Short Physical Performance Battery Assessments Research Articles

#1874 Comparative analysis of rehabilitation outcomes in hospitalized hemodialysis vs. non-hemodialysis patients: a retrospective cohort study

Abstract Background and Aims The hospitalization rate of patients undergoing hemodialysis (HD) is high, due to complications related to renal failure and hemodialysis treatment. Therefore, it is crucial to provide rehabilitation for hospitalized HD patients to improve their activities of daily living (ADL) and physical functions, so as to enable them to be discharged home, resume outpatient dialysis, and avoid re-hospitalization. However, the effectiveness of rehabilitation to improve the ADL and physical functions may differ between hospitalized patients undergoing HD (HD patients) and hospitalized patients not undergoing HD (non-HD patients), depending on their pathological conditions and influence of the HD treatment. The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD patients and non-HD patients. Method This was a retrospective cohort study. The inclusion criteria were hospitalized patients who received rehabilitation between April 2017 and February 2023. The exclusion criteria were patients who discontinued rehabilitation, were transferred to other hospitals, or died during the rehabilitation period. Rehabilitation consisted of physical therapy and/or occupational therapy provided six times a week, for both hospitalized HD and non-HD patients. The rehabilitation program comprised balance training, aerobic exercises, resistance training, and ADL training to prepare the patients for discharge to their homes. We measured several outcomes in the study, including the daily duration of rehabilitation (min/day), length of hospital stay (days), Barthel index (BI), as the ADL index, at the time of admission and discharge, grip strength and isometric knee extension strength (IKES) as muscle strength indices, and the 10-meter walking speed, timed up and go test (TUG), and short physical performance battery (SPPB) as mobility function indices. For the statistical analysis, missing values were completed by using multiple imputation methods. The inverse probability weighting (IPTW) method was used to match the HD group and non-HD group to adjust for confounding factors. The outcomes between the groups were then compared using a generalized linear model analysis. All procedures in the present study were conducted with the approval of the ethics committee of Seirei Christopher University. Results Of 1002 patients who were registered for the study, 100 patients who discontinued rehabilitation, were transferred to other hospitals, or died were excluded, and the data of the remaining 902 patients (765 of the non-HD group and 137 of the HD group) were included in the analysis in this study. The results of the generalized linear model analysis revealed a lower daily duration of rehabilitation [43.3(0.6) vs. 38.8(1.2) min/day, p=0.0003] and longer length of hospital stay [48.5(0.5) vs. 58.1(2.3) days, p=0.0108] in the HD group. In addition, the 10-meter walking speed [0.75(0.02) vs. 0.66(0.03) m/s, p=0.003] and scores on the TUG [20.8(0.7) vs. 24.3(1.0) sec, p=0.0021] and SPPB [6.3(4.57) vs. 4.7(0.6) points, p=0.0415] at discharge were also significantly lower in the HD group as compared with the non-HD group. There was no difference in the ability for ADL or muscle strength at discharge between the two groups. Conclusion This study was the first to demonstrate a lower daily duration of rehabilitation and longer hospital stay in hospitalized HD patients. Furthermore, rehabilitation had a lower impact on the mobility indices in HD patients as compared with non-HD patients. Although there was no difference in the ability for ADL or muscle strength at discharge between the two groups, HD patients exhibited a significantly lower ability for mobility functions, including a lower gait speed and lower scores on the TUG, and SPPB assessments. Therefore, rehabilitation efforts in HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement.

Prevalence and incidence of mobility limitation in Chinese older adults: evidence from the China health and retirement longitudinal study

BackgroundMobility limitation, a manifestation of impaired intrinsic capacity, is the first obvious sign of functional decline. However, few studies have been conducted on the prevalence and incidence of mobility limitation. This study aimed to estimate the prevalence and incidence of mobility limitation in Chinese older adults (over 60 years old) and evaluate its impact on mortality. MethodsThe study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013. The prevalence and incidence of mobility limitation were assessed using the methods recommended by the World Health Organization in the integrated care for older people guidelines, using the five-time sit-to-stand test as a screening and then the Short Physical Performance Battery assessment for diagnosis. Multivariable logistic regression was used to analyze the association between mobility limitation and death. ResultsOf the 5507 participants with complete baseline data, 1486 had limited mobility, and 4021 had intact mobility at baseline; 4093 participants completed follow-up assessment 2 years later, and 189 died between the baseline and follow-up assessments. Of the 2828 participants with intact mobility at baseline who completed the follow-up mobility assessment, 408 developed mobility limitation. The standardized prevalence was 30.4% (95% CI = 28.8–32.1 %). The standardized incidence of mobility limitation in 2 years was 18.1% (95% CI = 15.8–20.4 %). A total of 189 patients died during the follow-up period. After adjusting for sociodemographic factors and chronic diseases, mobility limitation was associated with an increased risk of death (odds ratio = 1.84, 95% CI = 1.33–2.55, P < .001). ConclusionsThe standardized prevalence of mobility limitation in Chinese older adults living in the community was 30.4%, and the standardized incidence was 18.1%. Mobility limitation significantly predicts 2-year death in older adults. This suggests that early screening, assessment of intrinsic capacity (particularly locomotion domain) as well as tailored interventions to tackle mobility limitation in older adults might reduce mortality.

RACE AND PLACE: PHYSICAL PERFORMANCE DECLINES IN BLACK AND WHITE OLDER ADULTS IN FOUR US COMMUNITIES

Abstract Studies suggest disparities in physical function between Black and White adults, but most lack longitudinal, objective functional measures across race and geographic regions. We examined Short Physical Performance Battery (SPPB) changes among 5,836 Black and White older adults (&amp;gt;65 years, 22% Black, 41% men) with up to three SPPB assessments. Exams were conducted in the Atherosclerosis Risk in Communities Study (Visit 5 (2011-13)-Visit 7 (2017-19), median follow-up 5.8 years (max 8.4)) in four US communities: North Carolina (n=1248; 7% Black), Mississippi (n=1179, 100% Black), Maryland (n=1618; 0.9% Black) and Minnesota (N=1791; n=0.5% Black). A difference of 0.5 SPPB points (scored 0-12) is clinically meaningful. SPPB declines were estimated using marginal standardization following GEE (with log-links, negative binomial distributions, exchangeable covariance, robust SE, adjusting for demographics, BMI, diabetes, hypertension, smoking, drinking status, heart failure, heart disease, and stroke). SPPB declines were 3.4 times greater among Black versus White participants overall; -1.99 versus -0.59 points; absolute difference=-1.41 (95% CI: -1.67,-1.14), relative difference=3.40 (2.65, 4.15). However, some within-race, between-site differences were similar; Maryland-White SPPB declines were 3.8 (2.3, 6.3) times greater than North Carolina-White SPPB declines, and Mississippi-Black declines were 2.5 (1.10, 5.90) times greater than North Carolina-Black declines. Furthermore, between-race (Black versus White) differences were less supported statistically within the same site; SPPB declines were 2.2 (0.85, 5.80) greater in Black than White participants in North Carolina. This suggests that regional variations in physical function declines may be at least as strong as differences attributed to race; both are important to consider.

The pace of biological aging helps explain the association between insomnia and chronic low back pain.

Chronic low back pain (cLBP) is associated with insomnia and advanced age. Emerging evidence suggests that the severity of both sleep disorders (like insomnia) and chronic pain are associated with a faster pace of biological aging. We aimed to determine whether the pace of biological age mediates the relationship between insomnia and the impact of cLBP in a sample of community-dwelling adults ages 19 to 85 years. Participants (49 with no pain, 32 with low-impact pain, and 37 with high-impact pain) completed sociodemographic, pain, insomnia, and short physical performance battery assessments. We calculated the pace of biological aging using DunedinPACE from blood leukocyte DNA. On average, individuals with high-impact cLBP had significantly faster biological aging than those with low-impact and no chronic pain (p < .001). Bivariate associations of DunedinPACE scores with insomnia severity and functional performance were significant at p < .01 (rs = 0.324 and -0.502, respectively). After adjusting for race and sex, the association of insomnia severity and the impact of cLBP was partially mediated by the pace of biological aging (β = 0.070, p < .001). Also, the association of insomnia severity with functional performance was partially mediated by the pace of biological aging (β = -0.105, p < .001). Thus, insomnia remains strongly predictive of cLBP outcomes, and the pace of biological aging helps explain this association. Future prospective studies with repeated assessments are needed to uncover the directionality of these complex relationships and ultimately develop interventions to manage cLBP.

Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen?

There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.

Immunometabolic signatures predict recovery from thyrotoxic myopathy in patients with Graves' disease

BackgroundThyroid hormone excess induces protein energy wasting, which in turn promotes muscle weakness and bone loss in patients with Graves' disease. Although most studies have confirmed a relationship between thyrotoxicosis and muscle dysfunction, few have measured changes in plasma metabolites and immune cells during the development and recovery from thyrotoxic myopathy. The aim of this study was to identify specific plasma metabolites and T‐cell subsets that predict thyrotoxic myopathy recovery in patients with Graves' disease.MethodsOne hundred patients (mean age, 40.0 ± 14.2 years; 67.0% female), with newly diagnosed or relapsed Graves' disease were enrolled at the start of methimazole treatment. Handgrip strength and Five Times Sit to Stand Test performance time were measured at Weeks 0, 12, and 24. In an additional 35 patients (mean age, 38.9 ± 13.5 years; 65.7% female), plasma metabolites and immunophenotypes of peripheral blood were evaluated at Weeks 0 and 12, and the results of a short physical performance battery assessment were recorded at the same time.ResultsIn both patient groups, methimazole‐induced euthyroidism was associated with improved handgrip strength and lower limb muscle function at 12 weeks. Elevated plasma metabolites including acylcarnitines were restored to normal levels at Week 12 regardless of gender, body mass index, or age (P trend <0.01). Senescent CD8+CD28−CD57+ T‐cell levels in peripheral blood were positively correlated with acylcarnitine levels (P < 0.05) and decreased during thyrotoxicosis recovery (P < 0.05). High levels of senescent CD8+ T cells at Week 0 were significantly associated with small increases in handgrip strength after 12 weeks of methimazole treatment (P < 0.05), but not statistically associated with Five Times Sit to Stand Test performance.ConclusionsRestoring euthyroidism in Graves' disease patients was associated with improved skeletal muscle function and performance, while thyroid hormone‐associated changes in plasma acylcarnitines levels correlated with muscle dysfunction recovery. T‐cell senescence‐related systemic inflammation correlated with plasma acylcarnitine levels and was also associated with small increases in handgrip strength.

Implementing routine physical function screening among elderly HIV-positive patients in Uganda

ABSTRACT We conducted a cross-sectional study to describe routine physical function assessment for HIV-infected adults aged ≥60 years attending a large urban HIV clinic in Kampala, Uganda. Assessed demographic and clinical factors associated with low physical function in the population, generalized linear regression model was used to estimate factors associated with low physical function. Of the 93 elderly patients that underwent the Short Physical Performance Battery (SPPB) assessment, 43/93 (44.1%) scored 1–8 points at the SPPB evaluation and were categorized as low function, 45/93 (48.4%) scored 9–11 points and were categorized as moderate function and 7/93 (7.5%) scored 12 points and were categorized as high (normal) function. Women (adjusted risk ratio (ARR) 2.57; 95% confidence interval (CI): 1.54–4.29, p = 0.000) had increased risk of low physical function compared to men. A one-year increase in age (ARR = 1.09; CI: 1.03–1.15, p = 0.004) and being overweight (BMI > 25.0, ARR = 1.96; CI: 1.89–3.24, p = 0.008) also carried an increased risk of low physical function status. A higher number 13/41(32%) of falls was recorded in female than among male 3/53(5.8%) patients (p = 0.001). The SPPB assessment is a starting point for clinicians to comprehensively evaluate and consider the management of physical function limitation among older HIV-positive patients.

Assessing Levels of Frailty in a Cohort of Lung Transplant Candidates Using Pre-Transplant Frailty Assessments

Purpose Frailty, a syndrome of fatigue, muscle wasting and weakness, has been shown to associate with adverse outcomes after surgery in many patients, and its importance in the lung transplant population was described by Singer and colleagues. This study explores the prevalence of frailty among lung transplant candidates using two standard frailty measures and their relationship with the lung allocation score (LAS). Methods In a single-center prospective study, frailty was assessed in lung transplant candidates ≥60 years of age using Fried's Frailty Phenotype (FFP) and the Short Physical Performance Battery (SPPB). The FFP score is based on self-reported weight loss, fatigue, physical activity, and measures of gait speed and grip strength. The SPPB score consists of measures of gait speed, balance, and lower extremity strength. Previously established cutoffs were used: FFP score of 0 = non-frail; 1-2 = pre-frail; 3-5 = frail; SPPB score of 0-6 = frail; 7-9 = pre-frail; 10-12 = non-frail. The LAS score was calculated from clinical and imaging data obtained during transplant candidacy evaluation. Results Out of 32 subjects, 26 completed both the SPPB and FFP assessments, while 6 completed only the SPPB assessment. The average SPPB and FFP scores were 8.4 (±2.7) and 2.8 (±1.2), respectively. SPPB and FFP were only weakly correlated with adjusted r2 0.133 (p = 0.038). The average LAS score was 43.8 (±14.3). Both the SPPB (r2 = 0.41, p Conclusion In lung transplant candidates, the prevalence of frailty considerably varies based upon which frailty assessment tool is utilized. Compared to the FFP score, the SPPB score has a stronger correlation with the LAS. A better understanding of the relationship between frailty measures and risk predictors such as the LAS will help to improve pre-transplant risk assessment protocols, identify vulnerable patients, and target interventions to optimize outcomes. Patient enrollment is ongoing at our center.