Test-retest reliability and minimal detectable change of four functional tests in community-dwelling older adults with high risk of falls.

Objectives: This study aimed to quantify test-retest reliability and minimal detectable change (MDC) of the four commonly used functional tests in older adults with a high risk of falling. Patients and methods: The cross-sectional study was conducted with 30 community-dwelling older adults (26 females, 4 males; mean age: 73.7±6.0 years; range, 65 to 88 years) with a high fall risk identified by the Thai falls risk assessment test between November 2018 and May 2019. Data from the 10-m walk test at a comfortable gait speed (CGS) and fast gait speed (FGS), timed up and go (TUG) test, five times sit to stand test (FTSST), and 6-min walk test (6MWT) were collected twice for each participant. The interval between test sessions was one week. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC). Standard error of measurement (SEM) and MDC at the 95% confidence interval (MDC95) were also calculated. Results: The four functional tests had ICC in the range of 0.92 to 0.97. The SEM values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.06 m/sec, 0.04 m/sec, 1.10 sec, 1.30 sec, and 20.60 m, respectively. The MDC95 values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.16 m/sec, 0.12 m/sec, 3.00 sec, 3.50 sec, and 57.20 m, respectively. Conclusion: All functional tests demonstrated excellent test-retest reliability. The SEM and MDC95 of all functional tests were established. These findings can help clinicians interpret the effectiveness of interventions and determine changes in functional ability over time in older adults at high risk of falls.

Determination of Body Composition in Community-Dwelling Older Adults With and Without Sarcopenia Using Data From Practical Measures.

Adequate body composition is essential for health, function, and independence in older adults. However, standard body composition assessments require complex and costly modalities, limiting their use for early detection of body composition changes and periodic follow-up. This study explored the ability of three practical measures-handgrip strength, five times sit-to-stand test, and upper limb loading during seated push-up test (ULL-SPUT)-to determine body composition in 109 older adults with and without sarcopenia. Participants (average age 76 years) were cross-sectionally measured for outcomes of the study. The ULL-SPUT and handgrip strength, but not the five times sit-to-stand test, significantly correlated with body composition (rs, r = .297-.827, p < .01). The ULL-SPUT, in combination with demographic data, could determine body composition up to 82%. Therefore, the ULL-SPUT may be a practical preliminary measure to identify older adults for whom standard body composition assessments and follow-up would prove timely and beneficial.

The determination of sarcopenia in older adults using a practical measure.

BACKGROUND: Many older adults are at risk of sarcopenia, a gradual loss of muscle mass affecting muscle strength and physical function, which can lead to adverse health consequences deteriorating their independence. However, the detection could be delayed due to the requirement of many measures, including a complex imaging modality. Thus, an exploration for a practical community- or home-based measure would be helpful to identify at-risk older adults and begin the timely management. OBJECTIVE: To explore the ability of the upper limb loading during a seated push-up test (ULL-SPUT) to determine the presence of sarcopenia in community-dwelling older adults. METHODS: Older adults (n= 110; 62 females, average age approximately 77 years) were cross-sectionally assessed for sarcopenia using standard measures (handgrip strength, appendicular skeletal muscle mass, and walking speed) and the ULL-SPUT. RESULTS: Data from standard measures indicated that 44 participants had sarcopenia. The ULL-SPUT index of < 16.9 kg/m2 for females (sensitivity = 86%, specificity = 78%, area under the receiver operating characteristic curve [AUC] = 0.85) and < 19.7 kg/m2 for males (sensitivity = 73%, specificity = 69%, AUC = 0.83) could optimally identify participants with sarcopenia. CONCLUSION: The ULL-SPUT index could be used to screen and monitor older adults with sarcopenia in various clinical, community, and home settings. This practical measure may be accomplished using a digital bathroom scale on a hard, even surface. Outcomes would identify an adult who should undergo further confirmation of sarcopenia through standard measures or the initiation of timely management to promote treatment effectiveness.

The Use of Practical Measures to Determine Body Composition of Older People.

Background: Older adults frequently experience body composition changes-decreased lean body mass (LBM) and bone mineral content (BMC), along with increased body fat mass (FM)-which affect their health and independence. However, the need for standard complex and costly imaging modalities could delay the detection of these changes and retard treatment effectiveness. Thus, this study explored the ability of practical measures, including simple muscle strength tests and demographic data, to determine the body composition of older adults. Methods: Participants (n = 111, with an average age of 77 years old) were cross-sectionally assessed for the outcomes of the study, including upper limb loading during a seated push-up test (ULL-SPUT), hand grip (HG) strength test and body composition. Results: The ULL-SPUT significantly correlated with body composition (r or rs, = 0.370-0.781; P < 0.05), particularly for female participants and was higher than that found for the HG strength test (rs = 0.340-0.614; P < 0.05). The ULL-SPUT and HG strength test, along with gender and body mass index (BMI), could accurately determine the LBM and BMC of the participants up to 82%. Conclusion: The ULL-SPUT along with gender and BMI can be used as a practical strategy to detect the LBM and BMC of older adults in various settings. Such a strategy would facilitate timely managements (i.e. standard confirmation or appropriate interventions) in various settings.

Walking speed to determine walking performance of people with mobility limitations from a developing country.

BACKGROUND: The criteria to determine walking performance of people with mobility limitations from developed countries have been already reported. However, these criteria may not be suitable to be applied for people with mobility limitations from developing countries due to the differences in sociodemographic characteristics and environmental conditions. OBJECTIVE: To explore cutoff points of walking speed to determine walking performance of individuals with mobility limitations from a developing country. METHODS: Individuals with mobility limitations from a developing country (n = 136) were cross-sectionally interviewed and assessed for their demographics and walking performance. Then they were assessed for their walking speed using the 10-meter walk test. RESULTS: Walking speeds of ≥0.30 m/s, ≥ 0.40 m/s, and ≥0.65 m/s could optimally indicate the ability of outside-home walking, limited-community walking, and full-community walking, respectively (sensitivity = 78%-84%, specificity = 81%-93%, and area under the receiver operating characteristic curve [AUC] > 0.90). Moreover, a walking speed of ≥0.35 m/s could suggest the ability of functional walking (sensitivity = 78%; specificity = 83%; and AUC = 0.89). CONCLUSIONS: With the need of standard practical measure for early screening and monitoring of functional alteration over time, the present walking speed cutoff points may be clinically applied to suggest walking performance in daily living specifically for individuals with mobility limitations from a developing country.

Seated push-up tests: Reliable and valid measures for older individuals when used by primary healthcare providers.

BACKGROUND: Body composition decline, lower limb impairments, and mobility deficits affect independence of older people. The exploration for a practical measure involving upper extremities may offer an alternative tool to be used by primary healthcare (PHC) providers for these individuals. OBJECTIVE: To explore reliability and validity of seated push-up tests (SPUTs) among older participants when used by PHC providers. METHODS: Older participants (n= 146) with an average age of > 70 years were cross-sectionally assessed using various demanding forms of SPUTs and standard measures to assess validity of the SPUTs. Reliability of the SPUTs were assessed in nine PHC raters, including an expert, health professionals, village health volunteers, and care givers. RESULTS: The SPUTs demonstrated very good agreement, with excellent rater and test-retest reliability (kappa values > 0.87 and ICCs > 0.93, p< 0.001). Moreover, the SPUT outcomes significantly correlated with lean body mass, bone mineral contents, muscle strength and mobility of older participants (r, rp⁢b=-0.270 to 0.758, p< 0.05). CONCLUSION: SPUTs are reliable and valid for older adults when used by PHC members. The incorporation of such practical measures is particularly important during this COVID-19 pandemic with limited people's hospital access.

Validity and feasibility of using a seated push-up test among community-dwelling older adults.

Background: Older individuals face a high risk of mobility and body composition decline, which can affect their independence. In light of a current uncertain healthcare situation created by the coronavirus (COVID-19) pandemic, healthcare paradigm has been shifted with increased demand for a practical measure to promote standard home healthcare services for all individuals, including older adults. Objective: This study explored the feasibility and validity of seated push-up tests (SPUTs) as clinical measures to reflect the body composition, muscle strength, and mobility among community-dwelling older individuals, aged ≥65 years (n=82). Methods: Participants were cross-sectionally assessed using SPUTs with various demanding forms, including the 1-time SPUT (1SPUT) along with its upper limb loading SPUT (ULL-SPUT), 5-time SPUT (5SPUT), 10-time SPUT (10SPUT), and 1-min SPUT (1minSPUT) and standard measures. Results: Participants who passed and failed a 1SPUT showed significant differences in the outcomes of all standard measures (p<0.05). The ULL-SPUT significantly correlated to all body composition, muscle strength, and mobility (r=0.247-0.785; p<0.05). Outcomes of 1minSPUT significantly correlated with muscle strength and mobility outcomes (r=0.306-0.526; p<0.05). Participants reported no adverse effects following the SPUTs. Conclusion: The findings suggest the use of the 1SPUT, ULL-SPUT, and 1minSPUT as practical measures to reflect the body composition, muscle strength, and mobility of older individuals, according to their functional levels. The tests may especially clinically benefit those with lower limb limitations and those in settings with limited space and equipment.