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Protocol - Physical Functioning - Objective

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Protocol Name from Source:

Short Physical Performance Battery

Availability:

Publicly available

Description:

This protocol is a brief series of tests used to evaluate a person’s balance, gait, strength, and endurance. A technician provides instructions and demonstrates how to perform each test. The tests include repeated chair stands, balance testing, and a measured walk. During each test, the technician uses a stopwatch to time the person and enters the result on an ordinal scale.

Protocol:

Study ID___________________ Date_____________ Tester Initials:____________

SHORT PHYSICAL PERFORMANCE BATTERY PROTOCOL AND SCORE SHEET

All of the tests should be performed in the same order as they are presented in this protocol. Instructions to the participants are shown in bold italic and should be given exactly as they are written in this script.

1. BALANCE TESTS

The participant must be able to stand unassisted without the use of a cane or walker. You may help the participant to get up.

Now let’s begin the evaluation. I would now like you to try to move your body in different movements. I will first describe and show each movement to you. Then I’d like you to try to do it. If you cannot do a particular movement, or if you feel it would be unsafe to try to do it, tell me and we’ll move on to the next one. Let me emphasize that I do not want you to try to do any exercise that you feel might be unsafe.

Do you have any questions before we begin?

A. Side-by-Side Stand

1. Now I will show you the first movement.

2. (Demonstrate) I want you to try to stand with your feet together, side-by-side, for about 10 seconds.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the side-by-side position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

9. If participant is unable to hold the position for 10 seconds, record result and go to the gait speed test.

B. Semi-Tandem Stand

1. Now I will show you the second movement.

2. (Demonstrate) Now I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the semi-tandem position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

9. If participant is unable to hold the position for 10 seconds, record result and go to the gait speed test.

C. Tandem Stand

1. Now I will show you the third movement.

2. (Demonstrate) Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.

3. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.

4. Stand next to the participant to help him/her into the tandem position.

5. Supply just enough support to the participant’s arm to prevent loss of balance.

6. When the participant has his/her feet together, ask "Are you ready?"

7. Then let go and begin timing as you say, "Ready, begin."

8. Stop the stopwatch and say "Stop" after 10 seconds or when the participant steps out of position or grabs your arm.

SCORING:

A. Side-by-Side Stand

[ ] 1 point Held for 10 sec

[ ] 0 points Not held for 10 sec

[ ] 0 points Not attempted

If 0 points, end Balance Tests

If participant did not attempt test or failed, mark why: [ ] 1 Tried but unable [ ] 2 Participant could not hold position unassisted [ ] 3 Not attempted, you felt unsafe [ ] 4 Not attempted, participant felt unsafe [ ] 5 Participant unable to understand instructions [ ] 6 Other (specify)______________________ [ ] 7 Participant refused

Number of seconds held if less than 10 sec: ___.__ __ sec

B. Semi-Tandem Stand

1 [ ] point Held for 10 sec

0 [ ] points Not held for 10 sec

0 [ ] points Not attempted (circle reason above)

If 0 points, end Balance Tests

Number of seconds held if less than 10 sec: ___.__ __ sec

C. Tandem Stand

2 [ ] points Held for 10 sec

1 [ ] point Not held for 3 to 9.99 sec

0 [ ] points Held for < than 3 sec

0 [ ] points Not attempted (circle reason above)

Number of seconds held if less than 10 sec: ___.__ __ sec

D. Total Balance Tests score _____________ (sum points)

Comments: _______________________________________________________________________

2. GAIT SPEED TEST

Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you need it to walk a short distance, then you may use it.

A. First Gait Speed Test

1. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking down the street to go to the store.

2. Demonstrate the walk for the participant.

3. Walk all the way past the other end of the tape before you stop. I will walk with you. Do you feel this would be safe?

4. Have the participant stand with both feet touching the starting line.

5. When I want you to start, I will say: "Ready, begin." When the participant acknowledges this instruction say: "Ready, begin."

6. Press the start/stop button to start the stopwatch as the participant begins walking.

7. Walk behind and to the side of the participant.

8. Stop timing when one of the participant’s feet is completely across the end line.

B. Second Gait Speed Test

1. Now I want you to repeat the walk. Remember to walk at your usual pace, and go all the way past the other end of the course.

2. Have the participant stand with both feet touching the starting line.

3. When I want you to start, I will say: "Ready, begin." When the participant acknowledges this instruction say: "Ready, begin."

4. Press the start/stop button to start the stopwatch as the participant begins walking.

5. Walk behind and to the side of the participant.

6. Stop timing when one of the participant’s feet is completely across the end line.

GAIT SPEED TEST SCORING:

Length of walk test course: [ ] Four meters [ ] Three meters

A. Time for First Gait Speed Test (sec)

1. Time for 3 or 4 meters __ __.__ __ sec

2. If participant did not attempt test or failed, mark why:

1 [ ] Tried but unable

2 [ ] Participant could not walk unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)__________________________

7 [ ] Participant refused

Complete score sheet and go to chair stand test

3. Aids for the first walk................... [ ] None [ ] Cane [ ] Other

Comments: _______________________________________________________________________________

B. Time for Second Gait Speed Test (sec)

1. Time for 3 or 4 meters __ __.__ __ sec

2. If participant did not attempt test or failed, circle why:

1 [ ] Tried but unable

2 [ ] Participant could not walk unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)__________________________

7 [ ] Participant refused

3. Aids for the second walk.............. [ ] None [ ] Cane [ ] Other

What is the time for the faster of the two walks?

Record the shorter of the two times __ __.__ __ sec

[If only 1 walk done, record that time] __ __.__ __ sec

If the participant was unable to do the walk: [ ] 0 points

For 4-Meter Walk:

[ ] 1 point If time is more than 8.70 sec

[ ] 2 points If time is 6.21 to 8.70 sec

[ ] 3 points If time is 4.82 to 6.20 sec

[ ] 4 points If time is less than 4.82 sec

For 3-Meter Walk:

[ ] 1 point If time is more than 6.52 sec

[ ] 2 points If time is 4.66 to 6.52 sec

[ ] 3 points If time is 3.62 to 4.65 sec

[ ] 4 points If time is less than 3.62 sec

3. CHAIR STAND TEST

Single Chair Stand

1. Let’s do the last movement test. Do you think it would be safe for you to try to stand up from a chair without using your arms?

2. The next test measures the strength in your legs.

3. (Demonstrate and explain the procedure.) First, fold your arms across your chest and sit so that your feet are on the floor; then stand up keeping your arms folded across your chest.

4. Please stand up keeping your arms folded across your chest. (Record results).

5. If participant cannot rise without using arms, say "Okay, try to stand up using your arms." This is the end of their test. Record result and go to the scoring page.

Repeated Chair Stands

1. Do you think it would be safe for you to try to stand up from a chair five times without using your arms?

2. (Demonstrate and explain the procedure.) Please stand up straight as QUICKLY as you can five times, without stopping in between. After standing up each time, sit down and then stand up again. Keep your arms folded across your chest. I’ll be timing you with a stopwatch.

3. When the participant is properly seated, say: "Ready? Stand" and begin timing.

4. Count out loud as the participant arises each time, up to five times.

5. Stop if participant becomes tired or short of breath during repeated chair stands.

6. Stop the stopwatch when he/she has straightened up completely for the fifth time.

7. Also stop:

• If participant uses his/her arms

• After 1 minute, if participant has not completed rises

• At your discretion, if concerned for participant’s safety

8. If the participant stops and appears to be fatigued before completing the five stands, confirm this by asking "Can you continue?"

9. If participant says "yes," continue timing. If participant says "No," stop and reset the stopwatch.

SCORING:

Single Chair Stand Test

A. Safe to stand without help

[ ] YES

[ ] NO

B. Results:

Participant stood without using arms

[ ] YES

[ ] NO → Go to Repeated Chair Stand Test

Participant used arms to stand

[ ] YES

[ ] NO → End test; score as 0 points

Test not completed

[ ] YES

[ ] NO → End test; score as 0 points

C. If participant did not attempt test or failed, mark why:

1 [ ] Tried but unable

2 [ ] Participant could not stand unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)________________________

7 [ ] Participant refused

Repeated Chair Stand Test

A. Safe to stand five times

[ ] YES

[ ] NO

B. If five stands done successfully, record time in seconds.

Time to complete five stands __ __.__ __ sec

C. If participant did not attempt test or failed, circle why:

1 [ ] Tried but unable

2 [ ] Participant could not stand unassisted

3 [ ] Not attempted, you felt unsafe

4 [ ] Not attempted, participant felt unsafe

5 [ ] Participant unable to understand instructions

6 [ ] Other (Specify)________________________

7 [ ] Participant refused

Scoring the Repeated Chair Test

0 [ ] points Participant unable to complete 5 chair stands or completes stands in >60 sec

1 [ ] point If chair stand time is 16.70 sec or more

2 [ ] points If chair stand time is 13.70 to 16.69 sec

3 [ ] points If chair stand time is 11.20 to 13.69 sec

4 [ ] points If chair stand time is 11.19 sec or less

Scoring for Complete Short Physical Performance Battery

Test Scores

_______ points

Gait Speed Test score

_______ points

Chair Stand Test score

_______ points

Total Score

_______ points

Test Scores

_______ points (sum of points above)

Personnel and Training Required

The individual who administers the tests should watch the video and familiarize themselves with each test. The test administrator should also be experienced with assisting the elderly.

Equipment Needs

Chair, stopwatch, tape measure

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Senior

Specific Instructions:

A video and specific protocols for the Short Physical Performance Battery are available at the National Institute on Aging website.

Research Domain Information

Release Date:

October 1, 2015

Definition

An objective tool used to measure lower extremity function in older adults

Purpose

This short battery of tests can be used to assess an older adult’s functional ability and to predict mortality and institutionalization.

Selection Rationale

These tests were validated in a study of 5,000 elderly participants in three communities. The tests can be completed in a participant’s home and in fewer than 10 minutes.

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Elderly Physical Function Objective Assessment Description Text3061246CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Phys func objective proto62825-5LOINC

Process and Review

The [link[phenx.org/node/62|Expert Review Panel #1]] reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• Revised descriptions of measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive ([link[www.phenxtoolkit.org/index.php?pageLink=browse.archive.protocols&id=150000|link]])

Source

Guralnik, J. M. (2013). Assessing physical performance in the older patient. National Institutes of Health, National Institute of Aging. Retrieved from http://www.grc.nia.nih.gov/branches/leps/sppb/

Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., . . . Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology: Medical Science, 49(2), M85-M94.

General References

None

Protocol ID:

150501

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX150501_SideBySide_StandPX150501010000Side-by-Side Stand4N/A
PX150501_SideBySide_Stand_Not_AttemptedPX150501020000If participant did not attempt test or failed, mark why:4N/A
PX150501_SideBySide_Stand_Not_Attempted_SpecifyPX150501020100If participant did not attempt test or failed, mark why:4N/A
PX150501_SideBySide_Number_SecondsPX150501030000Number of seconds held if less than 10 sec4N/A
PX150501_SemiTandemStandPX150501040000Semi-Tandem Stand4N/A
PX150501_SemiTandemStand_Not_AttemptedPX150501050000If participant did not attempt test or failed, mark why4N/A
PX150501_SemiTandemStand_Not_Attempted_SpecifyPX150501050100If participant did not attempt test or failed, mark why4N/A
PX150501_SemiTandemStand_Number_SecondsPX150501060000Number of seconds held if less than 10 sec4N/A
PX150501_TandemStandPX150501070000Tandem Stand4N/A
PX150501_TandemStand_Not_AttemptedPX150501080000If participant did not attempt test or failed, mark why4N/A
PX150501_TandemStand_Not_Attempted_SpecifyPX150501080100If participant did not attempt test or failed, mark why4N/A
PX150501_TandemStand_Number_SecondsPX150501090000Number of seconds held if less than 10 sec4N/A
PX150501_Total_Balance_ScorePX150501100000Total Balance Tests score (sum points)4N/A
PX150501_Balance_CommentsPX150501110000Comments4N/A
PX150501_WalkTest_Course_LengthPX150501120000Length of walk test course4N/A
PX150501_WalkTest_One_TimePX150501130000Time for 3 or 4 meters4N/A
PX150501_WalkTest_One_Not_AttemptedPX150501140000If participant did not attempt test or failed, mark why4N/A
PX150501_WalkTest_One_Not_Attempted_SpecifyPX150501140100If participant did not attempt test or failed, mark why4N/A
PX150501_WalkTest_One_AidsPX150501150000Aids for the first walk4N/A
PX150501_WalkTest_One_CommentsPX150501160000Comments4N/A
PX150501_WalkTest_Two_TimePX150501170000Time for 3 or 4 meters4N/A
PX150501_WalkTest_Two_Not_AttemptedPX150501180000If participant did not attempt test or failed, mark why:4N/A
PX150501_WalkTest_Two_Not_Attempted_SpecifyPX150501180100If participant did not attempt test or failed, mark why:4N/A
PX150501__WalkTest_Two_AidsPX150501190000Aids for the second walk4N/A
PX150501_Shorter_WalkTest_TimePX150501210000Record the shorter of the two times4N/A
PX150501_WalkTest_4Meter_ScorePX150501240000For 4-Meter Walk4N/A
PX150501_WalkTest_3Meter_ScorePX150501250000For 3-Meter Walk4N/A
PX150501_ChairStand_SafePX150501260000Safe to stand without help4N/A
PX150501_ChairStand_DidNot_Use_ArmsPX150501270000Participant stood without using arms4N/A
PX150501_ChairStand_Did_Use_ArmsPX150501280000Participant used arms to stand4N/A
PX150501_ChairStand_Not_CompletedPX150501290000Test not completed4N/A
PX150501_ChairStand_Not_AttemptedPX150501300000If participant did not attempt test or failed, mark why:4N/A
PX150501_ChairStand_Not_Attempted_SpecifyPX150501300100If participant did not attempt test or failed, mark why4N/A
PX150501_RepeatedChairStand_SafePX150501310000Safe to stand five times4N/A
PX150501_RepeatedChairStand_Not_AttemptedPX150501330000If participant did not attempt test or failed, circle why4N/A
PX150501_RepeatedChairStand_Not_Attempted_SpecifyPX150501330100If participant did not attempt test or failed, circle why4N/A
PX150501_RepeatedChairStand_TimePX150501330200Record the shorter of the two times4N/A
PX150501_RepeatedChairStand_ScorePX150501340000Scoring the Repeated Chair Test4N/A