SF-36 Physical Function Scores Research Articles

Self-Perceived Functionality Correlates With Power Predicted Using a 30s Chair Stand Test

As individuals age, their capacity to produce power becomes increasingly indicative of their level of functionality and therefore likelihood of remaining independent. Identifying individuals who are approaching the threshold of power production at which they are likely to lose functionality would allow health professionals to intervene before serious injury or loss of independence occurs. The SF-36 is a thoroughly documented and validated survey on 8 health constructs that can be easily administered by the subject in less than 15 minutes, which makes it a test that can be easily integrated into a normal health visit. PURPOSE: To determine if self-perceived functionality, as measured by the SF-36 physical function score (SF-36PF), which is the sum of the physical and general health items of the SF-36, correlates with an elderly person′s lower body power output as computed from performance on a 30s chair stand test. METHODS: 47 members of an extended care facility completed SF-36 questionnaires via an interview format and responses on the physical and general health items were selected for our analysis. Subjects were instructed to perform chair rises at maximum speed for 30 seconds or until volitional fatigue. The test was performed with the participant′s arms held across the chest. For a stand to be counted, the subject was required to touch the chair at the bottom of the repetition and reach a fully upright position. Peak lower body power was predicted using our regression equation, which used body mass and number of stands as the predictor variables. Scores from the SF-36PF were correlated with the predicted peak power figures using Pearson′s r. RESULTS: There was a significant correlation between the SF-36PF score and the peak power predicted by the 30s chair stand test (r=.40, p<0.01) as defined by critical values for Pearson′s r. CONCLUSIONS: These results suggest that power is a major dictate of self-rated physical function in the elderly, and that the power formula developed in our laboratory for use with the 30s chair stand test may be an important diagnostic tool to use in preparing an effective exercise prescription.

A Prospective Outcomes Analysis of Femoral Component Fixation in Revision Total Hip Arthroplasty

A prospective, surgeon-allocated, matched cohort analysis of patient outcomes compared cementless, modular metaphyseal and cemented femoral fixation used for revision total hip arthroplasty. First-time femoral revision operations (with and without acetabular revision) with Paprosky types I and II femoral bone stock were included. This series of 86 patients was matched for age, weight, diagnosis, Charnley class, Demand category, femoral bone stock, and outcome measures. At 8-year average follow-up (range, 4-13 years), there were no significant differences in visual analog pain scores (VAPS), Harris Hip Scores (HSS), and SF-36 Physical Function and Bodily Pain scores. One femoral rerevision (2.3%) occurred in the cementless group, and 2 (4.6%) occurred in the cemented group ( P = .557). Five-year survivorship for femoral rerevision was 94% for patients with cementless, modular metaphyseal fixation and 92% for patients with cemented fixation. In this study, cementless, modular metaphyseal fixation and cemented femoral fixation were both successful at intermediate-term follow-up in Paprosky types I and II femoral bone (level of evidence: therapeutic study; level II, prospective comparative study).

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program

This study tested the hypothesis that patients with PAD have impaired health-related quality of life (HRQoL) to a degree similar to that of patients with other types of cardiovascular disease (other-CVD), and also evaluated the clinical features of PAD associated with impaired HRQoL. This was a cross-sectional study in 350 primary care practice sites nationwide with 6,499 participants. The reference group had no clinical or hemodynamic evidence of PAD or other-CVD; the PAD group had an ankle-brachial index < 0.90 or a prior history of PAD; the other-CVD group had a clinical history of cardiac or cerebral vascular disease (but no PAD), and the combined PAD-other-CVD group included both diagnoses. Individuals were assessed using four HRQoL questionnaires including the Walking Impairment Questionnaire (WIQ), Medical Outcomes Study SF-36 (SF-36), Cantril Ladder of Life and the PAD Quality of Life questionnaire. PAD patients had lower WIQ distance scores than the other-CVD group. Both the PAD and other-CVD groups had significantly lower SF-36 Physical Function scores compared with the reference group. The WIQ revealed that PAD patients were more limited by calf pain, whereas other-CVD patients were more limited by chest pain, shortness of breath and palpitations. In conclusion, in this nationwide study, one of the first to directly compare the HRQoL burden of CVD with that of PAD, the evaluation of PAD in office practice revealed a HRQoL burden as great in magnitude as in patients with other forms of CVD.

Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial

Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period.Design Randomised controlled trial.Setting 17 primary care...

The Impact of Trauma-Center Care on Functional Outcomes Following Major Lower-Limb Trauma

Although studies have shown that treatment at a trauma center reduces a patient's risk of dying following major trauma, important questions remain as to the effect of trauma centers on functional outcomes, especially among patients who have sustained major lower-limb trauma. Domain-specific scores on the Medical Outcomes Study Short Form Health Survey (SF-36) supplemented by scores on the mobility subscale of the Musculoskeletal Function Assessment (MFA) and the Revised Center for Epidemiologic Studies Depression Scale (CESD-R) were compared among patients treated in eighteen hospitals with a level-I trauma center and fifty-one hospitals without a trauma center. Included in the study were 1389 adults, eighteen to eighty-four years of age, with at least one lower-limb injury with a score of >/=3 points according to the Abbreviated Injury Scale (AIS). To account for the competing risk of death, we estimated the survivors' average causal effect. Estimates were derived for all patients with a lower-limb injury and separately for a subset of patients without associated injuries of the head or spinal cord. For patients with a lower-limb injury resulting from a high-energy force, care at a trauma center yielded modest but clinically meaningful improvements in physical functioning and overall vitality at one year after the injury. After adjustment for differences in case mix and the competing risk of death, the average differences in the SF-36 physical functioning and vitality scores and the MFA mobility score were 7.82 points (95% confidence interval: 2.65, 12.98), 6.80 points (95% confidence interval: 2.53, 11.07), and 6.31 points (95% confidence interval: 0.25, 12.36), respectively. These results were similar when the analysis was restricted to patients without associated injuries to the head or spine. Treatment at a trauma center resulted in negligible differences in outcome for the subset of patients with injuries resulting from low-energy forces. This study provides evidence that patients who sustain high-energy lower-limb trauma benefit from treatment at a level-I trauma center.

Intervertebral Disc Biacuplasty for the Treatment of Lumbar Discogenic Pain: Results of a Six-Month Follow-Up

Intradiscal biacuplasty (IDB) is a novel bipolar cooled radiofrequency system for the treatment of degenerative disk disease. We present the results of a pilot trial with 6-month follow-up. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: Fifteen patients, 22-55 years old, underwent one- or two-level IDB treatment of their painful lumbar discs. All had chronic low back pain >6 months, back pain exceeding leg pain, concordant pain on provocative discography, disc height >50% of control, and evidence of single- or two-level degenerative disc disease without evidence of additional changes on magnetic resonance imaging. IDB was performed under fluoroscopy using two radiofrequency probes positioned bilaterally in the intervertebral disc. Thirteen patients completed follow-up questionnaires at 1, 3, and 6 months. Pain disability was evaluated with Oswestry and Short Form (SF)-36 questionnaires. Median visual analog scale pain scores were reduced from 7 (95% confidence interval [CI] 6, 8) to 4 (2, 5) cm at 1 month, and remained at 3 (2, 5) cm at 6 months. The Oswestry improved from 23.3 (SD 7.0) to 16.5 (6.8) points at 1 month and remained similar after 6 months. The SF-36 Physical Functioning scores improved from 51 (18) to 70 (16) points after 6 months, while the SF-36 Bodily Pain score improved from 38 (15) to 54 (23) points. Daily opioid use did not change significantly from baseline: from 40 (95% CI 40, 120) before IDB to 5 (0, 40) mg of morphine sulfate equivalent 6 months after IDB. No procedure-related complications were detected. Patients showed improvements in several pain assessment measures after undergoing IDB for discogenic pain. A randomized controlled study is warranted and needed to address the efficacy of the procedure.

Longitudinal Analysis of Sexual Function Reported by Men in the Prostate Cancer Prevention Trial

The Prostate Cancer Prevention Trial (PCPT) was a randomized, double-blind, placebo-controlled study of the efficacy of finasteride in preventing prostate cancer in 18,882 men aged 55 years or older. The PCPT offered an opportunity to prospectively study the effects of finasteride and other covariates on sexual dysfunction. We assessed sexual dysfunction in 17,313 PCPT participants during a 7-year period. A battery of questionnaires assessed sexual dysfunction (Sexual Activity Scale score); age; race; SF-36 Mental Health Inventory-5, Physical Function, and Vitality scores; body mass index; smoking status; and the presence of diabetes and hypertension. Assessments began at month 6 after random assignment and included the Sexual Activity Scale score at randomization as a covariate. Two-sided general t tests, with a cutoff of P value less than .05, were used to determine the statistical significance for mixed model effects with correlated random time slopes and intercepts. The changing impact of covariates on sexual dysfunction was also assessed at 6 months, 3.5 years, and 6.5 years after randomization. Finasteride increased sexual dysfunction only slightly and its impact diminished over time; the increase in the Sexual Activity Scale score relative to placebo of 3.21 points (95% confidence interval [CI] = 2.83 to 3.59 points; P<.001) at the first assessment decreased to 2.11 points (95% CI = 1.44 to 2.81 points; P<.001) at the end of study. These Sexual Activity score values were small on a scale of 0-100, the range observed in the study, and in comparison with individual variation. After adjustment for all covariates, mean sexual dysfunction increased in both arms from baseline (6 months after randomization) by 1.26 Sexual Activity points (95% CI = 1.16 to 1.36 points; P<.001) per year, corresponding to a cumulative increase of 8.22 points (95% CI = 7.52 to 8.92 points; P<.001) over the study period. The effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride.

Lack of relationship between gait parameters and physical function in peripheral arterial disease

Physical function is limited in patients with peripheral arterial disease who are symptomatic with intermittent claudication (PAD-IC). When patients with PAD-IC experience claudication, previous reports have described gait abnormalities, including alterations in step length and cadence. This study tested the hypothesis that patients with PAD-IC would have a decrease in usual and maximal walking speed and that this alteration in gait parameters would contribute to their decreased physical function scores, even in the absence of claudication. The aims were to evaluate usual and maximal walking speed and gait parameters (step length, cadence and toe out angle) in subjects with PAD-IC and control subjects with similar baseline activity levels. A cross-sectional study of 25 subjects with PAD-IC compared with 26 age-matched controls was conducted in a research laboratory in an academic medical center. Study subjects were similar in age, gender, and physical activity status. Subjects with PAD-IC had an ankle-brachial index <0.90 in at least one leg and reported symptoms of intermittent claudication that limited walking ability. Subjects in either group were excluded if they used assistive devices to walk or were limited in walking ability by orthopedic, neurologic, cardiac, or pulmonary symptoms. Gait parameters were assessed at the onset of walking (before the development of claudication pain in the PAD-IC group) at self-selected and maximal walking speeds during which step and stride characteristics were collected. Subjects completed a physical activity recall, a Short Form questionnaire (SF-36), and a 6-minute walk that was limited by claudication in the PAD-IC group. During gait testing, no patient with PAD-IC developed claudication. There were no significant differences between the PAD-IC and control groups in usual or maximal walking speed or other gait variables (step length, cadence, stride width, toe out angle). In contrast, the SF-36 physical function score was reduced 15.2 percentage points (P < .02) and the summary physical component score was reduced 6.7 percentage points in the PAD-IC group compared with controls (P = .002). In addition, the 6-minute walk distance was significantly less in the PAD-IC group than in the control group by 308.8 feet (P < .001). A series of bivariate analyses demonstrated that PAD-IC was the best predictor of reduced physical function, whereas no gait parameter was associated with reduced physical function. Patients with PAD-IC have significantly reduced 6-minute walk distance and reduced physical function by questionnaire scores that was not explained by any effects of PAD-IC on walking speed and selected gait parameters assessed before the onset of claudication pain.

Clinical impact of tamsulosin on generic and symptom‐specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36‐item Health Survey

To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.

Randomized trial of yoga in women with breast cancer undergoing radiation treatment

8505 Background: Yoga, an ancient Indian science, incorporates stress-reduction techniques that include regulated breathing, visual imagery, and meditation, as well as various postures that may be useful for cancer patients. Methods: A yoga program was developed that including loosening and breathing exercises, postures, alternate nostril breathing, a deep relaxation technique, and meditation for patients with breast cancer who were undergoing radiotherapy. Women participated in bi-weekly classes during their 6 weeks of radiation treatment. Sixty-one women with breast cancer were randomly assigned to either the yoga program or to a waitlist control group. Patients completed measures of intrusive thoughts and avoidance behaviors (Impact of Events Scale: IES), depressive symptoms (CES-D), sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (BFI), and quality of life (SF-36) at baseline, 1 week, and 1 and 3 months after the last radiation therapy. We report on the outcomes 1 week after the end of radiotherapy. Results: The average age of the women was 52, 3% stage 0, 28% stage I, 43% stage II, and 26% stage III, 48% had undergone breast-conserving surgery, and 75% had received chemotherapy prior to starting radiotherapy. Analysis of covariance, controlling for baseline, revealed that the yoga group had significantly better SF-36 physical function scores (adjusted means: yoga 81.8 vs. control 68.6, P &lt; 0.01), significantly higher SF-36 general health scores (adjusted means: yoga 78.3 vs. control 67.9, P &lt; 0.03), marginally better SF-36 social functioning scores (adjusted means: yoga 85.3 vs. control 76.0, P &gt; 0.1), significantly lower levels of sleep-related daytime dysfunction (adjusted means: yoga 0.5 vs. control 1.2, P &lt; 0.04), and marginally lower levels of fatigue (adjusted means: yoga 1.9 vs. control 3.1, P &lt; 0.06) than the control group. There were no other group differences on the SF-36 subscales or for the CES-D or IES scores. Conclusions: The results indicated that the yoga program was associated with statistically and clinical significant improvements in aspects of quality of life. No significant financial relationships to disclose.

Effectiveness of Physical Therapy for the Management of Chronic Spine Disorders: A Propensity Score Approach

Evidence on the effectiveness of physical therapy for the management of chronic spine disorders is limited. The purpose of this study was to use a large current database, the National Spine Network database, to assess the effectiveness of physical therapy in the management of chronic spine disorders. The participants were people who had spine problems lasting 3 months or longer and who were seen for an initial visit and a follow-up visit (N=4,479) at 1 of 17 US spine centers. A propensity score approach was used to create a matched sample of participants who received physical therapy (intervention group) and participants who did not receive physical therapy (control group). The 2 groups were similar with regard to more than 50 baseline characteristics. Outcomes were assessed with the Oswestry Disability Index (ODI) and the 36-Item Short-Form Health Survey (SF-36). Both the intervention and control groups improved between the initial and the follow-up visits on ODI scores and on SF-36 physical function, role physical, and bodily pain scores. Although the amount of improvement in the outcome measures was significantly greater for the intervention group than for the control group, the differences were small (3-5 points). When the subgroup of participants who had the greatest propensity for receiving physical therapy was examined, differences in the amount of improvement between the intervention and control groups were larger (5-13 points). Physical therapy was effective in the management of chronic spine disorders in participants with the greatest propensity for receiving physical therapy. When the entire sample was considered, differences in the amount of improvement between the intervention and control groups were not clinically relevant.

Quality of life after acute myocardial infarction: A comparison of diabetic versus non-diabetic acute myocardial infarction patients in Quebec acute care hospitals

BackgroundPrevious studies have evaluated the individual effects of acute myocardial infarction (AMI) and diabetes mellitus on health-related quality of life outcomes (QOL). Due to the rising incidence of these comorbid conditions, it is important to examine the synergistic impact of diabetes mellitus and AMI on QOL.MethodsIn this study, we assessed using several previously validated questionnaires the QOL and functional status of 96 diabetic patients and 491 non-diabetic patients admitted to Quebec hospital sites with AMI between 1997 and 1998. We also conducted multivariate analyses to ascertain whether diabetes mellitus was an independent determinant of SF-36 physical functioning (PCS) and mental health (MCS) component score QOL outcomes after AMI.ResultsBoth patient groups had similar baseline clinical characteristics, but diabetic patients had slightly higher rates of cardiac risk factors compared to non-diabetics. Overall, QOL measures were similar between both patient groups at baseline, but diabetic patients reported poorer functional status than non-diabetic patients. Over the study period, there were significant differences between the QOL and functional status of diabetic and non-diabetic populations. By one year, diabetic patients reported poorer QOL outcomes than non-diabetic patients. However, diabetic patients showed greater improvements in their functional status, but were less likely to return to work compared to non-diabetic patients. In contrast with these findings, our multivariate analyses showed that diabetes mellitus was not an independent determinant of QOL and functional status.ConclusionOur study findings suggest that diabetes mellitus is not an independent determinant of QOL after AMI.

Physical Function And Health-related Quality Of Life In Culturally Diverse Elders

PURPOSE The theory of environmental press suggests that health-related quality of life (HRQL) may be compromised when environmental demands are not matched with functional ability. The purpose of this investigation was to examine physical function and HRQL in culturally diverse elders. METHODS Seventy-eight older adults were evaluated for physical function using the continuous-scale physical functional performance test (CS-PFP) and HRQL using the SF-36 v. 2. Twenty-six predominantly African American community dwelling participants were from a lower socio-economic class (LOW), 26 were Caucasian adults from a higher socio-economic class (HIGH), and 26 were randomly selected from a larger population-based study (POP). RESULTS One-way ANOVA and follow-up LSD comparisons revealed group differences in age between LOW (72.2 ± 8.1 years) and HIGH (77.6 ± 4.8 years), while the mean age of the POP group = (73.4 ± 6.4). MANCOVA (age as a covariate) revealed group differences in physical function (F = 3.796, p <.001) and HRQL (F = 3.396, p <0.001). Follow-up LSD comparisons revealed that the LOW group had greater upper body strength compared to both the HIGH and POP groups (61.2 ± 3.7 vs. 43.6 ± 3.6 and 35.4 ± 3.6, respectively), and greater lower body strength (42.2 ± 3.3 vs. 36.5 ± 3.6) and total CS-PFP score (55.5 ± 3.5 vs. 44.4 ± 3.4) than the POP group. With respect to HRQL, the POP group had poorer SF-36 role physical (RP), physical function (PF), and physical component subscale (PCS) scores than the LOW and HIGH groups (PF: POP = 53.3 ± 5.8, LOW = 76.6 ± 5.3, HIGH = 75.5 ± 5.4; RP: POP = 56.6 ± 6.9, LOW = 80.9 ± 6.4, HIGH = 85.8 ± 6.4; PCS: POP = 38.3 ± 2.1, LOW = 49.6 ± 2.0, HIGH = 48.0 ± 2.0). The LOW had poorer mental health (MH) and mental component subscale (MCS) scores than the HIGH and POP groups (MH: LOW = 69.2 ± 2.6, HIGH = 88.4 ± 2.6, POP = 85.1 ± 2.6; MCS: LOW = 51.5 ± 1.4, HIGH = 57.7 ± 1.5, POP = 58.2 ± 1.6). CONCLUSIONS These findings are consistent with the theory that environmental press may interact with functional ability to impact HRQL.

Physical Function And Health-related Quality Of Life In Culturally Diverse Elders

PURPOSE The theory of environmental press suggests that health-related quality of life (HRQL) may be compromised when environmental demands are not matched with functional ability. The purpose of this investigation was to examine physical function and HRQL in culturally diverse elders. METHODS Seventy-eight older adults were evaluated for physical function using the continuous-scale physical functional performance test (CS-PFP) and HRQL using the SF-36 v. 2. Twenty-six predominantly African American community dwelling participants were from a lower socio-economic class (LOW), 26 were Caucasian adults from a higher socio-economic class (HIGH), and 26 were randomly selected from a larger population-based study (POP). RESULTS One-way ANOVA and follow-up LSD comparisons revealed group differences in age between LOW (72.2 ± 8.1 years) and HIGH (77.6 ± 4.8 years), while the mean age of the POP group = (73.4 ± 6.4). MANCOVA (age as a covariate) revealed group differences in physical function (F = 3.796, p <.001) and HRQL (F = 3.396, p <0.001). Follow-up LSD comparisons revealed that the LOW group had greater upper body strength compared to both the HIGH and POP groups (61.2 ± 3.7 vs. 43.6 ± 3.6 and 35.4 ± 3.6, respectively), and greater lower body strength (42.2 ± 3.3 vs. 36.5 ± 3.6) and total CS-PFP score (55.5 ± 3.5 vs. 44.4 ± 3.4) than the POP group. With respect to HRQL, the POP group had poorer SF-36 role physical (RP), physical function (PF), and physical component subscale (PCS) scores than the LOW and HIGH groups (PF: POP = 53.3 ± 5.8, LOW = 76.6 ± 5.3, HIGH = 75.5 ± 5.4; RP: POP = 56.6 ± 6.9, LOW = 80.9 ± 6.4, HIGH = 85.8 ± 6.4; PCS: POP = 38.3 ± 2.1, LOW = 49.6 ± 2.0, HIGH = 48.0 ± 2.0). The LOW had poorer mental health (MH) and mental component subscale (MCS) scores than the HIGH and POP groups (MH: LOW = 69.2 ± 2.6, HIGH = 88.4 ± 2.6, POP = 85.1 ± 2.6; MCS: LOW = 51.5 ± 1.4, HIGH = 57.7 ± 1.5, POP = 58.2 ± 1.6). CONCLUSIONS These findings are consistent with the theory that environmental press may interact with functional ability to impact HRQL.

Inflammatory and Thrombotic Blood Markers and Walking‐Related Disability in Men and Women with and Without Peripheral Arterial Disease

To determine whether higher circulating levels of thrombotic and inflammatory markers are associated with greater disability. Cross-sectional. Academic medical center. A total of 346 men and women with peripheral arterial disease (PAD) and 203 without PAD. Disability measures were the Walking Impairment Questionnaire (WIQ) distance, speed, and stair-climbing scores and the 36-item Short-Form (SF-36) physical functioning score. The SF-36 and WIQ are scored on a 0 to 100 scale (100=best). In persons with PAD, higher D-dimer levels were associated with lower WIQ speed scores (P<.001), lower stair-climbing scores (P<.04), and poorer SF-36 physical functioning scores (P<.01), adjusting for known and potential confounders. In participants without PAD, higher D-dimer levels were associated with lower WIQ distance scores (P<.03), lower speed scores (P<.05), and poorer SF-36 physical functioning scores (P<.02). Higher high-sensitivity C-reactive protein (hsCRP) levels were associated with lower WIQ distance (P<.02) and speed scores (P<.001) in persons without PAD. Most of these associations were attenuated after additional adjustment for objectively measured functional limitations. Higher circulating D-dimer and hsCRP levels are associated with greater disability in walking and physical functioning in individuals with and without PAD. Physiological changes that result in walking disability may mediate these associations.

Efficacy of Commonly Used Screening Parameters in Predicting Physical Function in Community Dwelling Older Adults.

2201 PURPOSE: By the year 2030, persons 85 years or older will be the fastest growing segment of the population, and the number who are 65 years or older will reach 70 million in the United States (ACSM, 1998). Because of this, it is important to identify effective screening methods for predicting functional independence among older adults. Parameters that are often used in primary care screening include Body Mass Index (BMI) and self-report measures such as the Medical Outcomes Survey (S hort Form – 36). This study investigated the efficacy of screening parameters that are commonly used in primary care to predict performance-based measures of physical function among independent older adults. METHODS: A cross sectional design was used. The sample included 34 male and 51 female subjects 58–84 years of age. All subjects were independent community dwellers that reported a high level of function in activities of daily living. Each subject completed: (1) the Continuous Scale Physical Functional Performance Test – a performance-based measure of physical function and (2) the MOS SF-36. In addition, Body Mass Index was calculated for all subjects. Multiple regression was used to identify predictors of overall performance-based physical function (CSP-total), upper body strength (CSP-UBS), and lower body strength (CSP-LBS) from a set of commonly used screening variables including age, BMI, SF-36 Physical Function score (SF-PF), and SF-36 General Health score (SFGH). RESULTS: Multiple regression indicated that age (p = .000, partial r2 adj. = .417) and SF-PF (p = .000, partial r2 adj. = .099) were significant predictors of CSP-total; age (p = .000, partial r2 adj. = .302) and SF-PF (p = .003, partial r2 adj. = .064) were significant predictors of CSP-UBS; and age (p = .000, partial r2 adj. = .412) and SF-PF (p = .000, partial r2 adj. = .086) were significant predictors of CSP-LBS. SF-GH and BMI were ineffective predictors of all performance measures. CONCLUSIONS: This study indicates that age is the only substantive predictor of performance-based physical function in this sample of high functioning older adults. Even though SF-PF was a significant predictor, it added little to the overall variance accounted for in the model used. These results suggest the need for more discriminating field screening tools for predicting physical function among healthy, independent community dwelling older adults such as this sample when resources, time, and money are not readily available for performance-based testing. Results also suggest that performance-based measures should be used whenever possible since SF-PF accounted for only 6.4 to 9.9% of the variance in CSP measures.

Objective Levels of Physical Activity and Performance and Selfreported Physical Function in Fibromyalgia (FM) Patients

2097 Purpose: Interpretation of self-report physical function is confounded by a dearth of accurate and specific measures of physical activity and function. Patients' self-reports of physical function are likely obfuscated by illness beliefs and fear of ramifications. This study sought to determine if 2 surrogate measures of physical function (activity monitoring and submaximal exercise testing) were related to self-reported physical function in FM. Methods: Thirty-five FM patients (40.7 ± 9.6yr; 74% female) and 43 controls (CTL, 37.7 ± 9.1; 47% female) completed a submaximal bicycle test. The test consisted of continuous 3-min stages, culminating when HR reached 85% of agepredicted maximum. Peak exercise performance was de. ned as the highest wattage achieved. Of these subjects, 30 FM (41.5 ± 8.9; 77% female) and 29 CTL (38 ± 8.9, 48% female) also wore an activity monitor for 5 consecutive days and 4 nights. Activity was sampled in 30-sec epochs, averaged into 5-min intervals. Self-reported physical functioning was assessed via the SF-36 and the Multidimensional Fatigue Inventory. Results: Mean peak performance on the exercise test was lower for the FM group than CTL (98 ± 30 watts vs. 128 ± 43, p = 0.001). Average daytime and nighttime activity levels were similar between FM and CTL (daytime: 1456 ± 492 vs. 1445 ± 556 and nighttime: 147 ± 156 vs. 152 ± 107 activity units, respectively). However, peak activity was significantly lower in FM relative to CTL (7870 ± 3223 vs. 12178 ± 7862 activity units, p = 0.023), and was more variable. As expected, peak and average symptom ratings were higher in FM than CTL and SF-36 physical functioning scores were lower (SF-36 physical composite score: 35.6 ± 10.8 vs. 55.8 ± 5.4, p = 0.00). However, none of these variables were related to average or peak activity levels. No objective measure of activity (peak exercise performance or peak or average activity) was correlated with any self-report measure of function, or symptoms, in either the patient or control group (r's = −.05 to 0.23). Conclusions: FM patients report the lowest physical function among almost all rheumatic illnesses. Despite this, FM patients in this study were able to maintain a “normal” average level of activity relative to the controls, albeit with considerably greater variability. Peak physical function as evaluated by 2 different measures was not related to self-reported physical function in either FM or CTL. These observations suggest that factors other than pure physical movement influence selfreported functioning, and support the notion that peak activity levels and peak exercise performance are indices of “capacity” rather than indices of day-to-day patient ability.

Efficacy of Commonly Used Screening Parameters in Predicting Physical Function in Community Dwelling Older Adults.

2201 PURPOSE: By the year 2030, persons 85 years or older will be the fastest growing segment of the population, and the number who are 65 years or older will reach 70 million in the United States (ACSM, 1998). Because of this, it is important to identify effective screening methods for predicting functional independence among older adults. Parameters that are often used in primary care screening include Body Mass Index (BMI) and self-report measures such as the Medical Outcomes Survey (S hort Form – 36). This study investigated the efficacy of screening parameters that are commonly used in primary care to predict performance-based measures of physical function among independent older adults. METHODS: A cross sectional design was used. The sample included 34 male and 51 female subjects 58–84 years of age. All subjects were independent community dwellers that reported a high level of function in activities of daily living. Each subject completed: (1) the Continuous Scale Physical Functional Performance Test – a performance-based measure of physical function and (2) the MOS SF-36. In addition, Body Mass Index was calculated for all subjects. Multiple regression was used to identify predictors of overall performance-based physical function (CSP-total), upper body strength (CSP-UBS), and lower body strength (CSP-LBS) from a set of commonly used screening variables including age, BMI, SF-36 Physical Function score (SF-PF), and SF-36 General Health score (SFGH). RESULTS: Multiple regression indicated that age (p = .000, partial r2 adj. = .417) and SF-PF (p = .000, partial r2 adj. = .099) were significant predictors of CSP-total; age (p = .000, partial r2 adj. = .302) and SF-PF (p = .003, partial r2 adj. = .064) were significant predictors of CSP-UBS; and age (p = .000, partial r2 adj. = .412) and SF-PF (p = .000, partial r2 adj. = .086) were significant predictors of CSP-LBS. SF-GH and BMI were ineffective predictors of all performance measures. CONCLUSIONS: This study indicates that age is the only substantive predictor of performance-based physical function in this sample of high functioning older adults. Even though SF-PF was a significant predictor, it added little to the overall variance accounted for in the model used. These results suggest the need for more discriminating field screening tools for predicting physical function among healthy, independent community dwelling older adults such as this sample when resources, time, and money are not readily available for performance-based testing. Results also suggest that performance-based measures should be used whenever possible since SF-PF accounted for only 6.4 to 9.9% of the variance in CSP measures.

Physical Functioning: Self-Report and Performance Measures Are Related but Distinct

Cross-sectional study of 63 patients with chronic low back pain (CLBP). To determine the relationship between the SF-36 physical functioning (PF) scale and physical performance on a modified symptom limited treadmill test, and to determine the effect of disability status and SF-36 mental health (MH) scores on self-reported physical functioning and on physical performance. Patients with CLBP report low levels of physical functioning. Because self-report measures are influenced by psychosocial factors, such as disability and low MH, a common recommendation is to supplement self-report with objective or physical performance testing. Little information exists regarding whether performance testing is also influenced by disability and low MH. Patients completed the SF-36 and performed a maximal, symptom-limited, modified treadmill test. Total walking time and heart rate on the treadmill were registered. The effects of disability and low MH on self-report and performance testing were calculated by unpaired Student's t-testing and effect size estimation. A strong relationship between the PF scale of the SF-36 and treadmill walking time was found, but there was little evidence of overlap between these physical functioning domains. Both disability status and low MH had a much larger effect on self-report measures than on physical performance. Self-report measurements and performance-based assessments provide information about distinct, although related, domains of physical functioning. Disability and low MH are associated with lower SF-36 PF scores. Our results confirm that self-report measures require supplementation with objective performance testing to provide optimal assessment for patients with CLBP.

Enhancing function in older adults with chronic low back pain: a pilot study of endurance training

Iversen MD, Fossel AH, Katz JN. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Arch Phys Med Rehabil 2003;84:1324–31. Objectives To assess the effectiveness of a bicycle endurance program in older adults with chronic low back pain (CLBP) and to identify correlates of exercise adherence. Design Prospective cohort. Setting Residential facilities and a tertiary care hospital. Participants Adults with CLBP aged 55 years and older. Of 29 subjects who agreed to participate, 3 (10%) were deemed ineligible at baseline. Nineteen subjects (73%) were women, and the median age was 72 years. Interventions Subjects were assessed at baseline and at 6 and 12 weeks by using standardized questionnaires, physical examination, and endurance testing by a physical therapist. Subjects received a bicycle and instructions to exercise 3 times a week for 12 weeks at a set wattage. A trained rescarcher collected exercise data weekly. Main outcome measures The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the lumbar spinal stenosis symptom severity and function scales, and kilocalories were used to assess change. Results At baseline, subjects were moderately impaired (mean SF-36 physical function score, 52.6). Eighteen (65%) completed the trial. At 12 weeks, physical functioning (SF-36) improved by 11%, mental health (Mental Health Inventory 5-Item Questionnaire) improved by 14%, and CLBP symptoms decreased by 8%. Reasons for withdrawing included illness, family issues, and bicycle-related discomfort. Conclusions The bicycle program was safe and effective for improving functional status and well-being.