Performance-Based Measures of Physical Function for High-Function Populations

Authors

  • J. David Curb MD, MPH,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Clementina D. Ceria-Ulep PhD, RN,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Beatriz L. Rodriguez MD, PhD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • John Grove PhD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Jack Guralnik MD, PhD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Brad J. Willcox MD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Tim A. Donlon PhD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Kamal H. Masaki MD,

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Randi Chen MS

    1. From the *Pacific Health Research Institute, Honolulu, HawaiiSchool of Nursing and Dental Hygiene and Departments of Geriatric Medicine§Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HawaiiNational Institute on Aging, National Institutes of Health, Bethesda, Maryland.
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  • Presented at the 57th Annual Scientific Meeting of the Gerontological Society of America, November 19–23, 2004.

Address correspondence to J. David Curb, MD, Pacific Health Research Institute, 846 South Hotel St., Suite 301, Honolulu, HI 96813. E-mail: jdcurb@phrihawaii.org

Abstract

OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings.

DESIGN: Cross-sectional repeated-measures study.

SETTING: Research clinic.

PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203).

MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity.

RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88–0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90).

CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform “foam pad, eyes closed,” elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level.

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