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Mobility Disability (mobility + disability)
Selected AbstractsStopping to Rest During a 400-Meter Walk and Incident Mobility Disability in Older Persons with Functional LimitationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Sonja Vestergaard PhD OBJECTIVES: To examine the association between stopping to rest during a 400-m usual-pace walk test (400-MWT) and incident mobility disability in older persons with functional limitations. DESIGN: Prospective cohort study. SETTING: Community based. PARTICIPANTS: Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) Study aged 70 to 89 with functional limitations (summary score ,9 on the Short Physical Performance Battery (SPPB)) but able to complete the 400-MWT within 15 minutes. MEASUREMENTS: Rest stops during the 400-MWT were recorded. The onset of mobility disability, defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so, was recorded at Months 6 and 12. RESULTS: Fifty-four (12.7%) participants rested during the 400-MWT at baseline, of whom 37.7% experienced mobility disability during follow-up, versus 8.6% of those not stopping to rest. Performing any rest stop was strongly associated with incident mobility disability at follow-up (odds ratio (OR)=5.4, 95% confidence interval (CI)=2.7,10.9) after adjustment for age, sex, and clinic site. This association was weaker, but remained statistically significant, after further adjusting for SPPB and time to complete the 400-MWT simultaneously (OR=2.6, 95% CI=1.2,5.9). CONCLUSION: Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations. Given the prognostic value, rest stops should be recorded as part of the standard assessment protocol for the 400-MWT. [source] Incidence of Loss of Ability to Walk 400 Meters in a Functionally Limited Older PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Milan Chang PhD Objectives: To assess the incidence of and factors related to nondisabled but functionally limited older adults aged 75 to 85 years losing the ability to walk 400 m. Design: Observational study with average follow-up of 21 months. Setting: Community. Participants: At baseline, 101 persons with objective signs of functional limitations and intact cognitive function agreed to participate in the study. Of these, 81 were able to walk 400 m at baseline, and 62 participated in the follow-up examination. Measurements: Mobility disability was defined as an inability to complete a 400-m walk test. At baseline, eligible participants (n=81) had the ability to walk 400 m, scored between 4 and 9 on the Short Physical Performance Battery (SPPB; range 0,12), and scored 18 or more on the Mini-Mental State Examination. Demographics, difficulty in daily activities, disease status, behavioral risk factors, and muscle strength were assessed at baseline and follow-up. Results: Of 62 persons at follow-up, 21 (33.9%) developed incident mobility disability. The strongest predictors of loss of mobility were the time to complete the 400-m walk at baseline (odds ratio (OR)=1.6 per 1-minute difference, 95% confidence interval (CI)=1.04,2.45), and decline in SPPB score over the follow-up (OR=1.4 per 1-point difference, 95% CI=1.01,1.92). Conclusion: Older persons with functional limitations have a high rate of loss of ability to walk 400 m. The 400-m walk test is a highly relevant, discrete outcome that is an ideal target for testing preventive interventions in vulnerable older populations. [source] Evaluation of a German version of the Rivermead Mobility Index (RMI) in acute and chronic stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2000M. R. Schindl The English Rivermead Mobility Index (RMI) has been proposed as a simple, valid and reliable measure in stroke rehabilitation. A German version was established and validated in two centres. In centre A 46 acute (median: 3.0 days after onset) and in centre B 151 chronic (median: 88.0 days after onset) stroke patients participated. Interrater reliability of the German RMI was tested in 12 subjects in the acute stage of stroke and was found to be statistically significant (r = 0.98, P < 0.0001). In centre A, a statistically significant correlation was found between the German RMI and the 10-m walk time at baseline (r = 0.73, P < 0.0001) and after three weeks (r = 0.92, P < 0.0001). In centre B, the German RMI correlated significantly with the motor part of the Functional Independence Measure (motor-FIM) on admission (r = 0.78, P < 0.0001) and after three weeks (r = 0.79, P < 0.0001), respectively. The change of the RMI correlated significantly with the change in 10-m walk time in acute patients (r = 0.87, P < 0.0001) and with the change in motor-FIM in chronic patients (r = 0.54, P < 0.0001). A moderate ceiling-effect was detected in the chronic study population. The German RMI appears to be a reliable, valid and responsive measure for mobility disability in acute and chronic stroke patients. [source] Measuring disability in older adults: The International Classification System of Functioning, Disability and Health (ICF) frameworkGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2008W Jack Rejeski Background: Despite the importance of disability to geriatric medicine, no large scale study has validated the activity and participation domains of the International Classification System of Functioning, Disability, and Health (ICF) in older adults. The current project was designed to conduct such as analysis, and then to examine the psychometric properties of a measure that is based on this conceptual structure. Methods: This was an archival analysis of older adults (n = 1388) who had participated in studies within our Claude D Pepper Older Americans Independence Center. Assessments included demographics and chronic disease status, a 23-item Pepper Assessment Tool for Disability (PAT-D) and 6-min walk performance. Results: Analysis of the PAT-D produced a three-factor structure that was consistent across several datasets: activities of daily living disability, mobility disability and instrumental activities of daily living disability. The first two factors are activities in the ICF framework, whereas the final factor falls into the participation domain. All factors had acceptable internal consistency reliability (>0.70) and test,retest (>0.70) reliability coefficients. Fast walkers self-reported better function on the PAT-D scales than slow walkers: effect sizes ranged from moderate to large (0.41,0.95); individuals with cardiovascular disease had poorer scores on all scales than those free of cardiovascular disease. In an 18-month randomized clinical trial, individuals who received a lifestyle intervention for weight loss had greater improvements in their mobility disability scores than those in a control condition. Conclusion: The ICF is a useful model for conceptualizing disability in aging research, and the PAT-D has acceptable psychometric properties as a measure for use in clinical research. [source] Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009José Alberto Ávila-Funes MD OBJECTIVES: To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes. DESIGN: Four-year longitudinal study. SETTING: The French Three-City Study. PARTICIPANTS: Six thousand thirty community-dwelling persons aged 65 to 95. MEASUREMENTS: Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment. RESULTS: Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality. CONCLUSION: Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population. [source] Stopping to Rest During a 400-Meter Walk and Incident Mobility Disability in Older Persons with Functional LimitationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Sonja Vestergaard PhD OBJECTIVES: To examine the association between stopping to rest during a 400-m usual-pace walk test (400-MWT) and incident mobility disability in older persons with functional limitations. DESIGN: Prospective cohort study. SETTING: Community based. PARTICIPANTS: Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) Study aged 70 to 89 with functional limitations (summary score ,9 on the Short Physical Performance Battery (SPPB)) but able to complete the 400-MWT within 15 minutes. MEASUREMENTS: Rest stops during the 400-MWT were recorded. The onset of mobility disability, defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so, was recorded at Months 6 and 12. RESULTS: Fifty-four (12.7%) participants rested during the 400-MWT at baseline, of whom 37.7% experienced mobility disability during follow-up, versus 8.6% of those not stopping to rest. Performing any rest stop was strongly associated with incident mobility disability at follow-up (odds ratio (OR)=5.4, 95% confidence interval (CI)=2.7,10.9) after adjustment for age, sex, and clinic site. This association was weaker, but remained statistically significant, after further adjusting for SPPB and time to complete the 400-MWT simultaneously (OR=2.6, 95% CI=1.2,5.9). CONCLUSION: Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations. Given the prognostic value, rest stops should be recorded as part of the standard assessment protocol for the 400-MWT. [source] Incidence of Loss of Ability to Walk 400 Meters in a Functionally Limited Older PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Milan Chang PhD Objectives: To assess the incidence of and factors related to nondisabled but functionally limited older adults aged 75 to 85 years losing the ability to walk 400 m. Design: Observational study with average follow-up of 21 months. Setting: Community. Participants: At baseline, 101 persons with objective signs of functional limitations and intact cognitive function agreed to participate in the study. Of these, 81 were able to walk 400 m at baseline, and 62 participated in the follow-up examination. Measurements: Mobility disability was defined as an inability to complete a 400-m walk test. At baseline, eligible participants (n=81) had the ability to walk 400 m, scored between 4 and 9 on the Short Physical Performance Battery (SPPB; range 0,12), and scored 18 or more on the Mini-Mental State Examination. Demographics, difficulty in daily activities, disease status, behavioral risk factors, and muscle strength were assessed at baseline and follow-up. Results: Of 62 persons at follow-up, 21 (33.9%) developed incident mobility disability. The strongest predictors of loss of mobility were the time to complete the 400-m walk at baseline (odds ratio (OR)=1.6 per 1-minute difference, 95% confidence interval (CI)=1.04,2.45), and decline in SPPB score over the follow-up (OR=1.4 per 1-point difference, 95% CI=1.01,1.92). Conclusion: Older persons with functional limitations have a high rate of loss of ability to walk 400 m. The 400-m walk test is a highly relevant, discrete outcome that is an ideal target for testing preventive interventions in vulnerable older populations. [source] Joint Analysis of Time-to-Event and Multiple Binary Indicators of Latent ClassesBIOMETRICS, Issue 1 2004Klaus Larsen Summary. Multiple categorical variables are commonly used in medical and epidemiological research to measure specific aspects of human health and functioning. To analyze such data, models have been developed considering these categorical variables as imperfect indicators of an individual's "true" status of health or functioning. In this article, the latent class regression model is used to model the relationship between covariates, a latent class variable (the unobserved status of health or functioning), and the observed indicators (e.g., variables from a questionnaire). The Cox model is extended to encompass a latent class variable as predictor of time-to-event, while using information about latent class membership available from multiple categorical indicators. The expectation-maximization (EM) algorithm is employed to obtain maximum likelihood estimates, and standard errors are calculated based on the profile likelihood, treating the nonparametric baseline hazard as a nuisance parameter. A sampling-based method for model checking is proposed. It allows for graphical investigation of the assumption of proportional hazards across latent classes. It may also be used for checking other model assumptions, such as no additional effect of the observed indicators given latent class. The usefulness of the model framework and the proposed techniques are illustrated in an analysis of data from the Women's Health and Aging Study concerning the effect of severe mobility disability on time-to-death for elderly women. [source] | ||||||||||