Short physical performance battery (SPPB) The SPPB combines the results of three simple functional tasks into a single functional battery with a maximal combined score of 12. The advantage of the SPPB is that it is a simple test of lower extremity function that mimics everyday activities and can be done in a small space (such as an exam room or a patient’s living room) with minimal equipment (Treacy & Hasset, 2017). A large diversity of research devoted to the SPPB finds that it is a valid and reliable test that can be used across a large variety of populations and settings, including in older adults with pulmonary, cardiovascular, or neurologic disease in both community and hospital settings (Shirley Ryan Ability Lab, 2022). It should be noted, however, that high-functioning older adults will generally score at or near the maximum for the SPPB (2022). The SPPB is responsive to improvements in mobility and can be used to document improvements following an exercise intervention (Treacy & Hassett, 2017). The three tasks used in the SPPB are a simple balance measure (the ability to stand with feet together, in a semitandem stance, and in a tandem stance for 10 seconds each); the time it takes to complete five repeated chair stands; and self-selected gait speed (Treacy & Hassett, 2017). Each task is scored from 0 to 4 for a possible combined maximum score of 12 and minimum score of 0 (Shirley Ryan Ability Lab, 2022).
Details for scoring each of the three subsections can be found in Table 12. For all balance tasks, individuals are allowed assistance to move into the position. For example, they may use the wall or the therapist’s hands for balance assistance to get into a semitandem stance. Once in this position, they are asked to balance without assistance. They are allowed to bend their legs and move their arms and trunk as necessary to hold the position. Time ends after 10 seconds for each position or if their feet move. Self-selected gait speed is determined as detailed above. While being timed for the five chair stands, participants are asked to keep their arms crossed over their chest and to perform a full stand without the assistance of their arms. Timing starts when they begin to stand up and ends when they reach full standing position for the fifth repetition. If they are unable to stand without using their upper extremities for assistance, it is scored a 0. Generally, a combined score of less than 10 indicates some level of disability (Puthoff, 2008) and is a strong predictor of future disability, risk of falling, risk for rehospitalization, and death in older adults (Pavasini et al., 2016; Shirley Ryan Ability Lab, 2022; Treacy & Hassett, 2017). The minimal clinically important difference is 1 point on the overall score. A change of 0.5 point on the SPPB is considered to be a small meaningful change (Treacy & Hassett 2017). Table 12. Scoring the Subsections of the Short Physical Performance Battery
Table 12: Scoring the Subsections of the Short Physical Performance Battery Score Balance Gait Speed
Five Chair Stands Cannot perform task.
0 1
• Stand feet side-by-side 0 to 9 seconds.
Cannot perform task.
• Stand feet side-by-side 10 seconds. • Stand feet semitandem 0 to 9 seconds. • Stand feet semitandem 10 seconds. • Stand full tandem 0 to 2 seconds.
<0.43 meter/second.
>16.7 seconds to completed.
2
0.44 to 0.60 meter/second. 13.7 to 16.6 seconds to completed.
3 4
• Stand full tandem 3 to 9 seconds.
.0.61 to 0.77 meter/second 11.2 to 13.6 seconds to completed.
• Stand full tandem 10 seconds.
>0.78 meters/second.
<11.1 seconds to completed.
Note . Adapted from Guralnik (1995).
How to measure changes after flexibility exercises Flexibility changes can be measured metrically or functionally. Standard occupational therapy prompts during a functional screen to observe functional movement include putting both hands behind one’s head, putting both hands behind one’s back, and touching one’s toes etc. Goniometric measurements can more specifically show changes by an
improvement in range of motion that can have a numeric value and can be compared to norms determined for older adults, but there are not generally accepted values for adults over age 69. Table 13 shows some values suggested from the American College of Sports Medicine for 65-to 69-year-old men and women.
Table 13: Normal Range of Motion for Men and Women ages 65–69 Joint Movement Men
Women
Hip extension
13° to 15°
16° to 18°
Hip flexion
126° to 129°
129° to 132°
Knee flexion
132° to 134°
137° to 139°
Ankle dorsiflexion
0° to 1°
1° to 2°
Shoulder flexion
162° to 166°
167° to 170°
Elbow extension
–2° to 0°
3° to 5°
Elbow flexion
142° to 145°
147° to 149°
Note : Adapted from Liguori & American College of Sports Medicine (2020).
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