Relative and absolute reliability of functional performance measures for adults with dementia living in residential aged care

Reliability and minimal detectable change of the Short Physical Performance Battery in older adults with mild cognitive impairment

OBJECTIVES

Reliability of the Short Physical Performance Battery (SPPB) are rarely examined among older adults with mild cognitive impairment (MCI). This study aimed to investigate the test-retest reliability and minimal detectable change (MDC) of the SPPB in older adults with MCI.

METHODS

Participants included 100 older adults with MCI. The SPPB was assessed with the first 2 assessments separated by a 20-min interval and the third separated by a 1-week interval. The intraclass correlation coefficient (ICC) and MDC values were estimated.

RESULTS

The intraday ICC was 0.73 for the SPPB score, 0.90 for the 4-m walk time (4mwt), and 0.95 for the 5-times chair stand time (5cst); the corresponding interday ICC values were 0.76, 0.89, and 0.91, respectively. The MDC values ranged from 1.1 to 1.2 for the SPPB score, from 0.77 to 0.80 s for the 4mwt, and from 1.32 to 1.77 for the 5cst.

CONCLUSIONS

The SPPB had satisfactory reliability among older adults with MCI. The test-retest reliability of the SPPB is sufficient (>0.7) for group comparisons. Moreover, the test-retest reliability for the 4mwt and 5cst subscale performances is acceptable (> 0.9) for individual-level measurements over time.

Determination of change of direction deficit thresholds across a spectrum of angles in basketball players

Change of direction deficit (CODD) offers valuable insights into a player's balance between linear and multidirectional speed. However, there are still no established reference values for CODD. The objectives of this study were to determine CODD thresholds for various change of direction angles in basketball players according to gender and analyse the relationships between CODD and execution time in speed tests. One hundred and thirty basketball players (46% female; age: 23.7 ± 5.29 years; height: 189.1 ± 11.1 cm; body mass: 84.3 ± 15.7 kg) undertook 10-m linear and change of direction speed test at 45º, 90º and 180º. A k-means cluster analysis was conducted to standardise CODD thresholds and a one-way analysis of variance to identify the differences between clusters. The results revealed angulation-specific CODD thresholds, ranging from 3% to 8%, 17% to 25% and 43% to 51% for 45º, 90º and 180º cutting angles, respectively for the pooled sample. Furthermore, differences inter-clusters (p < 0.05) were observed for execution time at all cutting angles for both genders. Therefore, strength and conditioning coaches are encouraged to assess CODD as a highly valid variable for evaluating change of direction performance and to use current CODD thresholds to tailor training programmes according to each athlete's needs.

The Psychometric Properties of the Short Physical Performance Battery to Assess Physical Performance in Older Adults: A Systematic Review

BACKGROUND

Maintaining physical performance in older age is critical. The Short Physical Performance Battery (SPPB) is one of many tools available to measure physical performance in older people.

PURPOSE

Describe the psychometric properties of the SPPB.

METHODS

Using a systematic review methodology, quantitative studies addressing the validity, reliability, and sensitivity of the SPPB in populations 60 years or older were included. We searched 8 databases: MEDLINE, CINAHL, Cochrane, Ageline, Amed, Embase, Scopus, and Emcare, as well as gray literature. Two researchers independently screened, appraised, and extracted data from the literature, following which a descriptive synthesis was undertaken.

RESULTS

Twenty-eight studies with varying methodological quality were included. Floor and ceiling effects were reported in 4 studies, generally related to very high or very low functioning adults. Nineteen studies investigated validity with varying correlations between the SPPB and other physical performance assessment tools. Ten studies reported good to excellent reliability (intraclass correlation coefficient ranging 0.82-0.92). Minimum detectable change indicates low sensitivity (ranging 0.7-3.42).

DISCUSSION

Evidence from the literature indicates that the SPPB is a reliable and valid measure of physical performance in adults older than 60 years. However, the SPPB has a narrow scope and is most appropriate for frail older adults who can ambulate and are cognitively able to follow instructions. It has limited applicability for specific populations such as people with dementia who have difficulty following instructions. Targeted training for users may improve its usability and success in clinical practice.

CONCLUSIONS

Clinicians should be mindful that while the SPPB has good validity and reliability, it has limited applicability for people with dementia and is not particularly sensitive to change. In practice, this means that it provides a good snapshot of a client's physical performance compared with the rest of the older population; it is less useful for tracking changes to physical performance over time.

The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study

PURPOSE

To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD).

MATERIALS AND METHODS

Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA.

RESULTS

Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise.

CONCLUSIONS

The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.

Assessment Tools to Evaluate Motor Function in People with Dementia: A Systematic Review

Background: In addition to cognitive changes, motor impairments have been observed in patients with dementia and are present early in the disease, even at the preclinical stage. Although it is difficult to assess motor function in this population, it is critical for monitoring disease progression and determining the efficacy of therapeutic interventions. However, the best measurement tools for assessing motor function in dementia patients have yet to be determined. Objective: We aimed to summarize and critically evaluate the measurement tools used to assess motor function indementia. Methods: A systematic review was conducted using the databases CENTRAL, MEDLINE, Embase, and PEDro from their inception to June 2021 to identify all experimental studies conducted in patients with dementia and that included an assessment of motor function. Two reviewers independently screened citations, extracted data, and assessed clinimetric properties. Results: We included 200 studies that assess motor function in dementia patients. Motor function was assessed using a total of 84 different measurement tools. Only nine (12% ) were used in over ten studies. The Timed-Up-and-Go test, 6MWT, Berg Balance Scale, and the Short Physical Performance Battery are all suggested. Conclusion: Currently, a wide variety of measurement instruments are used to assess motor performance in people with dementia, most instruments were not designed for this population and have not been validated for this use. We propose the development of an assessment protocol tailored to the different disease stages. We also recommend that future research continues to develop technological devices that can assist with this task.

Balance on the Brain: a randomised controlled trial evaluating the effect of a multimodal exercise programme on physical performance, falls, quality of life and cognition for people with mild cognitive impairment-study protocol

INTRODUCTION

Exercise and physical activity have been shown to improve cognition for people living with mild cognitive impairment (MCI). There is strong evidence for the benefits of aerobic exercise and medium evidence for participating in regular strength training for people with MCI. However, people living with MCI fall two times as often as those without cognitive impairment and the evidence is currently unknown as to whether balance training for people with MCI is beneficial, as has been demonstrated for older people without cognitive impairment. The aim of this study is to determine whether a balance-focused multimodal exercise intervention improves balance and reduces falls for people with MCI, compared with a control group receiving usual care.

METHODS AND ANALYSIS

This single blind randomised controlled trial (Balance on the Brain) will be offered to 396 people with MCI living in the community. The multimodal exercise intervention consists of two balance programmes and a walking programme to be delivered by physiotherapists over a 6-month intervention period. All participants will be followed up over 12 months (for the intervention group, this involves 6-month intervention and 6-month maintenance). The primary outcomes are (1) balance performance and (2) rate of falls. Physical performance, levels of physical activity and sedentary behaviour, quality of life and cognition are secondary outcomes. A health economic analysis will be undertaken to evaluate the cost-effectiveness of the intervention compared with usual care.

ETHICS AND DISSEMINATION

Ethics approval has been received from the South Metropolitan Health Service Human Research Ethics Committee (HREC), Curtin University HREC and the Western Australia Department of Health HREC; and approval has been received to obtain data for health costings from Services Australia. The results will be disseminated through peer-review publications, conference presentations and online platforms.

TRIAL REGISTRATION NUMBER

ACTRN12620001037998; Australian New Zealand Clinical Trials Registry (ANZCTR).

Reproducibility of Assessment Tests Addressing Body Structure and Function and Activity in Older Adults With Dementia: A Systematic Review

OBJECTIVE

The purpose of this study was to analyze the relative and absolute reliability of assessment tests addressing body structure and function and activity in older adults with dementia.

METHODS

Medline, Embase, Web of Science, The Cochrane Library, and Scielo were searched from inception until March 2021. Two independent reviewers performed the selection process based on titles, abstracts, and full text. Reliability studies of assessment tests in older adults with dementia were included. Methodological quality of the studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Relative reliability was analyzed using the intraclass correlation coefficient (ICC) interpreted based on Munro classification. Absolute reliability was analyzed using the minimal detectable change (MDC) and standard error of measurement.

RESULTS

Fifteen studies involving a total of 560 older adults with dementia were included. Nineteen assessment tests were identified: 13 addressing body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and 6 addressing activity (walking and mobility). Studies determined test-retest and interrater reliability. Fifteen studies evaluated relative reliability using the ICC, with values ranging from no or small correlation to very high correlations. Ten studies evaluated absolute reliability using the MDC or standard error of measurement or both.

CONCLUSION

Relative reliability of the assessment tests for body structure and function and activity was high to very high based on ICCs, demonstrating good reproducibility. Regarding absolute reliability, the analysis of the MDC values revealed the need for substantial change to determine that a real change had occurred. Future investigations should consider the type of dementia and standardization of verbal encouragement during the assessment.

IMPACT

This review identified the good reproducibility of assessment tests of body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and activity (walking and mobility) domains in older adults with dementia. Clinically important values may differ when older adults with dementia of diverse etiologies are analyzed together and older adults specifically with Alzheimer disease. Identifying the type of dementia, analyzing types of dementia separately, and standardizing verbal commands during the execution of tests is of considerable clinical importance for this population of older adults.

Impact of measurement timing on reproducibility of testing among haemodialysis patients

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland–Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion,  the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test–retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

Effects of a 16-Week Multimodal Exercise Program on Physical Performance in Individuals With Dementia: A Multicenter Randomized Controlled Trial

BACKGROUND AND PURPOSE

Dementia affects physical as well as cognitive performance. In individuals with dementia (IWD), decline in physical performance increases with disease progression and is associated with higher functional dependence and decreased quality of life. It is paramount to examine factors that potentially preserve physical performance in IWD, particularly in light of conflicting findings on the effectiveness of physical activity interventions on physical performance of IWD, mainly due to limited number of high-quality studies, large heterogeneity in methods used, or insufficient reporting of methods. The aim of this study was to investigate the effects of a 16-week multimodal exercise program (MEP) combining physical and cognitive tasks on physical performance in IWD, and to identify individual characteristics of MEP responders.

METHODS

A multicenter randomized controlled trial with assessment methods identified by an expert panel was conducted. We included 319 IWD of mild to moderate severity, older than 65 years, who underwent a standardized MEP specifically designed for IWD. At baseline and immediately after the MEP, we assessed physical performance (ie, mobility, balance, and strength) and function of lower extremities (primary outcomes). Potential effects of the MEP on physical performance were identified using 2-factor analyses of variance with repeated measurements within 2 samples (ie, intention-to-treat and per-protocol sample). Additionally, we compared characteristics related to physical performance between positive, non-, and negative responders.

RESULTS AND DISCUSSION

Neither analysis procedure revealed statistically significant time×group effects. However, 28% to 40% of participants were positive responders with regard to balance, and strength and function of lower extremities; and these persons had statistically significant lower baseline performance in the corresponding assessments.

CONCLUSIONS

This randomized controlled trial revealed no overall effects of the MEP on physical performance, probably due to high heterogeneity of the study sample. Findings in responder analysis showed that IWD with lower physical performance at baseline tended to benefit more than those with higher baseline performance. Thus, a higher degree of individualization of the MEP depending on baseline performance on IWD may improve overall MEP effectiveness.

The VITAAL Stepping Exergame Prototype for Older Adults With Major Neurocognitive Disorder: A Usability Study

Purpose: This study investigates the usability of a stepping exergame in older adults with major neurocognitive disorder (MNCD) residing in a long-term care facility.

Materials and Methods: A mixed methods study was conducted. Participants played exergames for 30 min on one try-out session. During the exergames, the think aloud method was used, and field notes were taken by the facilitator. Following the exergames, participants completed the System Usability Scale (SUS) and a semi-structured in-depth interview about usability including their personal experiences. Audio files were transcribed and a thematic content analysis of the think aloud data, field notes and interviews were performed using NVivo 12.

Results: Twenty-two participants with MNCD were included [mean age = 84.3 ± 5.5 (70–95) years; 81.8% women; Short Physical Performance Battery score = 7.5 ± 3.2 (1–12), Montreal Cognitive Assessment score = 11.9 ± 4.4 (2–19)]. System usability was rated “ok to good” with a mean SUS score of 57.8 (SD = 12.3) with scores ranging from 37.5 to 90.0. Five main themes emerged from the thematic content analysis: (1) perceived user friendliness and acceptability of the exergames; (2) interactional experience; (3) motivational factors; (4) training modalities; and (5) risks. There were no adverse events nor dropouts.

Conclusion: Participants evaluated the usability of the exergames positively. The results indicate that the stepping exergame is usable in older adults with MNCD.

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

BACKGROUND

It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities.

METHODS

Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η²p) effect sizes were calculated.

RESULTS

Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η²_p = 0.41), total SPPB (p < 0.001, η²_p = 0.64), SRTT (p<0.001, η²_p = 0.51), MoCA (p<0.001, η²_p = 0.38), and reductions in CSDD (p<0.001, η²_p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η²_p = 0.05), DQoL (p = 0.012, η²_p = 0.16), and ADL (p = 0.008, η²_p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team.

CONCLUSIONS

The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04436302.

Reliability, Validity, and Minimal Detectable Change of Backward Walk Test in Older Adults With Dementia

BACKGROUND AND PURPOSE

The backward walk test (BWT) has been used to evaluate the balance, gait, and fall risk for older adults, but its psychometric properties in older adults with dementia have not been investigated. This study aims at examining the test-retest and interrater reliability, construct and known-group validity, and absolute and relative minimal detectable changes at the 95% level of confidence (MDC95) of the BWT in older adults with dementia.

METHODS

This study was a cross-sectional study with repeated measures. Thirty older adults with a mean age of 83.3 years and a diagnosis of dementia who were able to walk backward independently for at least 3 m were recruited from day care and residential care units. The BWT was conducted on 3 separate testing occasions within 2 weeks under 2 independent raters using a modified progressive cueing system. The 10-m walk test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG) were used to assess the gait, balance, and mobility performances of the participants.

RESULTS AND DISCUSSION

The BWT had excellent test-retest reliability-intraclass correlation coefficient (ICC) = 0.96-and interrater reliability (ICC = 0.97-0.97) in the participants. Moderate correlations between the BWT and BBS (Spearman's ρ  = 0.60) and strong correlations between the BWT and 10MWT (ρ = 0.84) and TUG (ρ = -0.82) were found. The BWT could distinguish between the participants who ambulated with walking aids and those who did not (P = .005). The participants who had experienced a fall in the past year did not differ significantly in the BWT compared with those who had not fallen (P = .36). The absolute and relative MDC95 of the BWT in the participants were 0.10 m/s and 39.3%, respectively.

CONCLUSIONS

The BWT is reliable and valid in assessing balance and gait performances in older adults with dementia. Further investigation is needed to determine whether the BWT can identify those with an increased risk of falls.

Test-retest reliability of the functional reach test and the hand grip strength test in older adults using nursing home services

OBJECTIVE

This study aimed to determine the absolute and relative test-retest reliability of the functional reach test (FRT) and the handgrip strength test (HGST) in older adults using nursing homes.

METHODS

Participants (≥ 65 years old), living in nursing homes or using their day care services, were distributed into a group without cognitive impairment (GWCI, n = 43) and a group with mild cognitive impairment (GCI; n = 22). A 1-week test-retest was performed for the FRT and the HGST. Relative reliability was measured by the intraclass correlation coefficient (ICC_3.1), and absolute reliability by the standard error of measurement (SEM), minimal detectable change (MDC₉₅), and Bland-Altman plots.

RESULTS

The ICC showed high reliability for the FRT (GWCI, ICC = 0.83; GCI, ICC = 0.87) and the HGST (ICC ≥ 0.95 in both hands and participant groups). The absolute reliability was good: FRT, SEM = 2.96/2.29, MDC₉₅ = 8.20/6.35 for the GWCI and the GCI, respectively; HGST dominant hand SEM = 1.26/0.82, MDC₉₅ = 3.50/2.29, and HGST non-dominant hand SEM = 1.05/0.80, MDC₉₅ = 2.90/2.21, for the GWCI and the GCI, respectively. Bland-Altman showed that there was not a systematic bias for the tests in both groups.

DISCUSSION

Findings show that the FRT and the HGST are reliable, have acceptable measurement error, and may be used for research and clinical purposes to assess functional balance and strength of the hands in older adults using nursing homes.

Intraday reliability, sensitivity, and minimum detectable change of national physical fitness measurement for preschool children in China

China General Administration of Sport has published and adopted the National Physical Fitness Measurement (NPFM-preschool children version) since 2000. However, studies on intraday reliability, sensitivity, and minimum detectable change (MDC) are lacking. This study aimed to investigate and compare the reliability, sensitivity, and MDC values of NPFM in preschool children between the ages of 3.5 to 6 years. Six items of NPFM including 10-m shuttle run, standing long jump, balance beam walking, sit-and-reach, tennis throwing, and double-leg timed hop, were tested for 209 Chinese kindergarten children in Beijing in the morning. Intraday relative reliability was tested using intraclass correlation coefficient (ICC3,1) with a 95% confidence interval while absolute reliability was expressed in standard error of measurement (SEM) and percentage of coefficient of variation (CV%). Test sensitivity was assessed by comparing the smallest worthwhile change (SWC) with SEM, while MDC values with 95% confidence interval (MDC95) were established. Measurements in most groups, except 10-m shuttle run test (ICC3,1: 0.56 to 0.74 [moderate]) in the 3.5 to 5.5-year-old groups, balance beam test in 4- and 5-year-old (ICC3,1: 0.33 to 0.35 [poor]) and 5.5-year-old (ICC3,1 = 0.68 [moderate]) groups, and double-leg timed hop test (ICC3,1 = 0.67 [moderate]) in the 4.5-year-old group, demonstrated good to excellent relative reliability (ICC3,1: 0.77 to 0.97). The balance beam walking test showed poor absolute reliability in all the groups (SEM%: 11.76 to 22.28 and CV%: 15.40 to 24.78). Both standing long jump and sit-and-reach tests demonstrated good sensitivity (SWC > SEM) in all subjects group, boys, and girls. Pairwise comparison revealed systematic bias with significantly better performance in the second trial (p<0.01) of all the tests with moderate to large effect size.

Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain

Background

The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to capture, evaluate and discriminate pain from neuropathic and non-neuropathic sources. A recent systematic review found insufficient psychometric data with respect to musculoskeletal (MSK) health conditions. This study aimed to describe the reproducibility (test–retest reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain.

Methods

Eligible patients with shoulder pain from MSK sources completed the SF-MPQ-2: at baseline (n = 195), and a subset did so again after 3–7 days (n = 48), if their response to the Global Rating of Change (GROC) scale remained unchanged. Cronbach alpha (α) and intraclass correlation coefficient (ICC_2,1), and their related 95% CI were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland–Altman (BA) plots were used to assess agreement.

Results

Cronbach α ranged from 0.83 to 0.95 suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC_2,1 scores were found in support of the total scale (0.95) and continuous subscale (0.92) scores; the remaining subscales displayed good ICC_2,1 scores (0.78–0.88). Bland–Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13–0.19). While the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC_90individual = 1.2 and MDC_90group = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range 0.7–1; MDC_90individual: range 1.7–2.3; MDC_90group: range 0.4–0.5).

Conclusion

Good reproducibility supports the SF-MPQ-2 domains for augmented or independent use in MSK-related shoulder pain assessment, with the total scale displaying the best reproducibility coefficients. Additional research on the validity and responsiveness of the SF-MPQ-2 is still required in this population.

Assessment of Functional Performance in Acute Geriatric Psychiatry - Time for New Strategies?

OBJECTIVES

The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression.

METHOD

A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient (r_s).

RESULTS

A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and r_s for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and r_s were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB).

CONCLUSION

Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.

Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment

BACKGROUND

The ability to detect one's own memory capacity and develop strategies based on daily contexts is important for daily activities. The Contextual Memory Test (CMT) assesses self-awareness, self-efficacy, self-perception/evaluation of performance, recall, and strategy use that are associated with daily contexts, and could be a potentially suitable measurement for assessing memory and meta-memory in older adults with and without cognitive impairment. Nevertheless, the test-retest reliability and minimal detectable change (MDC) remain unknown in these individuals.

OBJECTIVE

The purpose of this study was to examine test-retest reliability and calculate MDC of the CMT in healthy older adults and those with mild cognitive impairment (MCI).

METHODS

Eighty-three participants completed the CMT twice with a one-month interval. Test-retest reliability was examined using intraclass correlation coefficient (ICC) in all seven domains of the CMT and the recognition subtest. The standard error of measurement (SEM) and MDC were calculated. The Bland-Altman analysis was performed to evaluate the degree of agreement between measurements.

RESULTS

The ICC of five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall) and the recognition subtest were good to excellent (ICC = 0.63-0.94) in healthy and MCI participants and the MDC% were less than 30% The ICC of the other two domains (self-efficacy and total strategy use, TSS) were low (ICC = 0.07-0.59) and the MDC% exceeded 30%. The Bland-Altman analysis showed generally better performance in the 2nd than the 1st measurement in most CMT domains.

CONCLUSIONS

Our results revealed sufficient test-retest reliability and acceptable MDC in most CMT domains in healthy and MCI participants. Only the self-efficacy and TSS domains demonstrated low ICC and large MDC. Possible practice effects were found between repeated measurements. Clinicians should be cautious when evaluating self-efficacy and strategy use using the CMT in older adults. Further improvements are needed for these two domains.

An ongoing physiotherapist-led exercise program in residential aged care: Description of participant satisfaction and outcomes

OBJECTIVE

This study documents aged care residents' outcomes after, and satisfaction with, participation in a rehabilitation program conducted in a co-located gym.

METHODS

A mixed-method prospective cohort study was conducted. All residents who attended the program were invited to participate in the study. Demographic information and outcome measures (walking speed, mobility, ability to stand, exercise self-efficacy and health status) were documented on study commencement and again after 6 months.

RESULTS

Thirty-eight participants were included with an average age of 83 years (SD 13). The majority of participants (61%) required physical assistance for mobility. Compliance with scheduled sessions was 94%. Most (92%) participants would recommend the program. The majority of participants (55%) experienced improved walking speed as measured by the 5-metre walk test.

CONCLUSIONS

The results suggest that a rehabilitative program can maintain the physical status of aged care residents, despite the common decline in physical performance in this population.

The impact of exercise on patients with dementia: A 2-year follow-up

The current absence of a disease-modifying treatment for Alzheimer disease highlights the necessity for the benefits of nonpharmacological approaches. We aimed to investigate the effect of exercise in older patients with Alzheimer dementia.This is an observational, prospective cohort study in medical center. Eighty older patients with Alzheimer dementia, including 54 with mild dementia and 26 with moderate dementia, were followed up over 2 years. Patients were divided into exercise and no-exercise groups according to their weekly exercise habit. Mini-Mental State Examination (MMSE), clinical dementia rating (CDR), and senior fitness test were checked initially. We defined death and unexpected hospitalization as the outcomes.Age, sex, education years, and MMSE showed no significant differences between the groups (P > .05) in all patients. All the patients of the exercise group had significantly better left upper body strength, higher aerobic endurance, and left and right balance maintenance time than those of the no-exercise group (P < .05). There were no changes in hospitalization and mortality between the exercise and non-exercise groups during the 2-year follow-ups in all participants. However, in the mild and moderate dementia subgroups, age, sex, education years, and MMSE showed no significant differences between the groups (P > .05). The exercise group had significantly better lower body strength, left upper body strength, aerobic endurance, right upper body flexibility, lower body flexibility, balance maintenance, and agility than the no-exercise group in patients with mild dementia (P < .05). Moreover, the exercise group had significantly lesser unexpected hospitalization than the no-exercise group in the patients with mild dementia (P = .037).Despite the similarity in the status of dementia, exercise habit was found to be associated with a better senior fitness test score status. Hence, exercise can decrease unexpected hospitalization in patients with mild dementia but not those with total dementia.

Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols

Objectives:

Regular physical activity for older adults as they age is important for maintaining not only physical function but also independence and self-worth. To be able to monitor changes in physical function, appropriate validated measures are required. Reliability of measures such as the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk has been demonstrated; however, the appropriateness of such measures in a population of adults living with dementia, who may be unable to follow instructions or have diminished physical capacity, is not as well quantified. This study sought to test modified standard protocols for these measures.

Methods:

Modification to the standard protocols of the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk was trialled. This occurred through modification of procedural components of the assessment, such as encouraging participants to use their hands to raise themselves from a seated position, or the incorporation of staged verbal cueing, demonstration, or physical guidance where required. The test–retest reliability of the modified protocols was assessed using Pearson’s correlation, and performance variances were assessed using the %coefficient of variation. Intraclass correlations were included for comparisons to previous research and to examine measurement consistency within three trials.

Results:

At least 64% of the population were able to complete all measures. Good test–retest reliability was indicated for the modified measures (timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93; and the four-metre walk = 0.83), and the %coefficient of variation (7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to good.

Conclusion:

This article describes the methodology of the modified assessments, presents the test–retest statistics, and reports how modification of the current protocols for common measures of physical function enabled more older adults living with dementia in a residential aged care facility to participate in assessments, with high reliability demonstrated for the measures.

Evaluating Mobility in Advanced Dementia: A Scoping Review and Feasibility Analysis

BACKGROUND AND OBJECTIVES

Mobility decline is a symptom of advanced dementia that affects function, safety, caregiving, and quality of life. Monitoring mobility status is essential for initiating timely and targeted interventions aimed at preventing excess disability in people with dementia (PWD). The physical, cognitive, and behavioral symptoms of dementia however, present unique challenges for mobility assessment. The goals of this review were to (a) identify and describe measures of mobility used for PWD and (b) assess measures' feasibility for use in people with advanced dementia; a group whose degree of cognitive impairment results in severe functional deficits.

RESEARCH DESIGN AND METHODS

Electronic searches of Medline, Embase, CINAHL, and PsychInfo databases were conducted using keywords related to dementia, mobility, measurement, and validation. Descriptive characteristics were extracted and measures coded for mobility components. Tools were also evaluated for feasibility of use in advanced dementia and those deemed feasible, screened for psychometric strength.

RESULTS

Thirty-eight measures were included and 68% of these tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%), and wheeled mobility (3%). 36% of studies included people with advanced dementia. Only 18% of tools received high scores for feasibility.

DISCUSSION AND IMPLICATIONS

Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most measures are not feasible for people with advanced dementia, and the psychometric evaluation of these measures is limited. Further research is needed to develop a comprehensive, dementia-specific, mobility assessment tool.

Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols

OBJECTIVES

1) To determine if there was a practice effect associated with walk tests performed by frail older adults with and without dementia, 2) to examine the role of systematic cueing in the walk tests for those with dementia, and 3) to make recommendations to testing protocols of the walk tests for frail older adults with and without dementia.

SETTING

Residential and day care facilities.

PARTICIPANTS

44 frail older adults with normal cognition (NON-DEM) and 39 older adults with Alzheimer's disease or dementia (DEM) who were able to walk independently for at least 15 m.

METHODS

All the participants completed multiple trials of 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions. The DEM group was facilitated to complete the walk tests using a progressive cueing system.

RESULTS

Significant increases in the walking performance within the same testing occasion were found in the 2MWT (NON-DEM: p = .002; DEM: p ≤ .044) and 6MWT (NON-DEM: p ≤ .004; DEM: p ≤ .002) for both groups but only in the 10MeWT (p ≤ .023) for the DEM group. Significant increases in the walking performance across testing occasions were shown in the 2MWT (p ≤ .047), 6MWT (p ≤ .005) and 10MeWT (p ≤ .039) for the NON-DEM group but not the DEM group (all p > .05). Multivariate regression analyses showed that the cognitive function of the DEM group was independently and inversely associated with the level of cueing provided during the walk tests (p ≤ .007).

CONCLUSION

Practice effect associated with the walk tests was found within and across testing occasions for frail older adults with normal cognition, and only within the same testing occasion for those with dementia. Systematic cueing should be provided for those with dementia to complete the walk tests. Testing protocols of the walk tests have been recommended for these two population groups.

Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review

Measuring joint range of motion is an important skill for many allied health professionals. While the Universal Goniometer is the most commonly utilised clinical tool for measuring joint range of motion, the evolution of smartphone technology and applications (apps) provides the clinician with more measurement options. However, the reliability and validity of these smartphones and apps is still somewhat uncertain. The aim of this study was to systematically review the literature regarding the intra- and inter-rater reliability and validity of smartphones and apps to measure joint range of motion. Eligible studies were published in English peer-reviewed journals with full text available, involving the assessment of reliability and/or validity of a non-videographic smartphone app to measure joint range of motion in participants >18 years old. An electronic search using PubMed, Medline via Ovid, EMBASE, CINAHL, and SPORTSDiscus was performed. The risk of bias was assessed using a standardised appraisal tool. Twenty-three of the eligible 25 studies exceeded the minimum 60% score to be classified as a low risk of bias, although 3 of the 13 criteria were not achieved in >50% of the studies. Most of the studies demonstrated adequate intra-rater or inter-rater reliability and/or validity for >50% of the range of motion tests across all joints assessed. However, this level of evidence appeared weaker for absolute (e.g. mean difference ± limit of agreement, minimal detectable change) than relative (e.g. intraclass correlation, correlation) measures; and for spinal rotation than spinal extension, flexion and lateral flexion. Our results provide clinicians with sufficient evidence to support the use of smartphones and apps in place of goniometers to measure joint motion. Future research should address some methodological limitations of the literature, especially including the inclusion of absolute and not just relative reliability and validity statistics.

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel - a qualitative approach

Background

Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials.

Methods

Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations.

Results

The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively.

Conclusions

These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.

Effect of physical exercise on physical performance and fall incidents of individuals living with dementia in nursing homes: a randomized controlled trial

Objective: To determine the effects of an exercise intervention on physical performance and reported fall incidents among individuals living with dementia in nursing homes. Methods: The study was a randomized controlled trial to determine the effect of the physical activity on physical performance and reported fall incidents. A sample of 60 participants from two nursing homes in Australia were randomly allocated to either: (1) Intervention Group 1: physical exercise intervention for 45 min, once a week; (2) Intervention Group 2: physical exercise intervention for 15 min, three times a week; or (3) usual care Control Group. Physical performance was assessed before and after the intervention (12 weeks) using: Six Meter Walk test, Five-Times-Sit-to-Stand test, Timed Up and Go (TUG) test, (Modified) Functional Reach test, timed static pedaling (TSP). The number of reported falls was determined by review of incident reports completed by nursing home staff. Results: The physical performance outcome measures demonstrated positive trends over time in favor of the intervention groups, though the observed changes were only statistically significant for TSP and TUG Test. The number of reported falls demonstrated a significant difference between groups during the intervention period. Conclusions: The results demonstrated that the physical exercise intervention could be beneficial for individuals living with dementia, and as little as 45 min per week could be effective for this population group. However, cautious interpretation was drawn as the pool of participants was not sufficiently large enough to generate a meaningful effect size.

CORP: Measurement of upper and lower limb muscle strength and voluntary activation

Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.

Reliability of mobility measures in older medical patients with cognitive impairment

Background

Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment.

Methods

A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist.

The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories.

As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated.

Results

Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests.

ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test).

Conclusions

The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose.

Trial registration

German Clinical Trials Register (DRKS00005591). Registered 2 February 2015.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.

The Nursing Home Physical Performance Test: A Secondary Data Analysis of Women in Long-Term Care Using Item Response Theory

Background and Objectives

The Nursing Home Physical Performance Test (NHPPT) was developed to measure function among nursing home residents using sit-to-stand, scooping applesauce, face washing, dialing phone, putting on sweater, and ambulating tasks. Using item response theory, we explore its measurement characteristics at item level and opportunities for improvements.

Research Design and Methods

We used data from long-term care women. We fitted a graded response model, estimated parameters, and constructed probability and information curves. We identified items to be targeted toward lower and higher functioning persons to increase the range of abilities to which the instrument is applicable. We revised the scoring by making sit-to-stand and sweater items harder and dialing phone easier. We examined changes to concurrent validity with activities of daily living (ADL), frailty, and cognitive function.

Results

Participants were 86 years old, had more than three comorbidities, and a NHPPT of 19.4. All items had high discrimination and were targeted toward the lower middle range of performance continuum. After revision, sit-to-stand and sweater items demonstrated greater discrimination among the higher functioning and/or greater spread of thresholds for response categories. The overall test showed discrimination over a wider range of individuals. Concurrent validity correlation improved from 0.60 to 0.68 for instrumental ADL and explained variability (R2) from 22% to 36% for frailty.

Discussion and Implications

NHPPT has good measurement characteristics at the item level. NHPPT can be improved, implemented in computerized adaptive testing, and combined with self-report for greater utility, but a definitive study is needed.

Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia

BACKGROUND

Walk tests are commonly used to evaluate walking ability in frail older adults with dementia but their psychometric evidence in this population is lacking.

OBJECTIVES

1) To examine test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC₉₅) of walk tests in frail older adults with dementia, and 2) to examine the feasibility and consistency of a cueing system in facilitating participants in completing walk tests.

DESIGN

Psychometric study with repeated measures.

SETTING

Day care and residential care facilities.

PARTICIPANTS

Thirty-nine frail older adults with a mean age 87.1 and a diagnosis of dementia or Alzheimer's disease who were able to walk independently for at least 15 m.

METHODS

The participants underwent a 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on 6 separate occasions under 2 independent assessors using a cueing system. Functional status was measured using the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and Modified Barthel Index (MBI).

RESULTS

Excellent test-retest (ICC = 0.91-0.98) and inter-rater reliability (ICC = 0.86-0.96) were shown in the 2MWT, 6MWT and 10MeWT. The walk tests were strongly correlated with each other (ρ = 0.85-0.94). The correlations between the walk tests and the functional measures were moderate in general (ρ = 0.34-0.55). All the walk tests were able to distinguish between those who could walk outdoor and indoor only (p ≤ .036). The MDC₉₅ were 9.1 m in the 2MWT, 28.1 m in the 6MWT, and.16 m/s in the 10MeWT. The cues provided by the assessors in the walk tests were generally consistent (ICC = 0.62-0.89).

CONCLUSIONS

The 2MWT, 6MWT and 10MeWT are reliable and valid measures in evaluating walking ability in frail older adults with dementia. The MDC₉₅ of the walk tests has been established. The cueing system is feasible and reliable to facilitate the administration of the walk tests in this population group.

The Korean version of relative and absolute reliability of gait and balance assessment tools for patients with dementia in day care center and nursing home

[Purpose] This study was aimed to determine the relative and absolute reliability of Korean version tools of the Berg Balance Scale (BBS), the Timed Up and Go (TUG), the Four-Meter Walking Test (4MWT) and the Groningen Meander Walking Test (GMWT) in patients with dementia. [Subjects and Methods] A total of 53 patients with dementia were tested on TUG, BBS, 4MWT and GMWT with a prospective cohort methodological design. Intra-class Correlation Coefficients (ICCs) to assess relative reliability and the standard error of measurement (SEM), minimal detectable change (MDC₉₅) and its percentage (MDC_%) to analyze the absolute reliability were calculated. [Results] Inter-rater reliability (ICC_(2,3)) of TUG, BBS and GMWT was 0.99 and that of 4MWT was 0.82. Inter-rater reliability was high for TUG, BBS and GMWT, with low SEM, MDC₉₅, and MDC_%. Inter-rater reliability was low for 4MWT, with high SEM, MDC₉₅, and MDC_%. Test-retest (ICC_(2,3)) of TUG, BBS and GMWT was 0.96–0.99 and Test-retest (ICC_(2,3)) of 4MWT was 0.85. The test-retest was high for TUG, BBS and GMWT, with low SEM, MDC₉₅, and MDC_%, but it was low for 4MWT, with high SEM, MDC₉₅, and MDC_%. [Conclusion] The relative reliability was high for all the assessment tools. The absolute reliability has a reasonable level of stability except the 4MWT.

Correlation Between Caregiver Reports of Physical Function and Performance-based Measures in a Cohort of Older Adults With Alzheimer Disease

The objectives of this report are to determine the association between performance-based measures of physical function with caregiver reports of physical function in older adults with Alzheimer disease (AD) and to examine whether those associations vary by the level of patients' cognitive functioning. Subjects included 180 patient-caregiver dyads who are enrolled in a clinical trial testing the impact of an occupational therapy intervention plus guideline-level care to delay functional decline among older adults with AD. The primary caregiver-reported measure is the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Inventory (ADCS-ADL). Performance-based measures include the Short Physical Performance Battery and the Short Portable Sarcopenia Measure. Analysis of covariance (ANCOVA) models were used to determine the associations of each physical performance measure with ADCS-ADL, adjusting for cognition function and other covariates. We found significant correlations between caregiver reports and observed performance-based measures across all levels of cognitive function, with patients in the lowest cognitive group showing the highest correlation. These findings support the use of proxy reports to assess physical function among older adults with AD.

Effects and feasibility of an exercise intervention for individuals living with dementia in nursing homes: study protocol

BACKGROUND

Worldwide, there are an estimated 35.6 million individuals living with dementia. It is important that non-pharmacological therapies are utilized to help manage the symptoms of dementia, such as agitation, as they are the recommended first approach in best practice guidelines.

METHODS

This protocol outlines a randomized controlled trial with a qualitative component which evaluated the effects and feasibility of a physical therapist-led physical exercise intervention on agitation of individuals living with dementia in nursing homes. Physical performance levels were considered as a secondary outcome. This evidence-based protocol consisted of a range of adaptable physical exercises that targeted strength, balance, endurance, and flexibility. To help determine the optimum parameters for this population group, the study used two intervention groups: (a) physical exercise intervention for 45 minutes once a week; (b) physical exercise intervention for 15 minutes three times a week (total time also 45 minutes per week). Both intervention groups were compared to a control group, which continued to participate in usual care only (no specific physical exercise intervention), such as basic seated exercise class, carpet bowls, and "armchair" activities.

CONCLUSIONS

The physical therapist-led physical exercise intervention detailed in this protocol could be integrated into dementia care in nursing homes or other similar settings to help reduce agitation and improve physical performance.

"Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia"

BACKGROUND

The purpose of the study was to establish the test-retest reliability of the Norwegian version of the Short Physical Performance Battery (SPPB).

METHODS

This was a cross- sectional reliability study. A convenience sample of 61 older adults with a mean age of 88.4(8.1) was tested by two different physiotherapists at two time points. The mean time interval between tests was 2.5 days. The Intraclass Correlation Coefficient model 3.1 (ICC, 3.1) with 95% confidence intervals as well as the weighted Kappa (K) were used as measures of relative reliability. The Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) were used to measure absolute reliability. The results were also analyzed for a subgroup of 24 older people with dementia.

RESULTS

The ICC reflected high relative reliability for the SPPB summary score and the 4 m walk test (4mwt), both for the total sample (ICC = 0.92, and 0.91 respectively)) and for the subgroup with dementia (ICC = 0.84 and 0.90 respectively). Furthermore, weighted Ks for the SPPB subscales were 0.64 for the chair stand, 0.80 for gait and 0.52 for balance for the total sample and almost identical for the subgroup with dementia. MDC-values at the 95% confidence intervals (MDC95) were calculated at 0.8 for the total score of SPPB and 0.39 m/s for the 4mwt in the total sample. For the subgroup with dementia MDC95 was 1.88 for the total score of SPPB and 0.28 m/s for 4mwt.

CONCLUSIONS

The SPPB total score and the timed walking test showed overall high relative and absolute reliability for the total sample indicating that the Norwegian version of the SPPB is reliable when used by trained physiotherapists with older people. The reliability of the Norwegian SPPB in older people with dementia seems high, but due to a small sample size this needs further investigation.

Reproducibility: Reliability and agreement of short version of Western Ontario Rotator Cuff Index (Short-WORC) in patients with rotator cuff disorders

INTRODUCTION

Recently, a shorter version of Western Ontario Rotator Cuff Index (Short-WORC) was proposed as a subset of 7 items from the original 21-item WORC. However, the reproducibility of the Short-WORC has not been established.

PURPOSE OF THE STUDY

To determine reproducibility (reliability and agreement) of the Short-WORC among patients with rotator cuff disorders (RCDs).

METHODS

Patients (n = 153) diagnosed with RCD completed the WORC at baseline and at 3 months post-operatively (n = 146). The Short-WORC was extracted from the full version of WORC. From this retrospective cohort, 43 patients were retested within 5 weeks, if they remained stable. Cronbach's alpha (α) and intra class correlation coefficients (ICC2,1) were used to assess internal consistency and test-retest reliability respectively. Standard error measurement (SEM), minimal detectable change (MDC90) and Bland Altman (BA) plots were used to assess agreement.

RESULTS

No floor and ceiling effects were reported for either the Short-WORC or WORC. Cronbach's α were 0.84 and 0.90 at baseline and 0.89 and 0.95 at 3 month of follow up for Short-WORC and WORC respectively. The ICC2,1 were 0.89 and 0.91 for the Short-WORC and WORC respectively. The agreement parameters for the Short-WORC were: SEMagreement = 8.8, MDC90individual = 20.3, MDC90group = 5.1. We found substantial agreement between the two versions of WORC on BA plots with minimal (mean difference (d) <1) systematic differences between them. The limits of agreement (LOA) between two versions of WORC were similar across sessions and fell within range of -11.7 to 13.2 points at test and -14.7 to 14.7 points at retest.

CONCLUSION

Short-WORC and WORC demonstrates strong reproducibility and can be used for group and individual comparison of health-related quality of life (HRQoL) among patients with RCD. Wider LOA may be expected when using the Short-WORC for individual patient assessment. Reproducibility data is essential, but should be supplemented by validation of actual Short-WORC with samples representing the spectrum of RCD.

LEVEL OF EVIDENCE

N/A.

Psychometric viability of measures of functional performance commonly used for people with dementia: a systematic review of measurement properties

BACKGROUND

Confidence in findings can only be drawn from measurement tools that have sound psychometric properties for the population with which they are used. Within a dementia specific population, measures of physical function have been poorly justified in exercise intervention studies, with justification of measures based on validity or reliability studies from dissimilar clinical populations, such as people with bronchitis or healthy older adults without dementia.

OBJECTIVES

To review the reliability and validity of quantitative measures of pre-identified physical function, as commonly used within exercise intervention literature for adults with dementia.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Participants were adults, aged 65 years and older, with a confirmed medical diagnosis of dementia.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

n/a

TYPES OF STUDIES

Desired studies were observational and cross-sectional and that assessed measures from a pre-identified list of measures of physical function.

OUTCOMES

Studies that assessed the psychometric constructs of reliability and validity were targeted. COSMIN taxology was used to define reliability and validity. This included, but were not limited to, Intra-Class Correlations, Kappa, Cronbach's Alpha, Chi Squared, Standard Error of Measurement, Minimal Detectable Change and Limits of Agreement.

SEARCH STRATEGY

Published material was sourced from the following four databases: MEDLINE, EMBASE, CINAHL and ISI Web of Science. Grey literature was searched for using ALOIS, Google Scholar and ProQuest.

METHODOLOGICAL QUALITY

The COSMIN checklist was used to assess methodological quality of included studies. Assessment was completed by two reviewers independently.

DATA EXTRACTION

Reliability and validity data was extracted from included studies using standardized Joanna Briggs Institute data collection forms. Extraction was completed by two reviewers.

DATA SYNTHESIS

A narrative synthesis of measurement properties of the tools used to measure physical function was performed. Quantitative meta-analysis was conducted for Intra-Class Correlation Coefficients only.

RESULTS

With respect to relative reliability, studies reporting assessed measures had intraclass correlation coefficients greater than 0.71, indicating their suitability for use at a group level. However, a consistent finding among studies that included assessment of absolute reliability was that intra individual variation was too large for meaningful measurement of individuals. This was indicated by large Minimal Detectable Change (MDC) scores. Walk Speed has the smallest reported Mimimal Detectable Change score at 0.11m/s. This represented a change of 35% before statistical variation could be eliminated as the cause for this change. All measures had large MDC values. Walk Speed had the smallest MDC values at 0.11m/s, which represented a necessary change of 35%. Only a limited number of studies assessed the validity of measures. This supports the use of these measures in a very narrow selection of circumstances (see Summary of Findings).

CONCLUSIONS

In summary, measures have shown appropriate levels of relative reliability. This supports their use at the group level. However, large levels of intra-individual variation undermine their applicability at the individual level. Limited studies of validity were available to this review, which limits a conclusion on whether measures are valid for people with dementia.

Comparison of the psychometric properties of four dementia knowledge measures: Which test should be used with dementia care staff?

OBJECTIVE

To compare the psychometric properties of four measures of dementia institutional knowledge.

METHODS

Fifty-eight dementia care staff completed the Dementia Knowledge Assessment Tool Version Two (DKAT2), Alzheimer's Disease Knowledge Test (ADKT), Alzheimer's Disease Knowledge Scale (ADKS) and Dementia Knowledge Twenty (DK-20). The convergent validity and reliability of each measure were examined.

RESULTS

The level of dementia knowledge in this sample was similar to that reported in comparable surveys. The ADKT, DKAT-2 and DK-20 had marginal to acceptable internal consistency (α ≥ 0.67), and the ADKT, DK-20 and ADKS were positively correlated with each other (r's = 0.45-0.60), demonstrating convergent validity. The DKAT2 had lower intercorrelations with the other measures (r's = 0.32-0.45). The ADKS had poor internal consistency (α = 0.29).

CONCLUSION

As the first head-to-head comparison of these tests in a single sample, this study should assist clinicians and researchers to select a dementia knowledge test.

Isometric hand grip strength measured by the Nintendo Wii Balance Board - a reliable new method

BACKGROUND

Low hand grip strength is a strong predictor for both long-term and short-term disability and mortality. The Nintendo Wii Balance Board (WBB) is an inexpensive, portable, wide-spread instrument with the potential for multiple purposes in assessing clinically relevant measures including muscle strength. The purpose of the study was to explore intrarater reliability and concurrent validity of the WBB by comparing it to the Jamar hand dynamometer.

METHOD

Intra-rater test-retest cohort design with randomized validity testing on the first session. Using custom WBB software, thirty old adults (69.0 ± 4.2 years of age) were studied for reproducibility and concurrent validity compared to the Jamar hand dynamometer. Reproducibility was tested for dominant and non-dominant hands during the same time-of-day, one week apart. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) and limits of agreement (LOA) were calculated to describe relative and absolute reproducibility respectively. To describe concurrent validity, Pearson's product-moment correlation and ICC was calculated.

RESULTS

Reproducibility was high with ICC values of >0.948 across all measures. Both SEM and LOA were low (0.2-0.5 kg and 2.7-4.2 kg, respectively) in both the dominant and non-dominant hand. For validity, Pearson correlations were high (0.80-0.88) and ICC values were fair to good (0.763-0.803).

CONCLUSION

Reproducibility for WBB was high for relative measures and acceptable for absolute measures. In addition, concurrent validity between the Jamar hand dynamometer and the WBB was acceptable. Thus, the WBB may be a valid instrument to assess hand grip strength in older adults.