics, in addition to a lack of accommodation for wheelchair use, limited item content for supported ambulation and minimal variation in content for a wide age-range.Conclusion: A comprehensive yet practical self-report measure applicable for all ages with items suitable for a child with a complete or incomplete injury is needed. The best means to achieve effective and efficient outcome monitoring may be computerized adaptive testing.

Performance-Based or Self-Report Measures of Physical Function: Which Should Be Used in Clinical Trials of Hip Fracture Patients?

Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, Chandler J. Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients? Objectives To assess the validity, sensitivity to change, and responsiveness of 3 self-report and 4 performance-based measures of physical function: activity measure for postacute care (AM-PAC) Physical Mobility and Personal Care scales, the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function scale (SF-36 PF), the Physical Functional Performance test (PFP-10), the Short Physical Performance Battery (SPPB), a 4-meter gait speed, and the six-minute walk test (6MWT). Design A prospective observational study of patients after a hip fracture. Assessments were performed at baseline and 12 weeks postenrollment. Setting Inpatient and outpatient rehabilitation facilities in Norway, the United Kingdom, Sweden, Israel, Germany, the United States, Denmark, and Spain. Participants A sample of study participants (N=108) who had a hip fracture. Interventions Not applicable. Main Outcome Measures Assessments of validity (known-groups, concurrent, construct, and predictive), sensitivity to change (effect size, standardized response mean [SRM], SE of measure, minimal detectable change (MDC), and responsiveness (optimal operating cut-points and area under the curve) between baseline and 12-week follow-up. Results All physical function measures achieved comparably acceptable levels of validity. Odds ratios in predicting patient Global Assessment of Improvement at 12 weeks were as follows: AM-PAC Physical Mobility scale, 5.3; AM-PAC Personal Care scale, 3.6; SF-36 PF, 4.3; SPPB, 2.0; PFP-10, 2.5; gait speed, 1.9; and 6MWT, 2.4. Effect sizes and SRM exceeded 1 SD for all 7 measures. Percent of patients who exceeded the MDC 90 at week 12 were as follows: AM-PAC Physical Mobility scale, 90%; AM-PAC Personal Care scale, 74%; SF-36 PF, 66%; SPPB, 36%; PFP-10, 75%; gait speed, 69%; and 6MWT, 75%. When evaluating responsiveness using the area under receiver operating curves for each measure, all measures had acceptable responsiveness, and no pattern emerged of superior responsiveness depending on the type of measure used. Conclusions Findings reveal that the validity, sensitivity, and responsiveness of self-report measures of physical function are comparable to performance-based measures in a sample of patients followed after fracturing a hip. From a psychometric perspective, either type of functional measure would be suitable for use in clinical trials where improvement in function is an endpoint of interest. The selection of the most appropriate type of functional measure as the primary endpoint for a clinical trial will depend on other factors, such as the measure's feasibility or the strength of the association between the hypothesized mechanism of action of the study intervention and a functional outcome measure.

Associations of Gait Speed and Other Measures of Physical Function With Cognition in a Healthy Cohort of Elderly Persons

Recent evidence suggests that physical decline and slower gait may be associated with early signs of dementia, but more information on healthy older adults is needed. We determined associations between cognitive function, gait speed, and self-reported measures of physical function in 3035 healthy mobile participants of the Ginkgo Evaluation of Memory Study evaluated in 2000-2001. Gait speed was measured over a 15-foot course with participants walking at both their usual and rapid pace. Self-reported difficulties with Activities of Daily Living (ADLs) and other physical function tasks were also collected. Results of the Modified Mini-Mental State Examination (3MSE) determined cognitive function. The average age of the cohort was 78.6 years (standard deviation [SD] 3.3), and 53.9% of participants were men. Mean gait speed was 0.95 (SD 0.23) m/s at a usual pace and 1.35 (SD 0.58) m/s at a rapid pace. More than three-fourths of participants had 3MSE scores > 90. In multiple logistic models adjusted for demographics and comorbidities, risk of low cognition (defined as 3MSE score of 80-85) was almost twice as great for participants in the slowest quartile of the rapid-paced walking task than for the fastest walkers (odds ratio: 1.96, 95% confidence interval, 1.25-3.08). Associations between cognition and usual-paced walking were borderline, and no relationships were found with self-reported measures of physical function, including ADLs. In very healthy older adults, performance-based measures better predict early cognitive decline than do subjective measures, and tasks requiring greater functional reserve, such as fast-paced walking, appear to be the most sensitive in assessing these relationships.

Relationship of Closed and Open Chain Measures of Strength with Perceived Physical Function and Mobility Following Unilateral Total Knee Replacement

The association between closed-chain knee extensor strength and perceived physical function following primary knee replacement has not received much attention.The purpose of this investigation was to determine the relationship of closed and open chain measures of strength with self-reported measures of physical function and mobility following unilateral knee replacement. Subjects were 9 individuals (68. 7 +/- 2.3 years) approximately 16 months postsurgery. The independent variables were closed-chain (elastic) and open-chain (isometric) measures of strength, while the dependent measures were perceived physical function (WOMAC) and mobility (Timed Up and Go, TUG). The relationship between independent and dependent variables was described using Spearman Rho correlation coefficients. Force produced during the closed-chain assessment was strongly associated to the WOMAC physical function dimension (-.96) and total WOMAC score (-.87). A poor to low relationship existed between the open-chain measure of strength and the physical function dimension (-.34) and the total WOMAC score (-.17). Force production of the entire lower limb, measured in the closed-chain was moderately related (-.62) with the TUG. The association between knee extensor isometric torque and the TUG (-.25) was low. Closed-chain assessment of entire lower limb strength, rather than open-chain measures of knee extensor strength, may provide greater insight to functional limitations.

Modeling early recovery of physical function following hip and knee arthroplasty

BackgroundInformation on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures.MethodsA sample of convenience of 152 subjects completed testing, of which 69 (mean age: 66.77 ± 8.23 years) underwent THA and 83 (mean age: 60.25 ± 11.19 years) TKA. Postoperatively, patients were treated using standardized care pathways and rehabilitation protocols. Using a repeated measures design, patients were assessed at multiple time points over the first four postoperative months. Outcome measures included the Lower Extremity Function Scale (LEFS), the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC PF), the 6 minute walk test (6 MWT), timed up and go test (TUG) and a timed stair test (ST). Average recovery curves for each of the measures were characterized using hierarchical linear modeling. Predictors of recovery were sequentially modeled after validation of the basic developmental models.ResultsSlopes of recovery were greater in the first 6 to 9 weeks with a second-degree polynomial growth term (weeks squared) providing a reasonable fit for the data over the study interval. Different patterns of recovery were observed between the self-report measures of physical function and the performance measures. In contrast to the models for the WOMAC PF and the LEFS, site of arthroplasty was a significant predictor (p = 0.001) in all of the physical performance measure models with the patients post TKA initially demonstrating higher function. Site of arthroplasty (p = 0.025) also predicted the rate of change for patients post THA and between 9 to 11 weeks after surgery, the THA group surpassed the function of the patients post TKA.ConclusionKnowledge about the predicted growth curves will assist clinicians in referencing patient progress, and determining the critical time points for measuring change. The study has contributed further evidence to highlight the benefit of using physical performance measures to learn about the patients' actual level of disability.

Determinants of physical health in frail older people: the importance of self-efficacy

Objective: There is continued uncertainty regarding the strength of association between performance-based and self-report measures of physical functioning, and of their relationship to self-efficacy and health-related quality of life (HRQoL). This study assessed the inter-relationships between such measures, and the predictors of ‘physical’ aspects of HRQoL in frail older patients. Design: We used statistical models to determine the predictors of ‘physical’ HRQoL, according to the physical component summary score and the physical functioning domain of the 36-item short form (SF-36) questionnaire. Setting: Patients were recruited from hospitals in Australia and New Zealand and followed up in their homes. Subjects: Two hundred and forty-three frail older patients. Main measures: Physical functioning was assessed using three performance-based measures (Timed Up and Go Test, gait speed and the Berg Balance Scale) and five self-report measures, including the modified falls self-efficacy scale, at three and six months after registration. Results: A moderate association (r=0.48=0.55) was found between each of the performance-based and self-report measures, including the SF-36 physical component summary score. Multiple linear regression analyses showed that the performance-based measures and falls self-efficacy predicted 33% of the SF-36 physical component summary score. Falls self-efficacy was the single highest predictor of both the SF-36 physical component summary score and SF-36 physical functioning domain. A curvilinear relationship was found between the SF-36 physical functioning domain and two variables: falls self-efficacy and the Berg Balance Scale. Conclusions: Although performance-based and self-report measures provide complementary but distinct measures of physical function, psychosocial factors such as self-efficacy have a strong influence on the HRQoL of frail older people.

An Objective Measure of Physical Function of Elderly Outpatients

Direct observation of physical function has the advantage of providing an objective, quantifiable measure of functional capabilities. We have developed the Physical Performance Test (PPT), which assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living of various degrees of difficulty. Two versions are presented: a nine-item scale that includes writing a sentence, simulated eating, turning 360 degrees, putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50-foot walk test, and climbing stairs (scored as two items); and a seven-item scale that does not include stairs. The PPT can be completed in less than 10 minutes and requires only a few simple props. We then tested the validity of PPT using 183 subjects (mean age, 79 years) in six settings including four clinical practices (one of Parkinson's disease patients), a board-and-care home, and a senior citizens' apartment. The PPT was reliable (Cronbach's alpha = 0.87 and 0.79, interrater reliability = 0.99 and 0.93 for the nine-item and seven-item tests, respectively) and demonstrated concurrent validity with self-reported measures of physical function. Scores on the PPT for both scales were highly correlated (.50 to .80) with modified Rosow-Breslau, Instrumental and Basic Activities of Daily Living scales, and Tinetti gait score. Scores on the PPT were more moderately correlated with self-reported health status, cognitive status, and mental health (.24 to .47), and negatively with age (-.24 and -.18). Thus, the PPT also demonstrated construct validity. The PPT is a promising objective measurement of physical function, but its clinical and research value for screening, monitoring, and prediction will have to be determined.