Lecture 6: Field-Based Physical & Mobility Assessments Flashcards
Performing Assessments will help you with what 6 things
- Help identify and predict if a participant is at risk for mobility problems and disability (OA)
- Determine if the program is appropriate for the older exercising population (OA)
- Motivate your participants to set personal goals (OA & YA)
- Select exercises that meet specific needs of older participants (OA)
- Provide meaningful feedback to participants (OA & YA)
- Document the benefits of your physical activity program (OA & YA)
For the Chair Sit and Reach test which muscle is being tested and what side should you be on
The hamstrings muscles are being assessed and you should be kneeling on the side of the extended leg. Ensure that the knee of the participant is not bent
Functional Fitness Framework:
Identifies______
Relates_______
Functional Fitness Framework:
Identifies physical fitness parameters associated with functional mobility
Relates functional mobility and ADL
In the functional Fitness Framework what are the Physical Parameters
Muscle
-Strength and endurance
Aerobic endurance
Flexibility
Motor Ability
- Balance
- coordination
- speed/agility
- power
Physical impairment
In the functional Fitness Framework what are the functions
Walking
-stair climbing
Standing up from a chair
Lifting/reaching
bending/kneeling
Jogging/running
Functional Limitation
In the functional Fitness Framework what are the Activity Goals
Personal care
-shopping/errands
Housework
Gardening
Sports
Traveling
Physical disability
Dependance
Define Physical Impairment
Loss/abnormality at the tissue, organ, or body system level
Define Functional Limitation
Restriction in physical behaviors (rising from a chair, lifting or climbing stairs)
Physical Disability
Restriction in the ability to perform a task or an activity
In the example of increasing quad muscles leading to the increase in ability to climb stairs which leads to an increase in ADL, place each one in the physical fitness framework
Quad Strength = Physical Parameter (physical impairment)
Stair climbing = Function (functional limitation)
ADL = Activity goals (physical disability)
Should OA do squats
Yes!
In the articles about squats and older adults what was the purpose of the study
To determine the relationships of the quad rate of torque development and the time to peak torque with the physical function of the elderly
What were the results of the study
The time to peak torque showed significant correlation with all measures of physical activity tests
Isometric and Isokinetic torques had no significant correlations with any of the physical activity tests
What is the best type of squat for OA
Fast squats - improve the speed because the OA’s that have a faster time to peak torque were the ones who performed best in the tasks
What are the 4 common obstacles with assessments
- Lack of time, space, budget
- Lack of trained personnel (to administer the test or interpret the test)
- Lack of assessment tools
- Absence of a requirement by facility management
Are most PA centers for OA good at conducting field based assessments?
Yes, for the initial assessment but not for follow up
What are the 2 major criteria for selection and evaluation of test instruments
1) Practicality
2) Psychometric properties
What is practicality
The “usability” of the test
What are the 5 factors that influence usability
- Medical supervision or permission required and available
- Time needed to administer and score the test
- Personnel and expertise needed to administer the test
- Level of fatigue to participant per test
- Is the test meaningful to your participants
What does psychometric properties refer to
Refers to the degree the test will meet specific and established test construction guidelines
What are the 4 psychometric properties
- Reliability
- Validity
- Discrimination Power
- Performance Standards
Define Reliability
Refers to the degree that two test scores are similar when tested under identical conditions
When a test is reliable it is free of
Measurement error
Referred to as Test-Re-Test Reliability
Should be ABOVE 0.8
Must originate from published protocol
Define Inter-Rater Reliability
When scores obtained from multiple testers are very similar
High correlation
Define Validity
Refers to the test having shown to measure what it is intended to measure
What is the most important characteristic of any test
Validity
What is criterion related validity
Development of a new test, evaluates a tests validity by comparing its scores with others scores already found to be valid
Give an example of criterion related validity
30-second chair stand test vs lab based measure such as the 1 RM leg press on the biodex
What is the acceptable correlation value for criterion related validity
values ABOVE 0.7
Define Content Validity
The degree to which a test measured the domain of interest
Content validity is determined by who
Experts in the field
Example: the domain of interest of the Fullerton Advanced Balance Scale is balance
What is predictive validity
Ability of a test to predict the future outcome of the test
Research data must show a strong statistical prediction to the future outcome
What score on the Fullerton Balance scale indicates a high risk of falls
less than or equal to 25
What is discrimination power
ability of the test to detect changes in performance over time
to assess a change in performance over time or in relation to an intervention, the test should have a minimum floor or ceiling effect
What is a floor effect
When the test is too difficult for specific subjects being tested
What is a ceiling effect
When the test is too easy for specific subjects being tested
When using the berg balance scale
Floor effect: none of the participants would be able to score above______
Ceiling effect: participants woulds score _____ on most test items
When using the berg balance scale
Floor effect: none of the participants would be able to score above 0
Ceiling effect: participants woulds score 4 on most test items
On the Berg Balance Scale items 12-14 are most difficult for most_____
hemiparietic participants and elderly with balance problems = close supervision is extremely important = can lead to a floor effect
Performance Standard Interpretation of the scores (providing feedback to participants) consists of what 2 thing?
- Norm-referenced standards
2. Criterion-referenced standards
What are norm-referenced standards?
Evaluates by comparing others to the same GENDER and AGE
What are criterion-referenced standards
Evaluate performance in relation to a particular reference point or specific goal
Give an example of how criterion-references standards evaluates performance in relation to a particular reference point or specific goal
Fitness level to climb stairs or to remain functionally independent
What are the 2 field based assessment tools designed to measure physical impairments and functional limitations in OA?
- Senior fitness test
2. Fullerton Advanced Balance Scale
How many pub med papers on the FAB
49
Is the FAB more demanding than BERG
yes
What are the 5 good reasons for using the senior fitness test?
- Meets psychometric properties (reliable, discriminative and valid)
- Is convenient and practical in terms of equipment, training space, and time requirements
- Has norm-referenced standards for interpretability of test results: 5 year age group norms for independent living men and women aged 60-94 (established on large groups of participants)
- Allow OA to perform that test safely without the need for a medical release (most cases)
- Evaluates a large range of physical abilities and functions
What are the 7 components of the SFT
- 30 sec chair stand
- 30 sec arm curl
- 6 min walk
- 2 min step test
- chair sit and reach test
- back scratch
- 8 foot up and go
What is the purpose and risk zone for the 30 s chair stand
Purpose: To assess lower body strength
Risk: less than 8 unassisted stands for men and women
What is the purpose, description and risk zone for the 30 sec arm curl
Purpose: To assess upper body strength
Description: 5 lbs for woman and 8 lbs for men
Risk: less than 11 curls using correct form for men and women
What is the purpose and risk for the 6 min walk
Purpose: To assess aerobic endurance
Risk: Less than 350 yards / 320 meters for men and women
What is the purpose and risk for the 2 min step test
Purpose: Alternate aerobic endurance test
Risk: less than 65 steps for both men and women
What is the purpose and the risk for the chair sit and reach test
Purpose: To assess lower body flexibility
Risk:
Men: -4 inches or more (inches away from the toes)
Women: -2 inches or more
*at the toe = 0, beyond toes = +
What is the purpose and the risk zone for the back scratch test
Purpose: To assess upper body shoulder flexibility
Risk:
Men: -8 inches
Women: -4 inches
*can choose whatever side the want, when fingers overlap its +)
What i the purpose and risk zone for the 8 foot up and go test
Purpose: To assess agility and dynamic balance)
Risk: more than 9 seconds
*walker allowed if noted
The Fullerton Advanced Balance Scale is a series of _____ functional tests which assess both ______&______ balance under varied ________ conditions
The Fullerton Advanced Balance Scale is a series of 10 functional tests which assess both STATIC & DYNAMIC balance under varied SENSORY conditions
What point scale is used to measure the outcome of the test
4 point
the FAB has high (4)
- Predictive Validity
- test-re-test reliability
- intra and interrater reliability
- Content validity
What is the relationship between probability of falling and FAB score
Negative, as the FAB score increase, the probability of falling decreases
Who is the author of “Prediction which older adults will or will not fall using the FAB scale
Hernandez D, Rose DJ
What was the objective of the study
The purpose of the study was to determine if the FAV scale can predict faller status in a group of independently functioning older adults
What was a faller classified as
an older adults with a history of 2 or more falls in the pervious 12 months
What was the participant description
A sample of independently functioning older adults (N=192 mean age=77+/-6.5)
What were the main outcome measures
FAB scale, a retrospective history of falls
What were the results of the study
a regressions analysis indicated that the total FAB scale score could be used to predict fall status. In this sample the probability of falling increased by 8% with each 1 pnt decrease in the FAB scale. Cut off score of 25/40 had the highest sensitivity and specificity in predicting fall status.
5 test items were the best fall status and could be combined to form a short versions of the scale
What was the conclusion
The FAB scale is a predictive measure of faller status when used with independently functioning older adults. A practitioner can be confident in more than 7 out of the 10 cases that an older adult who scores 25 or lower on the FAB scale is at high risk for falls and in need of immediate intervention
the FAB is an excellent test for OA without what type of issues
balance issues
For lower functioning OA due to chronic diseases and disabilities (stroke, parkinsons…) its better to use?
Easier test such as Berg Balance Scale
What are the 10 items on the FAB scale and does it measure Posture (P), Stepping (S) or Time (T)
- Stand with feet together and eyes closed (sensory) (P+T)
- Reach forward to retrieve an object (pencil) help at shoulder height with outstretched arm (P+S)
- Turn 360 degrees in right and left directions (P+S)
- Step onto and over a 6 inch bench (P)
- Tandem Walk (S)
- Stand on one leg (P+T)
- Stand on foam with eyes closed (sensory)
- Two-footed jump (jumping)
- Walk with head turns (P+S)
- Reactive postural control (P+S)
When evaluating Risk for Falls, Long form is how many items and what is the cut off score
Long Form = 10 items
Cut off = less than or equal to 25/40 is high risk
When evaluating Risk for Falls, Short form is how many items and what is the cut off score
Short Form = 4, 5, 6, 7
Cut off = less than or equal to 9/16 is high risk
When interpreting the results of the SFT, Performance Norms are based over how man OA and what ages?
Norms based on over 7000 community dwelling OA between ages of 60 and 94
What is ‘normal’ define as
defines as the middle 50% of the population
When interpreting the results of the SFT, criterion standards scores are compared to a threshold scores which can be used to identify what
U/sed to identify participants at risk for mobility problems, falls or disability
Prior to the test, participants must complete?
- a health and PA questionnaire
- informed consent
- medical clearance if required
On assessment day participants must be advised
- to avoid heavy exertion and alcohol use for 24 hours before testing
- to eat a light mean one hour before testing
- to wear appropriate clothing for exercise
OA are stressed out before this assessment
