Measurement of Physical Functioning in National HESs

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Measurement of Physical Functioning in National
HESs

• Workshop on Health Examination Surveys
• Luxembourg 10th April 2008
• Sanna Natunen
• Recommendations on Measurement of Physical
  Functioning
• Natunen S., Viet L., Verscuren M.

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Content

• Why to measure
• How to measure
• 1. Grip strength
• 2. Walking speed
• 3. Standing balance
• 4. Single-leg stand
• 5. Timed chair stand
• Open questions

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Why to measure

• Demographic changes Aging population
• Used extensively in population studies/surveys
• NHANES
• Health Surveys for England
• Mini-Finland, Health 2000-surveys etc.
• Add valuable information over self report
• Predict subsequent disability, need of
  assistance, falls, nursing home admission and
  mortality ? e.g. targeting the interventions
  /prevention initiatives

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How to measure

• No international standards / recommendations
• FEHES review on measurement of physical
  functioning
• Used methods in previous HES
• Feasibility with in general health surveys
• Valid and reliable methods
• Administrable in different settings
  (home/clinics)
• Not expensive equipments
• Not extensive training
• Not time consuming

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Why to measure

• Theoretical advantages and disadvantages of
• performance versus self-report measures of
  physical functioning
• _________________________________________________
  ___________________________________
• Advantages
• _________________________________________________
  ______________________
• Face validity clear for task being performed
• Better reproducibility
• Greater sensitivity to change
• Usual activity vs. maximal capacity
• Influenced less by poor cognitive functioning
• Influenced less by culture, language, and
  education
• _________________________________________________
  ______________________________
• Disadvantages
• _________________________________________________
  ______________________
• More time consuming
• Adequate space and special equipment needed
• Special training of examiners
• Modifications necessary for home surveys
• Potential injuries

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Grip strength
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Grip strength
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Grip strength

• Strength of the dominant hand from 30 years and
  older
• Selection of the measurement device
• Hydraulic dynamometer
• Position of the participant?
• Recommendation of American Hand Therapist
• Sitting in a straight-backed chair
• Shoulders adducted in neutral, elbows flexed at
  90 degrees
• Procedure
• Test on the dominant hand
• Repeat the test three times and record the result
  after each time
• 3 to 5 minutes to perform

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Walking speed
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Walking speed
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Walking speed

• Review ? Guralnik et al 1994, Curb et al 2006
• Measure normal walking speed from all 50 years
  and older
• Equipment Stopwatch and measurement tape
• Procedure
• A distance of 4 meters (Guralnik et al 2000)
• Normal walking speed
• The time is recorded to the nearest 0.1 second
• If any walking aid (cane, walker, etc.) is used
  during the test, this is recorded on the
  collection form
• 1 minutes to perform

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Standing Balance
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Standing balance

• No previous international recommendations for
  standardized protocol exist
• Measure standing balance from 60 years and older
• Procedure
• Adapted from Guralnik et al 1994
• Semi-tandem stand (10s)
• Side-by-side stand (10s) / Full-tandem stand
  (10s)
• 5 minutes to perform

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Unassisted singel leg stand

• No previous international recommendations for
  standardized protocol exist
• Measure balance and other domains of functioning
• 30 years and elderly
• Protocol
• One leg standing position for 30 seconds
• Participant can choose the foot to raise
• 3 minutes to perform

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Timed chair stand
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Chair stand
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Timed chair stand

• No previous international recommendations for
  standardized protocol exist
• For all 30 years and older
• Equipment
• Stopwatch
• Armless chair (height 45 cm) with straight back
• Procedure
• Rise from the chair without the help of arms
• If successful, proceed to the next step of chair
  rises
• Rise from the chair without the help of arms
  (arms folded across chest), 10 times
• 2 to 3 minutes to perform

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Open questions

• Grip strength
• Dominant hand / both?
• Walking speed
• Normal walking speed / maximal walking speed?
• Standing balance
• Some more discriminating test also for highly
  functioning population?
• Timed chair stand
• 10 times, but is also time for 5 times rise
  needed?

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Conclusions

• Importance and public health relevance
• Feasible HIS/HES
• Future development
• EUNAAPA http//www.eunaapa.org/index.php
• ALPHA http//www.thealphaproject.eu/
• PROFANE http//www.profane.eu.org/
• National networks for example in Finland
  http//www.toimia.fi
• Other?

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itBut if you see it you believe it!!!!