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Archives of Gerontology and Geriatrics Sep 2023Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported...
Estimating cutpoints of gait speed and sit-to-stand test values for self-reported mobility limitations in a cohort of community-dwelling older adults from Singapore: comparing receiver operating characteristic (ROC) analysis with adjusted predictive modelling.
OBJECTIVES
Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported mobility limitations (SRML) on gait speed and 5-STS performance, and estimating clinical cutpoints for SRML using the receiver operating characteristics (ROC) method. Accumulating evidence, however, suggests that the adjusted predictive modeling (APM) method may be more appropriate to estimate these interpretational cutpoints. Thus, we aimed to compare, in community-dwelling older adults, gait speed and 5-STS cutpoints estimated using the ROC and APM methods.
DESIGN
Cross-sectional study.
SETTING AND PARTICIPANTS
This study analyzed data from 955 community-dwelling independently walking older adults (73%women) aged ≥60 years (mean, 68; range, 60-88).
METHODS
Participants completed the 10-metre gait speed and 5-STS tests. Participants were classified as having SRML if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty. Cutpoints for SRML and its component questions were estimated using ROC analysis with Youden criterion and the APM method.
RESULTS
The proportions of participants with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML were 10%, 19%, and 22%, respectively. Gait speed and 5-STS time were moderately correlated with each other (r=-0.56) and with the self-reported measures (absolute r-values, 0.39-0.44). ROC-based gait speed cutpoints were 0.14 to 0.16 m/s greater than APM-based cutpoints (P < 0.05) whilst ROC-based 5-STS time cutpoints were 0.8 to 3.3 s lower than APM-based cutpoints (P < 0.05 for walking difficulty). Compared with ROC-based cutpoints, APM-based cutptoints were more precise and they varied monotonically with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML.
CONCLUSIONS AND IMPLICATIONS
In a sample of 955 older adults, our findings of precise and biologically plausible gait speed and 5-STS cutpoints for SRML estimated using the APM method indicate that this promising method could potentially complement or even replace traditional ROC methods.
Topics: Aged; Humans; Female; Independent Living; Walking Speed; ROC Curve; Mobility Limitation; Self Report; Cross-Sectional Studies; Singapore; Geriatric Assessment; Walking; Gait
PubMed: 37075584
DOI: 10.1016/j.archger.2023.105036 -
The Gerontologist Dec 2015Optimal mobility is an important element of healthy aging. Yet, older adults' perceptions of mobility and mobility preservation are not well understood. The purposes of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF THE STUDY
Optimal mobility is an important element of healthy aging. Yet, older adults' perceptions of mobility and mobility preservation are not well understood. The purposes of our study were to (a) identify studies that report older adults' perceptions of mobility, (b) conduct a standardized methodological quality assessment, and (c) conduct a metasynthesis of the identified studies.
DESIGN AND METHODS
We included studies with community-dwelling adults aged ≥65 years, focused on perceptions of mobility pertaining to everyday functioning, used qualitative methods, and were cited in PubMed, Embase, CINAHLPlus, or Geobase databases. Study quality was appraised using the McMaster University Tool.
RESULTS
Out of 748 studies identified, 12 met inclusion criteria. Overall quality of the studies was variable. Metasynthesis produced 3 overarching themes: (a) mobility is part of sense of self and feeling whole, (b) assisted mobility is fundamental to living, and (c) adaptability is key to moving forward.
IMPLICATIONS
Older adults' perceptions of mobility can inform interventions that would involve actively planning for future mobility needs and enhance the acceptance of the changes, both to the older adult and the perceived response to changes by those around them.
Topics: Aged; Aging; Health Status; Humans; Mobility Limitation; Perception; Qualitative Research
PubMed: 24637252
DOI: 10.1093/geront/gnu014 -
Breast Cancer Research and Treatment Oct 2022We explored the impact of persistent sensory and motor taxane-induced peripheral neuropathy (TIPN) symptoms on health-related quality of life (HRQL) among early-stage...
BACKGROUND
We explored the impact of persistent sensory and motor taxane-induced peripheral neuropathy (TIPN) symptoms on health-related quality of life (HRQL) among early-stage breast cancer survivors (ESBCS).
METHODS
A population-based cohort of 884 residual-free ESBCS received a postal questionnaire, including the EORTC chemotherapy-induced PN (CIPN20) and the EORTC QLQ-C30 instruments. Mean scores of QLQ-C30 scales among ESBCS with and without TIPN were calculated and adjusted for confounding factors (age, lifestyle factors, co-morbidities; linear regression analyses). Interpretation of QLQ-C30 results were based on guidelines.
RESULTS
Response rate was 79%, and 646 survivors were included in the analysis. In median, 3.6 (1.5-7.3) years had elapsed post-taxane treatment. All TIPN symptoms had a significant impact on global QoL, which worsened with increased severity of TIPN. Between 29.5% and 93.3% of ESBCS with moderate-severe TIPN reported a clinical important impairment of functioning and personal finances, 64.3-85.7% reporting "difficulty walking because of foot drop," and 53.1-81.3% reporting "problems standing/walking because of difficulty feeling ground under feet" had impaired functioning/finances. The difference in mean scores between affected and non-affected survivors was highest for "numbness in toes/feet" and "difficulty walking because of foot drop." Moderate-severe "difficulty climbing stairs or getting out of chair because of weakness of legs" and "problems standing/walking because of difficulty feeling ground under feet" were associated with the largest clinically important differences on all scales.
CONCLUSION
Persistent sensory and motor TIPN is associated with clinically relevant impairment of global QoL, functioning, and personal finances among ESBCS, which increased with level of TIPN severity.
Topics: Breast Neoplasms; Cancer Survivors; Cross-Sectional Studies; Female; Humans; Mobility Limitation; Peripheral Nervous System Diseases; Peroneal Neuropathies; Quality of Life; Surveys and Questionnaires; Survivors; Taxoids
PubMed: 35941422
DOI: 10.1007/s10549-022-06670-9 -
The Journals of Gerontology. Series A,... Mar 2019Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of... (Review)
Review
Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of physiologic systems. Measures of physical, cognitive and sensory, and psychosocial or emotional function predict important health outcomes like death and disability independently from the severity of a specific disease, cumulative co-morbidity, or disease severity measures. A growing number of clinical scientists in several subspecialties are exploring the utility of functional assessment to predict complication risk, indicate stress resistance, inform disease screening approaches and risk factor interpretation, and evaluate care. Because a substantial number of older adults in the community have some form of functional limitation, integrating functional assessment into clinical medicine could have a large impact. Although interest in functional implications for health and disease management is growing, the science underlying functional capacity, functional limitation, physical frailty, and functional metrics is often siloed among different clinicians and researchers, with fragmented concepts and methods. On August 25-26, 2016, participants at a trans-disciplinary workshop, supported by the National Institute on Aging and the John A. Hartford Foundation, explored what is known about the pathways, contributors, and correlates of physical, cognitive, and sensory functional measures across conditions and disease states; considered social determinants and health disparities; identified knowledge gaps, and suggested priorities for future research. This article summarizes those discussions.
Topics: Aging; Frailty; Humans; Mobility Limitation
PubMed: 29697758
DOI: 10.1093/gerona/gly093 -
The Journals of Gerontology. Series B,... Jan 2021This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.
OBJECTIVES
This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.
METHODS
Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.
RESULTS
Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.
DISCUSSION
To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.
Topics: Adult; Age Factors; Aged; Aging; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Middle Aged; Mobility Limitation; Motor Activity; Risk Factors; United States
PubMed: 31362309
DOI: 10.1093/geronb/gbz091 -
Journal of Hospital Medicine Jun 2017
Topics: Aged; Geriatric Assessment; Hospitals; Humans; Mobility Limitation; Prognosis
PubMed: 28574542
DOI: 10.12788/jhm.2759 -
Measures of movement and mobility used in clinical practice and research: a scoping review protocol.JBI Database of Systematic Reviews and... Dec 2018The first objective of this scoping review is to identify all tools designed to measure movement or mobility in adults. The second objective is to compare the tools to... (Review)
Review
The first objective of this scoping review is to identify all tools designed to measure movement or mobility in adults. The second objective is to compare the tools to the conceptual definitions of movement and mobility by mapping them against the International Classification of Functioning, Disability and Health (ICF).The specific questions that will be answered for each tool by the mapping are.
Topics: Activities of Daily Living; Disability Evaluation; Disabled Persons; Humans; Mobility Limitation
PubMed: 30531482
DOI: 10.11124/JBISRIR-2017-003800 -
The Journal of Nutrition, Health & Aging Dec 2009
Topics: Activities of Daily Living; Aged; Aging; Gait; Humans; Kinetics; Mobility Limitation; Walking
PubMed: 19924347
DOI: 10.1007/s12603-009-0245-0 -
Journal of the American Geriatrics... Jul 2012
Meta-Analysis Review
Topics: Accidental Falls; Aged; Humans; Mobility Limitation
PubMed: 22788399
DOI: 10.1111/j.1532-5415.2012.04017.x -
Physical Therapy Dec 2012
Topics: Critical Illness; Disability Evaluation; Humans; Intensive Care Units; Mobility Limitation; Motor Activity; Patient Care Team; Patient Discharge; Physical Therapy Modalities
PubMed: 23204510
DOI: 10.2522/ptj.2012.92.12.1484