Short Physical Performance Battery Total Score Research Articles

Beyond sarcopenia: frailty in chronic haemodialysis patients.

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

Predictors of Urinary and Fecal Incontinence in Prefrail and Frail Older Adults: A Cross-Sectional Study of the FRAGSALUD Project.

Frailty is associated with urinary and fecal incontinence, which are common geriatric syndromes. This study aims to identify health factors associated with incontinence in prefrail or frail older adults living in the community. This multicenter cross-sectional study included 225 older adults (75.0 ± 6.4 years) with prefrailty or frailty based on the 5-component Fried phenotype. Physical function was assessed using the Short Physical Performance Battery (SPPB). Physical activity, inactivity, and sleep were estimated using a wrist-worn accelerometer. Urinary or fecal incontinence was registered using the Barthel scale (urine and bowel items). Multivariable logistic regression analyses, with age as a covariate, were conducted to identify associations of incontinence. In our participants, 27% presented urinary or fecal incontinence with no sex differences (p = .266). Our results showed that age, daily medication count, and number of falls in the previous year independently predicted incontinence in frail and prefrail older adults (p < .05). Some Fried's criteria, including self-reported exhaustion, gait speed, and handgrip strength, were associated with the presence of incontinence (p < .05), but not Fried's classification. The SPPB total score and its isolated variables were significantly associated with the urinary and fecal incontinence (p < .05). However, none of the accelerometer outcomes showed significant associations with incontinence status. According to this study, age, number of medications, and falls (but not sex) are linked to urinary and fecal incontinence in frail or prefrail older adults living in the community, recommending the assessment of physical function using the SPPB rather than estimating daily physical activity, inactivity, or sleep.

Plasma levels of Neurofilament light chain correlate with handgrip strength and sarcopenia in patients with chronic obstructive pulmonary disease

BackgroundAge-associated muscle decline, termed sarcopenia, is a common systemic effect of chronic obstructive pulmonary disease (COPD). Circulating Neurofilament light chain (NfL) levels reflect neuronal degradation and may be relevant to sarcopenia phenotype. However, such an association in COPD patients remains elusive. MethodsWe investigated male, 60–76 years old controls (n = 50) and COPD patients (n = 139) for plasma NfL levels in relation to sarcopenia and physical capacity markers. We measured handgrip strength (HGS), body composition, and short physical performance battery (SPPB) to evaluate sarcopenia and physical capacity. ResultsCOPD patients had higher plasma NfL and lower HGS and SPPB performance than controls. Plasma NfL levels demonstrated negative associations with HGS and gait speed in COPD patients (all p < 0.05). Further, NfL levels were negatively associated with total SPPB scores in controls and patients with advanced COPD (p < 0.05). Plasma NfL also demonstrated an acceptable accuracy in diagnosing sarcopenia in controls (AUC = 0.757, p < 0.05) and COPD (AUC = 0.806, p < 0.05) patients. ConclusionCollectively, plasma NfL may be helpful in evaluating sarcopenia phenotype and physical capacity in geriatric patients with COPD.

Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study

BackgroundPreservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT).MethodsData were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed “Up & Go” (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system.ResultsBoth the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible.ConclusionsSSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care.Trial RegistrationDRKS00026191.

Adaptation and reliability of tests of functional mobility and muscle strength using telehealth for older people with dementia

Objective: Adapt functional mobility and muscle strength tests for older people with dementia to be performed remotely in the home environment; determine intra-rater and inter-rater reliability of functional mobility and strength tests for older people with dementia; and correlate the performance on the physical tests executed remotely and the Timed Up and Go (TUG) test, which was validated remotely in healthy older people. Methods: We included 43 people with dementia. The Short Physical Performance Battery (SPPB), TUG, TUG Dual Task (TUG-DT), and 30-Second Sit-to-Stand Test (SST30s) were performed through videocalls. Test performance was documented to facilitate the subsequent determination of inter- and intra-rater reliability. The intra-rater reliability was determined at a 2-week interval from the real-time videocall to analysis of the recording. Results: Intra-rater reliability ranged from good to excellent for all tests performed (ICC 0.862–1.000). Inter-rater reliability values were fair for gait speed (ICC = 0.223), moderate for some of the SPPB items (ICC = 0.706–0.801), good for the SPPB two-foot balance (ICC = 0.860) and the SPPB total score (ICC = 0.831), and excellent for the rest of the tests. Conclusion: Functional mobility and muscle strength tests proved reliable and feasible for remote, at-home assessments of older people with dementia when assisted by their respective caregivers, providing an additional alternative for assessment of this patient population.

Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial

ObjectivesThis study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. Study designA randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. Main outcome measuresThe primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. ResultsAfter completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. ConclusionsOur findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.

Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events

ObjectiveSevere acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients’ risk for future events. MethodsThis observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected. ResultsForty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1. ConclusionPatients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge.

Examining the safety and effectiveness of a 4-week supervised exercise intervention in the treatment of frailty in patients with chronic kidney disease.

The optimal duration of antifrailty interventions and how best to deliver them to patients with chronic kidney disease (CKD) is unknown. The aim of this study was to examine the safety, feasibility and preliminary efficacy of a 4-week supervised exercise intervention on frailty in patients with CKD. We conducted a prospective feasibility study involving patients with ≥stage 3 CKD (1 patient with stage 3 CKD, 7 patients with stage 4 CKD and 17 patients with stage 5 CKD) who were either frail or prefrail according to the physical frailty phenotype and/or had a Short Physical Performance Battery (SPPB) score ≤10. The exercise intervention consisted of two supervised outpatient sessions per week for 4weeks (eight total sessions). Frailty and other study measures were assessed at baseline and after 4weeks of exercise. Of the 34 participants who completed the baseline assessment and were included in the analyses, 25 (73.5%) completed the 4-week assessment. Overall, 64.0% of patients were on dialysis and 64.0% had diabetes mellitus. After 4weeks of exercise, frailty prevalence, total SPPB scores and energy/fatigue scores improved. No adverse study-related outcomes were reported. The 4weeks of supervised exercise was safe, was associated with an excellent completion rate and improved frailty parameters in CKD patients with CKD. This study provides important preliminary data for a future larger prospective randomized study. registration: NCT03535584.

Functional status and quality of life in post-COVID-19 patients two to three weeks after hospitalization: A cross-sectional study.

Extended hospitalization due to coronavirus disease 2019 (COVID-19) is associated with residual musculoskeletal and functional deficits lasting even 6 months after discharge; therefore, it is crucial that post-hospitalized patients are promptly assessed. The aim of this study was to identify post-COVID-19 patients' functional status and quality of life, as well as to investigate their inter-relatedness 2-3 weeks after hospital discharge. The study included 39 post-COVID-19 patients previously hospitalized in the Clinic for Infectious Diseases at the University Clinical Center of Kosovo (UCCK) from August to December 2021. Physiotherapeutic assessment encompassed socio-demographic and clinical data including Short Physical Performance Battery (SPPB) for physical functional performance, hand grip strength, 6-min Walk Test (6MWT) for aerobic capacity and endurance, EuroQol 5-Dimension 5-Level (EQ-5D-5L) for quality of life, Visual Analogue Scale (VAS) for pain, Borg CR10 for dyspnea, peripheral oxygen saturation and heart rate. Descriptive statistics, Pearson correlation, and multiple linear regression analysis were utilized for data processing. The median (interquartile range [IQR]) for Borg CR10, VAS pain scale, total SPPB, grip strength, and 6MWT were 1 (0-3), 3 (1-6), 9 (8-10), 30.5 (23.2-43.5) kg, 344.5 (312.7-381.7) m respectively, while the mean (SD) for EQ-5D-5L index value was 0.7 (0.2). The strongest and most significant correlation was depicted between SPPB total score and its subscales, followed by correlation with EQ-5D-5L (r = 0.719, p < 0.001), grip strength (r = 0.612 p < 0.001), Borg CR10 (r = -0.515, p = 0.001), 6MWT (r = 0.416, p = 0.02), and VAS scale (r = -0.343, p = 0.03). Using the multiple regression analysis, the grip strength, Borg-CR10, and 6MWT were found to be strongly predictive of SPPB total score. In post-COVID-19 patients' functional status and quality of life were impaired 2-3 weeks following hospitalization. SPPB showed the most frequent and significant correlation with other variables, hence it should be considered as one of the primary screening tools.

0850 Association of Actigraphy-Assessed Sleep Parameters and Physical Functioning following Acute Hospitalization in Older Adults

Abstract Introduction Three out of 10 older adults are admitted for acute care in U.S. hospitals where they are at risk for a rapid decline in physical function due to deconditioning. Identifying factors, such as sleep continuity, that may be related to recovery of physical functioning is a key step in facilitating independence following hospital discharge. Thus, this study aimed to examine the association between actigraphy-assessed sleep parameters and physical functioning after an acute hospitalization in community dwelling older adults. Methods Participants (n=24; age 68.9±5.5y, 71% female, 96% white), were recruited during an acute hospitalization. Participants completed physical performance testing using the Short Physical Performance Battery (SPPB) during acute hospitalization (baseline) and at 4-weeks post-discharge (follow-up). At the time of discharge, participants were given Philips Actiwatch-2® device to record sleep continuity for four weeks following hospital discharge. Actigraphy parameters included total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL) and wake after sleep onset (WASO). We conducted multivariate regression analyses using Poisson distribution to determine whether actigraphy-derived sleep parameters predicted of physical function. Results Increase in actigraphy-derived SE was associated with greater SPPB Balance (0.05±0.02, p=0.04) at the 4-week follow-up assessment. Increased TST was associated with improvements in SPPB total score (0.004±0.002, p=0.05) change score from baseline to 4-week follow-up. SE (0.11±0.04, p=0.01) and TST (0.004±0.002, p=0.005) were positively associated, whereas WASO (0.03±0.01, p=0.05) and SOL (0.15±0.07, p=0.03) were inversely associated with improvement in SPPB Balance change score from baseline to 4-week follow-up. Conclusion Together, these results demonstrated that improvements in actigraphy-derived sleep parameters (increased sleep efficiency and total sleep time; and decreased wake after sleep onset and sleep onset latency) were associated with improvements in physical functioning from hospital to 4-week follow up. Improving sleep during hospitalization may reduce hospital deconditioning and improve functional recovery. Support (if any) This work is supported by NIH Grant #s R01NR018342 (PI: Nowakowski), P30AG024832, UTMB Pepper OAIC, (PI: Volpi), UL1TR001439, (UTMB ITS); and the National Dairy Council (1229, PI: Volpi) Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).

Brain predicted age difference mediates pain impact on physical performance in community dwelling middle to older aged adults.

The purpose of the study was to examine associations between physical performance and brain aging in individuals with knee pain and whether the association between pain and physical performance is mediated by brain aging. Participants (n=202) with low impact knee pain (n=111), high impact knee pain (n=60) and pain-free controls (n=31) completed self-reported pain, magnetic resonance imaging (MRI), and a Short Physical Performance Battery (SPPB) that included balance, walking, and sit to stand tasks. Brain predicted age difference, calculated using machine learning from MRI images, significantly mediated the relationships between walking and knee pain impact (CI: -0.124; -0.013), walking and pain-severity (CI: -0.008; -0.001), total SPPB score and knee pain impact (CI: -0.232; -0.025), and total SPPB scores and pain-severity (CI: -0.019; -0.001). Brain-aging begins to explain the association between pain and physical performance, especially walking. This study supports the idea that a brain aging prediction can be calculated from shorter duration MRI sequences and possibly implemented in a clinical setting to be used to identify individuals with pain who are at risk for accelerated brain atrophy and increased likelihood of disability.

Machine learning versus binomial logistic regression analysis for fall risk based on SPPB scores in older adult outpatients.

To compare the performance of the diagnostic model for fall risk based on the short physical performance battery (SPPB) developed using commercial machine learning software (MLS) and binomial logistic regression analysis (BLRA). We enrolled 797 out of 850 outpatients who visited the clinic between March 2016 and November 2021. Patients were categorized into the development (n = 642) and validation (n = 155) datasets. Age, sex, number of comorbidities, number of medications, body mass index (BMI), calf circumference (left-right average), handgrip strength (left-right average), total SPPB score, and history of falls were determined. We defined fall risk by an SPPB score of ≤6 in men and ≤9 in women. The main metrics used for evaluating the machine learning model and BLRA were the area under the curve (AUC), accuracy, precision, recall (sensitivity), specificity, and F-measure. The commercial MLS automatically calculates the parameter range of the highest contribution. The participants included 797 outpatients (mean age, 76.3 years; interquartile range, 73.0-81.0; 288 men). The metrics of the current diagnostic model in the commercial MLS were as follows: AUC = 0.78, accuracy = 0.74, precision = 0.46, recall (sensitivity) = 0.81, specificity = 0.71, F-measure = 0.59. The metrics of the current diagnostic model in the BLRA were as follows: AUC = 0.77, accuracy = 0.75, precision = 0.47, recall (sensitivity) = 0.67, specificity = 0.77, F-measure = 0.55. The risk factors for falls in older adult outpatients were handgrip strength, female sex, experience of falls, BMI, and calf circumference in the commercial MLS. The diagnostic model for fall risk based on SPPB scores constructed using commercial MLS is noninferior to BLRA.

Associations of the Short Physical Performance Battery (SPPB) with Adverse Health Outcomes in Older Adults: A 14-Year Follow-Up from the English Longitudinal Study of Ageing (ELSA)

The Short Physical Performance Battery (SPPB) is an objective tool for evaluating three domains (balance, repeated chair stands, and gait speed) of lower extremity physical function in older age. It is unclear how the associations between SPPB scores and health outcomes persist over time. The aim of this 14-year cohort study was to investigate associations between SPPB scores and health outcomes among participants aged 60+ years in the English Longitudinal Study of Ageing (ELSA). The exposures were SPPB scores (total and domain-specific) at baseline (Wave 2). The outcomes were mobility impairments, difficulties in performing basic activities of daily living (ADL) or instrumental activities of daily living (IADL), and falls, measured at seven subsequent timepoints (Waves 3 to 9). The analyses involved linear and logistic multilevel regressions. After adjusting for potential confounders, a one-point increase in the total SPPB score was associated with a 0.13 (95% CI: -0.16, -0.10) decrease in mobility impairment, a 0.06 (-0.08, -0.05) decrease in ADL disabilities, a 0.06 (-0.07, -0.04) decrease in IADL disabilities, and 8% (0.90, 0.95) lower odds of falling (averaged across all follow-ups). Associations between the SPPB domains and health outcomes were more varied. The SPPB may be a useful measure for identifying older adults at a high risk of adverse outcomes.

Technology-based assessment of Short Physical Performance Battery in elderly population

The Short Physical Performance Battery (SPPB) is an objective evaluation of the lower extremity strength [1]. It has been proposed as a reliable method to assess the physical performance of elderly people (65+) through three simple tasks of daily life (gait, standing, chair stand) [2]. In clinical research, the SPPB is administered by research staff who are experienced in the standardized protocol of the examination, with each component measured manually by a stopwatch [3,4]. Therefore, these investigations may be subject to possible interrater and intrarater variabilities [5]. This work aims to validate an automatic method for the objective assessment of SPPB through the combination of wearable inertial and sEMG sensors. The present study included a sub-cohort of Salus in the Apulia Study of 137 old subjects, recruited consecutively from 2019 on a recall-based from an ongoing population-based prospective cohort comprising 2472 individuals aged 65+ and residents in Castellana Grotte, Puglia (Italy). Eligible participants were equipped with an inertial sensor (positioned around the subjets' waist, BTS G- SENSOR2, BTS SpA) and four surface electromyographic probes (BTS FREEEMG, BTS SpA) on Tibialis Anterior (TA) and Gastrocnemius Medialis (GAM) of both legs. The medical doctor instructed subjects to perform three different tasks: balance (stance phase, semi-tandem phase, and tandem phase), five repetition STS and 4-m walk. A stopwatch was used to measure the time required by the subject to complete each task and then assign the SPPB score according to the specific range (SPPB). Kinematics and EMG data of subjects were collected via BTS EMGAnalyzer and exported in MATLAB R2020a to calculate the technology-based SPPB (tSPPB). Descriptive statistics were used to describe the demographic characteristics and outcomes of the sample. The Spearman correlations were used to explore the relationship between the SPPB and tSPPB total score and the three-component scores. We compared the internal consistency of the SPPB and tSPPB using Cronbach’s alpha. Ninety-seven subjects (mean age [±SD] = 75.1 ± 5.53, female = 50.5%) were finally included in the analysis. The total SPPB (9.49 ± 2.55) and tSPPB (8.88 ± 2.51) scores were significantly different, yet highly correlated (r = 0.87, p < 0.01). The alpha coefficient for the SPPB score was high (0.93, 95% CI: 0.90 - 0.96), suggesting that the two methods have relatively high internal consistency. Technology-based assessment of SPPB represents a step forward in adapting the administration of objective measures of physical function to significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.

Plasma Biomarkers of Alzheimer's Disease Are Associated with Physical Functioning Outcomes Among Cognitively Normal Adults in the Multiethnic HABS-HD Cohort.

In this study, we examined the link between plasma Alzheimer's disease (AD) biomarkers and physical functioning outcomes within a community-dwelling, multiethnic cohort. Data from 1 328 cognitively unimpaired participants (n = 659 Mexican American and n = 669 non-Hispanic White) from the ongoing Health & Aging Brain Study-Health Disparities (HABS-HD) cohort were examined. Plasma AD biomarkers (amyloid beta [Aβ]40, Aβ42, total tau [t-tau], and neurofilament light chain [NfL]) were assayed using the ultra-sensitive Simoa platform. Physical functioning measures were the Timed Up and Go (TUG) and the Short Physical Performance Battery (SPPB). Cross-sectional linear regression analyses revealed that plasma Aβ 40 (p < .001), Aβ 42 (p = .003), and NfL (p < .001) were each significantly associated with TUG time in seconds. Plasma Aβ 40 (p < .001), Aβ 42 (p < .001), t-tau (p = .002), and NfL (p < .001) were each significantly associated with SPPB Total Score. Additional analyses demonstrate that the link between plasma AD biomarkers and physical functioning outcomes were strongest among Mexican Americans. Plasma AD biomarkers are receiving a great deal of attention in the literature and are now available clinically including use in clinical trials. The examination of AD biomarkers and physical functioning may allow for the development of risk profiles, which could stratify a person's risk for neurodegenerative diseases, such as AD, based on plasma AD biomarkers, physical functioning, ethnicity, or a combination of these measures prior to the onset of cognitive impairment.

What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach

BackgroundMobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework.MethodsData were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman’s Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores.ResultsUse of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12–23%), with no parameter from the activities and participation component being significantly predictive.ConclusionsFOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.

Diagnostic Accuracy of the Short Physical Performance Battery in Detecting Frailty and Prefrailty in Community-Dwelling Older Adults: Results From the PRO-EVA Study.

The Short Physical Performance Battery (SPPB) is widely used for older adults since it has a high level of validity, reliability, and responsiveness in measuring function in this population. However, only a few studies of diagnostic accuracy have assessed SPPB capacity in detecting frailty and prefrailty by estimating more detailed measurement properties. Thus, the present study aimed to evaluate the SPPB's diagnostic accuracy in detecting frailty and prefrailty, in addition to identifying cut-off points for walking time and chair stand time. This is a cross-sectional study composed of 786 community-dwelling older adults 60 years or older, in which sociodemographic and anthropometric data, frailty phenotype, and total SPPB score, as well as walking time and chair stand time, were assessed. Analysis of a receiver operating characteristic curve was performed to identify the cut-off point, sensitivity, and specificity in the total SPPB score, as well as the walking time and chair stand time for frailty and prefrailty screening. Accuracy and positive and negative predictive values were subsequently calculated. The cut-off points identified for the total SPPB score, walking time, and chair stand time were 9 points or less (accuracy of 72.6%), 5 seconds or less, and 13 seconds or less, respectively, for frailty screening and 11 points or less (accuracy of 58.7%), 4 seconds or less, and 10 seconds or less, respectively, for prefrailty screening. The walking time showed greater frailty discriminatory capacity compared with the chair stand time (effect size = 1.24 vs 0.64; sensitivity = 69% vs 59%; and specificity = 84% vs 75%). The total SPPB score has good diagnostic accuracy to discriminate between nonfrail and frail older adults using a cut-off point of 9 or less, being better to identify the true negatives (older adults who are not frail). Although the SPPB's diagnostic accuracy measures for detecting prefrailty were low to moderate, this instrument can help in screening prefrail older adults from the cutoff point of 11 or less in the total SPPB score. Identification of prefrail older adults enables implementing early treatment in this target audience and can prevent their advance to frailty.

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer.

Introduction: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. Methods: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. Results: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37–4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37–5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). Conclusions: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL.

The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group. A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs. There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression. Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.

Recovery and prediction of physical function 1year following hip fracture.

ObjectivesTo investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months.DesignA prospective single‐center observational study, as part of the HIPFRAC trial. Settings: One hospital with two associated municipalities in Norway. Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short‐term nursing home placement and 67 transferred directly home at discharge from hospital).MethodOutcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ‐5D‐5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses.ResultsThere were statistically significant improvements in physical function (SPPB total score and TUG), NRS‐pain in activity, and HRQoL (EQ‐5D‐5L) from hospital discharge to 3‐month follow‐up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post‐fracture were physical function (SPPB) at hospital discharge and pre‐fracture requirement of a walking aid.ConclusionThe recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12‐month follow‐up, with the largest improvements within the first 3 months.