Age-related mobility disability: Difference between revisions
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=='''Mobility Disability'''== |
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{{cleanup-reorganize|date=April 2017}} |
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{{sections|date=April 2017}} |
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In the statement by National Research Council Committee, the population of older adults is expected to increase in the United States due to aging with “baby boomers” by 2030; this will further increase the population of mobility disabled individuals in the community (People & Feasley, 1996). Unfortunately, if there is no solution initiated to predict disability due to inability to walk at an early stage, the outcome will increase in all health care costs. Over time, age-related changes are shown to cause decrease in strength and power in lower extremities which ultimately leads to decrease in mobility (Jack M Guralnik et al., 2000), in turn leading to disability which is proven to be more common in women than men due to differences in distribution of resources and opportunities (Zunzunegui et al., 2015). Because of these age-related changes and cost associated with the mobility disability, it appears important to predict risk factors at an early onset (Shah et al., 2011). This early detection will help clinicians and patients in determining the early management of the conditions which could be associated with the future mobility disability. Further, it is important to note that mobility disability is not restricted to frail older and hospitalized individuals, it has been reported in young and non-hospitalized individuals as well due to decreased mobility (Iezzoni, McCarthy, Davis, & Siebens, 2001). This increase in the rate of mobility disability causes loss of functional independence (Fried & Guralnik, 1997; Hirvensalo, Rantanen, & Heikkinen, 2000), and increases the risk of future chronic diseases (Khokhar et al., 2001; Manton, 1988; Reuben, Rubenstein, Hirsch, & Hays, 1992). As we have come across the importance of early detection of mobility disability, the question arises, in which conditions they state that person has decreased mobility or is disabled. |
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*History |
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While there are many definitions that contribute in providing meaning of mobility disability, it is repeatedly stated as the “self-reports of a lot of difficulties or inability to walk a quarter of a mile” (Ward et al., 2014) without sitting and within time limit of fifteen minutes (Fried & Guralnik, 1997; Gill, Allore, Hardy, & Guo, 2006; Marsh et al., 2011; Vestergaard et al., 2009). Failure to walk within this time frame results in the use of walking aid devices such as wheelchair, crutches or a walker which will eventually help in community ambulation. Another term that is coined to define mobility disability based on performance is “performance based mobility disability” (Shah et al., 2011). It is the inability to increase your gait speed more than 0.4m/s, this is frequently used cut off point to discriminate between community and household ambulation (Melzer, Dik, van Kamp, Jonker, & Deeg, 2005; Rantanen, Guralnik, Ferrucci, Leveille, & Fried, 1999; Tinetti, Inouye, Gill, & Doucette, 1995). If an individual is unable to walk at >0.4 m/s, he or she is considered severely disabled and would require a mobility device to walk in community. |
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*Definition |
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*Risk Factors |
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*Measures |
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==='''History'''=== |
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Even though, there could be number of factors that could be associated with mobility disability, however in accordance with center of disease control and prevention statistics, “stroke is found to be the leading cause of mobility disability, in turn reducing mobility in more than half of the stroke survivors above 65 years of age” (Mozaffarian et al., 2016). Therefore, it seems important to find tools that can detect mobility disability at an early onset. Furthermore, there is a need to differentiate between the measures based on their ability to detect mobility disability, for instance, differences in reliability and validity of performance-based and self-reported measures. Although self-reported measures are commonly used to detect mobility disability (Ettinger et al., 1994; Keenan, Tennant, Fear, Emery, & Conaghan, 2006; Leveille, Fried, & Guralnik, 2002; Mottram, Peat, Thomas, Wilkie, & Croft, 2008; Odding et al., 1995), recently developed performance-based measures have been proven to be strongly associated with risk of future mobility disability in older adults (Vestergaard et al., 2009). This review article describes scales that are important to measure mobility disability in older adults. The measures are broadly classified into two categories based on their design, that is, self-reported measures and performance-based measures. |
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According to [[National Research Council]], the population of older adults is expected to increase in the United States due to [[aging]] with ''[[Baby boomers]]'' by 2030; this will further increase the population of [[mobility]] [[disabled]] individuals in the community.<ref>[https://www.ncbi.nlm.nih.gov/books/NBK233352/].</ref> Unfortunately, if there is no solution initiated to predict [[disability]] due to inability to walk at an early stage, the outcome will increase health care costs. Over time, age-related changes are shown to cause a decrease in [[strength]] and [[power]] in lower extremities which ultimately leads to decrease in [[mobility]] <ref> [https://www.ncbi.nlm.nih.gov/pubmed/10811152].</ref>, in turn leading to [[disability]] which is proven to be more common in women than men due to differences in distribution of resources and opportunities.<ref>[https://www.ncbi.nlm.nih.gov/labs/articles/26113021/].</ref> Because of these age-related changes and cost associated with the [[disability]], it appears important to predict risk factors at an early onset.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/20966101].</ref> This early detection can help clinicians and patients in determining the early management of the conditions which could be associated with the future [[disability]]. Further, it is important to note that [[disability]] due to inability to move is not restricted to older and [[hospitalized]] individuals, it has been reported in young and non-hospitalized individuals as well due to decreased [[mobility]].<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495195/].</ref> The increase in the rate of [[disability]] causes loss of functional independence <ref>[https://www.ncbi.nlm.nih.gov/pubmed/8994496],[http://www.ncbi.nlm.nih.gov/pubmed/10811541].</ref> and increases the risk of future [[chronic diseases]].<ref>[http://www.ncbi.nlm.nih.gov/pubmed/1466363],[http://www.ncbi.nlm.nih.gov/pubmed/2971088],[http://www.ncbi.nlm.nih.gov/pubmed/11890596].</ref> As we have come across the importance of early detection of [[disability]] due to inability to walk, the question arises, in which conditions person has decreased [[mobility]] or is [[disabled]]. |
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'''Self- Reported measures:''' Several qualitative studies uses surveys, questionnaires and self-reported scales as measures to detect a decrease in mobility or to predict future mobility disability in older individuals (Pruitt et al., 2008). The advantages of these qualitative scales are easier data acquisition and can be performed on the larger population. Even though there is difference in perception of condition between subjects (gender difference), type of chronic conditions they have and age-related changes such as memory and reasoning, all of which can affect the information and scores of the individual, still self-reported measures have been used extensively in behavioral and correlational studies (Baranowski, 1988). The commonly used self- reported measures for mobility disability are Stroke Impact scale version 2.0, Rosow- Breslau scale, Barthel index, Tinetti Falls Efficacy Scale. |
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==='''Definition'''=== |
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''Stroke impact scale'' is a 59-item scale which measures eight domains- strength, hand function, activities of daily living (ADL)/ instrumental ADL, mobility, communication, emotion, memory and thinking, participation/role function (“Rehab Measures - Stroke Impact Scale,” n.d.). Each of these items is rated on the five-points Likert scale per difficulty in completing specific item and the total score ranges from 0 to 100. The test- retest reliability of this scale varies from average to excellent that is 0.70 to 0.92 (Duncan et al., 1999). In context of construct validity, studies have found moderate to excellent correlations (range= 0.40 to 0.80) (Carod-Artal, Coral, Trizotto, & Moreira, 2008; Doyle et al., 2007; Duncan et al., 1999). |
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While there are many definitions that contribute in providing the meaning of [[mobility disability]], it is repeatedly stated as the “self-reports of a lot of difficulties or inability to walk a [[quarter]] of a mile” <ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270855/].</ref> without sitting and within time limit of fifteen minutes <ref>[https://www.ncbi.nlm.nih.gov/pubmed/8994496],[https://www.ncbi.nlm.nih.gov/pubmed/16460375],[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640434/],[https://www.ncbi.nlm.nih.gov/pubmed/21975090].</ref> Failure to walk within this time frame results in the use of [[walking aid]] devices such as [[wheelchair]], [[crutches]] or a [[walker]] which will eventually help in community [[ambulation]]. Another term that is coined to define [[mobility disability]] based on performance is “performance based mobility disability”.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392849/].</ref> It is the inability to increase your [[walking speed]] more than 0.4m/s, this is frequently used cut off point to discriminate between the community and household [[ambulation]].<ref>[http://www.ncbi.nlm.nih.gov/pubmed/7715059],[http://www.ncbi.nlm.nih.gov/pubmed/10219007],[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892815/].</ref> If an individual is unable to walk at >0.4 m/s, he or she is considered severely [[disabled]] and would require a [[mobility device]] to walk in community. |
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''Rosow- Breslau scale'' is a three-item scale which measures activities of the individual such as walking up and down the stairs, walking 500-meter distance, and doing heavy household work such as vacuuming, cleaning (Rosow & Breslau, 1966). Individuals are asked if they can perform these tasks and if they are unable to perform >1 tasks out of three, they are considered disabled (Shah et al., 2011). The reliability and validity of this scale haven’t been measured yet. This could be due to less number of items involved in the test or these tasks get covered while assessing activities of daily living. |
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==='''Risk Factors'''=== |
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''Barthel Index'' is a 10-item scale which measures the ability of the individual in performing daily activities of living which involve self-care. The important items involved in the scale are feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation, stair climbing (“Rehab Measures - Barthel Index,” n.d.). The total score ranges from 0 to 100 and the cutoff score of >95 has proven to have high sensitivity (85.6%) and specificity (91.7%) (Uyttenboogaart, Stewart, Vroomen, De Keyser, & Luijckx, 2005). The test- retest reliability of the scale hasn’t been established yet, however, it has fair to good interrater reliability to assess items in elderly individuals (Richards et al., 2000). The construct validity of the scale shows excellent correlation with other disability scales (r=0.84) (Hobart & Thompson, 2001). |
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Even though, there could be number of factors that could be associated with [[mobility disability]], in accordance with [[center for disease control and prevention]], “[[stroke]] is found to be the leading cause of [[mobility disability]], in turn reducing [[mobility]] in more than half of the [[stroke]] survivors above 65 years of age”.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/26673558].</ref> |
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''Tinetti Falls Efficacy Scale'' is a 10-item questionnaire based scale which assesses the balance and stability perception in individuals, moreover, fear of falling in elderly individuals. It is rated from 1 to 10 based on confidence level and total score ranges from 10 to 100 (best to worst possible score); lower the score better the confidence level in terms of balance and stability (“Rehab Measures - Tinetti Falls Efficacy Scale,” n.d.). The cutoff score of >80 shows the high risk of fall (Tinetti, Richman, & Powell, 1990). This scale has moderate test-retest reliability (r=0.71) (Tinetti et al., 1990), and moderate to excellent correlation with balance, gait, mobility, fall history (Huang & Wang, 2009). |
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==='''Measures'''=== |
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Based on reliability and validity of these scales, stroke impact scale has proven to have excellent test-retest reliability and construct validity, however, it is difficult to say that if it can predict future mobility disability in older individuals. In contrast, Rosow- Breslau scale, Barthel Index and Tinetti Falls Efficacy Scale appears important measures to predict future mobility disability based on the activities involved in these questionnaire scales. Rosow-Breslau scale and Barthel index includes measures such as activities of daily living and self-care. Among these two scales, Barthel index has been proven to have moderate to excellent reliability and validity to predict disability. Although Tinetti Falls Efficacy scale measures the balance and stability by discriminating individuals based on their tendency to fall, but it fails to predict mobility disability. |
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Due to above reasons, it seems important to find tools that can detect [[mobility disability]] at an early onset. Furthermore, there is a need to differentiate between the measures based on their ability to detect [[mobility disability]], for instance, differences in [[reliability]] and [[validity]] of [[performance]] and [[self-reported]] measures. Although [[self-reported]] measures are commonly used to detect [[mobility disability]] <ref>[http://www.ncbi.nlm.nih.gov/pubmed/7930326],[http://www.ncbi.nlm.nih.gov/pubmed/7495342],[http://www.ncbi.nlm.nih.gov/pubmed/12390552],[https://www.ncbi.nlm.nih.gov/pubmed/17013823],[https://www.ncbi.nlm.nih.gov/pubmed/18365768].</ref> recently developed [[performance]] measures have been proven to be strongly associated with risk of future [[mobility disability]] in older adults.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/16460375].</ref> The measures are broadly classified into two categories based on their design, that is, [[self-reported]] measures and [[performance]] measures. |
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'''Performance-based measures:''' Mobility disability because of age-related musculoskeletal pain or increase in chronic conditions is easier to detect by performance-based measures. The commonly used measures that can detect mobility disability based on the performance of the individual are 400-meter walk test, 5-minute walk test, gait speed, short physical performance battery test. |
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====''Self- Reported measures''==== |
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''Four hundred meter walk test'' is a novel test measure that has been used extensively in various studies to predict mobility disability (Pahor et al., 2014; Vasunilashorn et al., 2009). The purpose of this test is to differentiate between healthy elderly individuals and mobility disabled individuals (Rolland et al., 2004). In this test, individuals are instructed to walk at their self-selected speed for a set distance (400m) in set amount of time (15 minutes), preferably without sitting in between the test (Fielding et al., 2011; Marsh et al., 2011; Pahor et al., 2014; Rolland et al., 2004). However, the number and specific duration of stops are allowed during the testing (Vestergaard et al., 2009). If a person is unable to complete the distance that is 400 meter in fifteen minutes, he or she is considered having mobility disability (Fielding et al., 2011). The test-retest reliability and concurrent validity of this test are proven to be high in elderly individuals, however, there are similarities between 400 m and six-minute walk test such as the proposed distance and time administration (Pettee Gabriel et al., 2010; Rolland et al., 2004). The distance walked in six-minute test and time took to complete 400 meters is usually similar, the only dissimilarity between two tests is the speed of the individual. |
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Several [[qualitative]] studies use [[surveys]], [[questionnaires]] and [[self-reported]] scales as measures to detect a decrease in [[mobility]] or to predict future [[mobility disability]] in older adults.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895565/].</ref> The advantages of these [[qualitative]] scales are easier [[data acquisition]] and can be performed on the larger population. Even though there is a difference in [[perception]] of condition between subjects (gender difference), type of [[chronic conditions]] and age-related changes such as [[memory]] and [[reasoning]], all of which can affect the information and scores of the individual, still [[self-reported]] measures have been used extensively in [[behavioral]] and [[correlation]] studies.<ref>[http://www.tandfonline.com/doi/abs/10.1080/02701367.1988.10609379].</ref> The commonly used [[self-reported]] measures for [[mobility disability]] are Stroke Impact scale [http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=934 Stroke Impact Scale], Rosow- Breslau scale [https://www.radc.rush.edu/docs/var/detail.htm;jsessionid=B3230195781CD0E8FB1AD4FBA904F317?category=Disabilities&variable=rosbsum Rosow-Breslau scale], [[Barthel index]], Tinetti Falls Efficacy Scale [http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=899 Tinetti Falls Efficacy Scale]. |
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''Five-minute walk test or the gait endurance test'' (Protas & Tissier, 2009) is used to assess the endurance of the individual by recording distance completed (for sensitivity & specificity- cut off score of 305m) in the certain time limit (Murphy, Olson, Protas, & Overby, 2003). The individual is instructed to walk as quickly as possible (Protas et al., 2001). This test has proven to have excellent test-retest reliability, r=0.92 (Peloquin, Gauthier, Bravo, Lacombe, & Billiard, 1998) and responsiveness (Peterson et al., 1993; Price, Hewett, Kay, & Minor, 1988). Although this test is shown to differentiate elderly individuals between fallers and non-fallers (Murphy et al., 2003), but it’s importance to predict mobility disability is yet unknown. |
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Based on [[reliability]] and [[validity]] of these scales, stroke impact scale [http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=934] has proven to have excellent [[test-retest reliability]] and [[construct validity]], however, it is difficult to say if it can predict future [[mobility disability]] in older adults. In contrast, Rosow- Breslau scale [https://www.radc.rush.edu/docs/var/detail.htm;jsessionid=B3230195781CD0E8FB1AD4FBA904F317?category=Disabilities&variable=rosbsum], [[Barthel Index]] and Tinetti Falls Efficacy Scale [http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=899] appears important to predict future [[mobility disability]] based on the activities involved in these [[questionnaire]] scales. |
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====''Performance-based measures''==== |
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''Gait speed test'' assesses the self-selected and fast speed of the individual on the GaitRite instrumented walkway system (Protas & Tissier, 2009). The individual is instructed to walk on a mat at their self-selected and fast gait speed at a time, averages will be taken from three trials of each speed, the cut-off point of ≤0.85m/s is considered sensitive and specific to differentiate between fallers and non-fallers (Murphy et al., 2003; Protas & Tissier, 2009). This test has been shown to have excellent reliability and validity in healthy adults (Cutlip, Mancinelli, Huber, & DiPasquale, 2000; McDonough, Batavia, Chen, Kwon, & Ziai, 2001). Although this test has been used to predict mobility disability in elderly individuals before and after intervention (Protas & Tissier, 2009), further studies need to be done to find out its reliability and validity in older adults with decreased mobility. |
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[[Mobility disability]] because of age-related [[musculoskeletal pain]] or increase in [[chronic conditions]] is easier to detect by [[performance]] measures. The commonly used measures that can detect [[mobility disability]] based on the performance of the individual are 400-meter walk test [http://www.bu.edu/bostonroc/performance-based-measures-pbm-core/400-meter-walk/], 5-minute walk test [http://onlinelibrary.wiley.com/doi/10.1002/art.1790010108/pdf], [[walking speed]], short physical performance battery test [http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1104]. |
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''Short Physical Performance Battery test (SPPB)'' consists of balance test that involves testing of standing balance side to side, in semi-tandem and tandem position, timed walk test (4m test) and five repetitions of chair stands (Gómez, Curcio, Alvarado, Zunzunegui, & Guralnik, 2013; J M Guralnik et al., 1994, 2000; Vasunilashorn et al., 2009). Each sub-test score ranges from 0 to 4 and the total score is from 0 to 12 (Vasunilashorn et al., 2009). The cut- off score of ≤9 is considered sensitive and specific (J M Guralnik et al., 1994, 2000), a score of 10 or less is considered to define elders as having lower extremity disabilities (Bean et al., 2004; Protas & Tissier, 2009). The test-retest reliability (r=0.87) and validity of the scale are relatively high making it a comparative measure to discriminate between individuals based on disabilities (Gómez et al., 2013). Furthermore, this test has been shown to be a strong predictor of mobility disability or person’s inability to walk 400-meter distance (Vasunilashorn et al., 2009). |
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Among these measures, four hundred meters walk test [http://www.bu.edu/bostonroc/performance-based-measures-pbm-core/400-meter-walk/] and short physical performance battery test [http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1104] has been proven to be strong predictors of [[mobility disability]] in older adults. In addition to prediction, there is moderate to an excellent [[correlation]] between these two tests.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/19182232].</ref> In conclusion, based on [[reliability]] and [[validity]] of the scales to predict [[mobility disability]], [[self-reported]] measures such as [[Barthel index]], and [[performance]] measures such as 400 m walk test [http://www.bu.edu/bostonroc/performance-based-measures-pbm-core/400-meter-walk/] and short physical performance battery test [http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1104] have been strongly associated to detect future [[mobility disability]] in older adults. |
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==='''References'''=== |
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Among these performance-based measures, four hundred meter walk test and SPPB has been proven repeatedly to be strong predictors of mobility disability in elderly individuals. In addition, there is moderate to an excellent correlation between these two tests (Vasunilashorn et al., 2009). In conclusion, based on reliability and validity of the scales to predict mobility disability, self-reported measures such as Barthel index, and performance-based measures such as 400 m walk test and SPPB demonstrated to be strongly associated to detect future mobility disability in older adults. |
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'''References:''' |
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Baranowski, T. (1988). Validity and Reliability of Self Report Measures of Physical Activity: An Information-Processing Perspective. ''Research Quarterly for Exercise and Sport'', ''59''(4), 314–327. <nowiki>https://doi.org/10.1080/02701367.1988.10609379</nowiki> |
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Bean, J. F., Herman, S., Kiely, D. K., Frey, I. C., Leveille, S. G., Fielding, R. A., & Frontera, W. R. (2004). Increased Velocity Exercise Specific to Task (InVEST) Training: A Pilot Study Exploring Effects on Leg Power, Balance, and Mobility in Community-Dwelling Older Women. ''Journal of the American Geriatrics Society'', ''52''(5), 799–804. <nowiki>https://doi.org/10.1111/j.1532-5415.2004.52222.x</nowiki> |
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Carod-Artal, F. J., Coral, L. F., Trizotto, D. S., & Moreira, C. M. (2008). The Stroke Impact Scale 3.0: Evaluation of Acceptability, Reliability, and Validity of the Brazilian Version. ''Stroke'', ''39''(9), 2477–2484. <nowiki>https://doi.org/10.1161/STROKEAHA.107.513671</nowiki> |
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Cutlip, R. G., Mancinelli, C., Huber, F., & DiPasquale, J. (2000). Evaluation of an instrumented walkway for measurement of the kinematic parameters of gait. ''Gait & Posture'', ''12''(2), 134–8. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/10998610</nowiki> |
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Doyle, P. J., McNeil, M. R., Bost, J. E., Ross, K. B., Wambaugh, J. L., Hula, W. D., & Mikolic, J. M. (2007). The Burden of Stroke Scale (BOSS) provided valid, reliable, and responsive score estimates of functioning and well-being during the first year of recovery from stroke. ''Quality of Life Research'', ''16''(8), 1389–1398. <nowiki>https://doi.org/10.1007/s11136-007-9247-8</nowiki> |
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Duncan, P. W., Wallace, D., Lai, S. M., Johnson, D., Embretson, S., & Laster, L. J. (1999). The Stroke Impact Scale Version 2.0. ''Development'', ''30''(10), 2131–40. <nowiki>https://doi.org/10.1007/978-0-387-79948-3_1846</nowiki> |
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Ettinger, W. H., Fried, L. P., Harris, T., Shemanski, L., Schulz, R., & Robbins, J. (1994). Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group. ''Journal of the American Geriatrics Society'', ''42''(10), 1035–44. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/7930326</nowiki> |
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Fielding, R. A., Rejeski, W. J., Blair, S., Church, T., Espeland, M. A., Gill, T. M., … LIFE Research Group. (2011). The Lifestyle Interventions and Independence for Elders Study: Design and Methods. ''The Journals of Gerontology Series A: Biological Sciences and Medical Sciences'', ''66A''(11), 1226–1237. <nowiki>https://doi.org/10.1093/gerona/glr123</nowiki> |
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Fried, L. P., & Guralnik, J. M. (1997). Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk. ''Journal of the American Geriatrics Society'', ''45''(1), 92–100. <nowiki>https://doi.org/10.1111/j.1532-5415.1997.tb00986.x</nowiki> |
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Gill, T. M., Allore, H. G., Hardy, S. E., & Guo, Z. (2006). The dynamic nature of mobility disability in older persons. ''Journal of the American Geriatrics Society'', ''54''(2), 248–254. <nowiki>https://doi.org/10.1111/j.1532-5415.2005.00586.x</nowiki> |
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Gómez, J. F., Curcio, C.-L., Alvarado, B., Zunzunegui, M. V., & Guralnik, J. (2013). Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes. ''Colombia Medica (Cali, Colombia)'', ''44''(3), 165–71. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/24892614</nowiki> |
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Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V, … Wallace, R. B. (2000). Lower Extremity Function and Subsequent Disability: Consistency Across Studies, Predictive Models, and Value of Gait Speed Alone Compared With the Short Physical Performance Battery. ''Journal of Gerontology: MEDICAL SCIENCES In the Public Domain'', ''55''(4), 221–231. |
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Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V, … Wallace, R. B. (2000). Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. ''The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences'', ''55''(4), M221-31. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/10811152</nowiki> |
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Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., … Wallace, R. B. (1994). A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. ''Journal of Gerontology'', ''49''(2), M85-94. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/8126356</nowiki> |
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Hirvensalo, M., Rantanen, T., & Heikkinen, E. (2000). Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. ''Journal of the American Geriatrics Society'', ''48''(5), 493–8. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/10811541</nowiki> |
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Hobart, J. C., & Thompson, A. J. (2001). The five item Barthel index. ''Journal of Neurology, Neurosurgery, and Psychiatry'', ''71''(2), 225–30. Retrieved from <nowiki>http://www.ncbi.nlm.nih.gov/pubmed/11459898</nowiki> |
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Huang, T.-T., & Wang, W.-S. (2009). Comparison of three established measures of fear of falling in community-dwelling older adults: Psychometric testing. ''International Journal of Nursing Studies'', ''46''(10), 1313–1319. <nowiki>https://doi.org/10.1016/j.ijnurstu.2009.03.010</nowiki> |
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Iezzoni, L. I., McCarthy, E. P., Davis, R. B., & Siebens, H. (2001). Mobility difficulties are not only a problem of old age. ''Journal of General Internal Medicine'', ''16''(4), 235–243. <nowiki>https://doi.org/10.1046/j.1525-1497.2001.016004235.x</nowiki> |
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Keenan, A.-M., Tennant, A., Fear, J., Emery, P., & Conaghan, P. G. (2006). Impact of multiple joint problems on daily living tasks in people in the community over age fifty-five. ''Arthritis and Rheumatism'', ''55''(5), 757–64. <nowiki>https://doi.org/10.1002/art.22239</nowiki> |
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Revision as of 08:46, 26 April 2017
Mobility Disability
- History
- Definition
- Risk Factors
- Measures
History
According to National Research Council, the population of older adults is expected to increase in the United States due to aging with Baby boomers by 2030; this will further increase the population of mobility disabled individuals in the community.[1] Unfortunately, if there is no solution initiated to predict disability due to inability to walk at an early stage, the outcome will increase health care costs. Over time, age-related changes are shown to cause a decrease in strength and power in lower extremities which ultimately leads to decrease in mobility [2], in turn leading to disability which is proven to be more common in women than men due to differences in distribution of resources and opportunities.[3] Because of these age-related changes and cost associated with the disability, it appears important to predict risk factors at an early onset.[4] This early detection can help clinicians and patients in determining the early management of the conditions which could be associated with the future disability. Further, it is important to note that disability due to inability to move is not restricted to older and hospitalized individuals, it has been reported in young and non-hospitalized individuals as well due to decreased mobility.[5] The increase in the rate of disability causes loss of functional independence [6] and increases the risk of future chronic diseases.[7] As we have come across the importance of early detection of disability due to inability to walk, the question arises, in which conditions person has decreased mobility or is disabled.
Definition
While there are many definitions that contribute in providing the meaning of mobility disability, it is repeatedly stated as the “self-reports of a lot of difficulties or inability to walk a quarter of a mile” [8] without sitting and within time limit of fifteen minutes [9] Failure to walk within this time frame results in the use of walking aid devices such as wheelchair, crutches or a walker which will eventually help in community ambulation. Another term that is coined to define mobility disability based on performance is “performance based mobility disability”.[10] It is the inability to increase your walking speed more than 0.4m/s, this is frequently used cut off point to discriminate between the community and household ambulation.[11] If an individual is unable to walk at >0.4 m/s, he or she is considered severely disabled and would require a mobility device to walk in community.
Risk Factors
Even though, there could be number of factors that could be associated with mobility disability, in accordance with center for disease control and prevention, “stroke is found to be the leading cause of mobility disability, in turn reducing mobility in more than half of the stroke survivors above 65 years of age”.[12]
Measures
Due to above reasons, it seems important to find tools that can detect mobility disability at an early onset. Furthermore, there is a need to differentiate between the measures based on their ability to detect mobility disability, for instance, differences in reliability and validity of performance and self-reported measures. Although self-reported measures are commonly used to detect mobility disability [13] recently developed performance measures have been proven to be strongly associated with risk of future mobility disability in older adults.[14] The measures are broadly classified into two categories based on their design, that is, self-reported measures and performance measures.
Self- Reported measures
Several qualitative studies use surveys, questionnaires and self-reported scales as measures to detect a decrease in mobility or to predict future mobility disability in older adults.[15] The advantages of these qualitative scales are easier data acquisition and can be performed on the larger population. Even though there is a difference in perception of condition between subjects (gender difference), type of chronic conditions and age-related changes such as memory and reasoning, all of which can affect the information and scores of the individual, still self-reported measures have been used extensively in behavioral and correlation studies.[16] The commonly used self-reported measures for mobility disability are Stroke Impact scale Stroke Impact Scale, Rosow- Breslau scale Rosow-Breslau scale, Barthel index, Tinetti Falls Efficacy Scale Tinetti Falls Efficacy Scale. Based on reliability and validity of these scales, stroke impact scale [1] has proven to have excellent test-retest reliability and construct validity, however, it is difficult to say if it can predict future mobility disability in older adults. In contrast, Rosow- Breslau scale [2], Barthel Index and Tinetti Falls Efficacy Scale [3] appears important to predict future mobility disability based on the activities involved in these questionnaire scales.
Performance-based measures
Mobility disability because of age-related musculoskeletal pain or increase in chronic conditions is easier to detect by performance measures. The commonly used measures that can detect mobility disability based on the performance of the individual are 400-meter walk test [4], 5-minute walk test [5], walking speed, short physical performance battery test [6]. Among these measures, four hundred meters walk test [7] and short physical performance battery test [8] has been proven to be strong predictors of mobility disability in older adults. In addition to prediction, there is moderate to an excellent correlation between these two tests.[17] In conclusion, based on reliability and validity of the scales to predict mobility disability, self-reported measures such as Barthel index, and performance measures such as 400 m walk test [9] and short physical performance battery test [10] have been strongly associated to detect future mobility disability in older adults.