Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois.
University of Arizona Cancer Center, Tucson, Arizona.
J Am Geriatr Soc. 2018 Apr;66(4):706-713. doi: 10.1111/jgs.15273. Epub 2018 Feb 10.
To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women.
Prospective cohort study.
Forty clinical centers in the United States.
Women aged 65 to 79 enrolled in the Women's Health Initiative Clinical Trials with gait speed and SF-36 assessed at baseline (1993-1998) and follow-up Years 1, 3, and 6 (N = 3,587).
Women were categorized as nondecliners or decliners based on changes (from baseline to Year 1) in gait speed and SF-36 PF scores. Logistic regression models were used to estimate incident PCMD (gait speed <1.0 m/s) at Years 3 and 6. Area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of SF-36 PF with that of measured gait speed.
Slower baseline gait speed and lower SF-36 PF scores were associated with higher adjusted odds of PCMD at Years 3 and 6 (all P < .001). For gait speed, decliners were 2.59 times as likely to have developed PCMD as nondecliners by Year 3 and 2.35 times as likely by Year 6. Likewise, for SF-36, decliners were 1.42 times as likely to have developed PCMD by Year 3 and 1.49 times as likely by Year 6. Baseline gait speed (AUC = 0.713) was nonsignificantly better than SF-36 (AUC = 0.705) at predicting PCMD over 6 years (P = .21); including measures at a second time point significantly improved model discrimination for predicting PCMD (all P < .001).
Gait speed identified PCMD risk in older women better than the SF-36 PF did, although the results may be limited given that gait speed served as a predictor and to define the PCMD outcome. Nonetheless, monitoring trajectories of change in mobility are better predictors of future mobility disability than single measures.
比较临床测量的步态速度与自我报告的医疗结果研究 36 项简明健康调查问卷（SF-36）物理功能指数（PF）在预测老年女性未来临床前移动障碍（PCMD）方面的价值。
前瞻性队列研究。
美国 40 个临床中心。
参加妇女健康倡议临床试验的年龄在 65 至 79 岁的女性，在基线（1993-1998 年）和随访第 1、3 和 6 年（N=3587）时评估步态速度和 SF-36 PF。
根据步态速度和 SF-36 PF 评分从基线到第 1 年的变化，将女性分为非下降者或下降者。使用逻辑回归模型估计第 3 年和第 6 年的 PCMD（步态速度<1.0 m/s）的发生率。接收者操作特征曲线下的面积（AUC）用于比较 SF-36 PF 的预测价值与测量的步态速度。
基线时较慢的步态速度和较低的 SF-36 PF 评分与更高的调整后 PCMD 发生率相关，在第 3 年和第 6 年时均有统计学意义（均 P<0.001）。对于步态速度，第 3 年时下降者发生 PCMD 的可能性是未下降者的 2.59 倍，第 6 年时的可能性是未下降者的 2.35 倍。同样，对于 SF-36，第 3 年时下降者发生 PCMD 的可能性是未下降者的 1.42 倍，第 6 年时的可能性是未下降者的 1.49 倍。基线步态速度（AUC=0.713）在预测 6 年内的 PCMD 方面略优于 SF-36（AUC=0.705）（P=0.21）；在第二个时间点纳入测量结果可显著提高预测 PCMD 的模型区分度（均 P<0.001）。
步态速度比 SF-36 PF 更能识别老年女性的 PCMD 风险，尽管由于步态速度是预测指标且用于定义 PCMD 结局，因此结果可能存在局限性。然而，监测移动轨迹的变化比单次测量更能预测未来的移动障碍。
