Week 5 - Field Based Physical and Mobility Assessments Flashcards
When testing OA (vs YA), which physical parameter(s) should we focus on and why?
Strength to prevent sarcopenia and balance to prevent loss of balance and falls
Performing assessments will help us identify and predict if a participant is at risk for mobility problems and disability. Is this parameter the same for OA vs YA, or is it different?
Different, this is more for OA.
Performing assessments will help us determine if the program is appropriate for the older exercising population. Is this parameter the same for OA vs YA, or is it different?
Different, this is more for OA.
Performing assessments will help us motivate your participants to set personal goals. Is this parameter the same for OA vs YA, or is it different?
The same for YA and OA. In OA that are more frial, we want to make sure they’re able to attain their goal; we want them to succeed.
Performing assessments will help us select exercises that meet specific needs of older participants. Is this parameter the same for OA vs YA, or is it different?
Different, this is more for OA.
Performing assessments will help us provide feedback to participants. Is this parameter the same for OA vs YA, or is it different?
The same for YA and OA.
Performing assessments will help us document the benefits of your physical activity program. Is this parameter the same for OA vs YA, or is it different?
Different, this is more for OA.
What are the 2 goals of a functional fitness framework?
- Identifies physical fitness parameters associated with functional mobility
- Relates functional mobility to ability and active daily living
What are the 3 categories in the functional fitness framework?
- physical parameters
- function
- activity goals
Provide some examples of physical parameters in the functional fitness framework.
- muscle strength/endurance
- aerobic endurance
- flexibility
- motor ability: balance, coordination, speed/agility, power
What occurs when there is a deficiency in physical parameters?
Physical impairment
What is physical impairment?
Loss or abnormality at the tissue, organ or body system level (definition of the WHO).
Provide some examples of function in the functional fitness framework.
- walking
- stair climbing
- standing up from chair
- lifting/reaching
- bending/kneeling
- jogging/running
What occurs when there is a deficiency in function?
Functional limitation
What is a functional limitation?
restriction in physical behaviours such as rising from a chair, lifting or climbing stairs
Provide some examples of activity goals in the functional fitness framework.
- personal care
- shopping/errands
- housework
- gardening
- sports
- traveling
What occurs when there is a deficiency in activity goals?
Physical disability/dependence
What is a physical disability?
any restriction or lack of ability to perform a task or an activity in the manner considered normal
Is quadriceps muscle strength a determinant of physical function of the elderly? AKA should we made OA do squats and train their quads?
Yes! Some OA have to move to homes because they can’t go to the bathroom and come back because their quad muscles are too weak.
Study says: time to peak torque showed significant correlations with all measures of physical activity tests. (how much time it takes to reach maximum strength on a knee extension exercise)
Do isometric and isokinetic torques hold significant correlations with any of the physical activity tests?
No.
Which physical activity tests correlated the most with time to peak torque?
Stair climbing (R = 0.59) and ramp up (time to walk up the length of a 3.66m ramp, R = 0.49).
Therefore, those capable of generating peak torque force faster were the best at climbing stairs, and the fastest at walking up the ramp.
What are common obstacles with assessments?
- lack of time, space and budget
- lack of trained personnel (for administering test or interpreting test)
- lack of assessment tools
4. absence of a requirement by facility management
Are most physical activity centers for OA good at conducting field-based assessments?
Yes for initial assessment but not for follow up
Give me two examples of functional tests performed in less than 2 min.
- Functional reach test
- four square step test (allows us to predict risk of falls in OA depending on the time taken to perform the test)
What are the 2 major criteria for selection and devaluation of test instruments?
1) Practicality
2) psychometric properties
What is practicality?
The “usability” of the test
What are the factors influencing practicality?
1) medical permission avoid or supervision required available
2) time needed to administer and score the test needs to be easy, quick
3) personnel and expertise needed to administer test
4) level of fatigue to participant per test do not want them to be exhausted, especially if they’re already weak
5) is the test meaningful to your participants? can they understand the results/are the results explainable/interpretable?
What are the 4 psychometric properties?
reliability, validity, discrimination power, performance standards
What is reliability?
Degree that 2 test scores are similar when tested under identical conditions. –> test would be free of measurement error
- referred to as “Test-Re-Test Reliability”
- must originate from a published protocol
What degree of correlation of reliability of a test should we aim for?
higher than 0.80
What is inter-rater reliability?
when scores obtained from multiple testers are very similar. Indicates high correlation
What is validity?
refers to the test having shown to measure what it is intended to measure. Most important characteristic of any test.
What is criterion-related validity and when is it used?
It is used in the development of a new test. It evaluates a test’s validity by comparing its scores with other scores already found to be valid.
What are the acceptable correlation values of validity?
higher than 0.70
What is the 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
Which scores on the Fullerton Balance Scale is predictive of a high risk of falls?
Scores of 25 or less
What is discrimination power?
ability of the test to detect changes in performance over time
Which factors need to be checked to assess changes in performance over time, and define these factors?
- floor effect: test is too difficult for subjects
- ceiling effect: test is too easy for subjects
Which scores out of 4 would appear the most in a floor effect or ceiling effect on the Berg Balance Scale?
0/4 = floor, 4/4 = ceiling
What are performance standards and provide the 2 types of performance standards?
interpretation of the scores (provide feedback to participants).
We can use norm-referenced standards or criterion-referenced standards.
What are norm-referenced standards?
Evaluates by comparing others to the same gender and age
What are criterion-referenced standards?
evaluates performance in relation to a particular reference point or specific goal such as: fitness level to climb stairs or to remain functionally independent
Recall: what is the minimal VO2 to remain functionally independent at age 85 for women and men?
women = 15
men = 18
Name 2 field-based assessment tools designed to measure physical impairments and functional limitations in OA.
- Short Physical Performance Battery (SPPB) Protocol
- Fullerton Advanced Balance (FAB) Scale
What are the 3 tests performed in the SPPB protocol and how is it scored
- balance tests (feet together, feet aligned heel to toe, one foot behind the other)
- gait speed test
- chair stand test
scores are out of 4 for each test
0 to 3 = worst physical performance
4 - 9 = reduced physical performance
10 - 12 = best physical performance
What are 4 good reasons for using SPPB?
-
meets psychometric properties
- interrater reliability (0.81 to 0.91)
- test-retest reliability (0.84) - convenient and practical (equipment, space and time requirements)
- Allows OA to perform the tests safely without need of medical release (sub-max effort)
- evaluates physical abilities and functions
What is the Fullerton Advanced Balance (FAB) Scale and how is it scored?
series of 10 functional tests which assess both static and dynamic balance under varied sensory conditions.
Uses a 4-point scale to measure the outcome of the test. (max pts = 40)
What are the advantages of the FAB Scale?
high predictive validity, test-retest reliability, intra- & interrater reliability, content validity
excellent test for OA with no major balance issues
When is it better to use the Berg Balance Scale?
with lower functioning OA due to diseases and disabilities (e.g., stroke, frailty, Parkinson’s)
Name the first 5 tests on the FAB Scale and what they assess (P = posture, S = stepping, T = time)
- Stand with feet together and eyes closed (P + T)
- Reach forward to retrieve an object (pencil) held at shoulder height (P + S)
- Turn 360 degree in right and left directions (P + S)
- Step up onto and over a 6 inch bench (P)
- Tandem walk (S)
Name the last 5 tests on the FAB Scale and what they assess (P = posture, S = stepping, T = time)
- Stand on one leg (P + T)
- Stand on foam with eyes closed (P + T)
- Two-footed jump (jumping)
- Walk with head turns (P + S)
- Reactive postural control (P + S)
What is the cut-off score for evaluating risk for falls in the long form FAB scale?
Long form = all 10 tests
cut-off = 25 or lower out of 40
What is the cut-off score for evaluating risk for falls in the short form FAB scale?
Short form = tests 4-5-6-7
cut-off = 9 or lower out of 16
What should we do on assessment day, prior to the test?
- A health and PA (physical activity) questionnaire
- Informed consent form
- Medical clearance (if required)
What should participants be advised to do to prepare for assessment day?
- To avoid heavy exertion and alcohol use 24h before testing
- To eat a light meal 1h before testing
- To wear appropriate clothing for exercise
Are OA stressed out before their assessment?
Yes, and this can influence their results.
How are results interpreted on the senior fitness test (SFT)? What are performance norms?
Norms are based on over 7000 community-dwelling OA between 60 and 94 years of age.
“Normal” defined as the middle 50% of the population
How are results interpreted on the senior fitness test (SFT)? What are criterion standards?
Scores are compared to a threshold score. This can be used to identify participants at risk for mobility problems, falls or disability
