Rocky Mountain University of Health Professions, Provo, Utah.
Visiting Nurse Service of New York Home Care, Brooklyn, New York.
J Geriatr Phys Ther. 2020 Apr/Jun;43(2):62-70. doi: 10.1519/JPT.0000000000000189.
The ability to get down to and up from the floor or to perform a floor transfer (FT) is a vital and useful skill for older adults at risk of falling. Little is known about the health-related factors that separate older adults who can perform FT independently from those who cannot. Therefore, the specific aims of this cross-sectional study are to (1) describe and compare health-related factors among older adults who were independent, assisted, or dependent in FT performance; and (2) establish the parallel reliability between self-reported and actual performance of FT.
A total of 46 community-dwelling adults ages 65 to 96 years were recruited using a stratified sampling technique based on self-reported levels of FT ability: independent (n = 15), assisted (n = 15), or dependent (n = 15). Participants were asked to perform the actual FT test and were categorized according to test result as independent (n = 18), assisted (n = 10), or dependent (n = 17). Sociodemographic and health-related factors of participants were separated into the 3 FT test outcome groups. The Kruskal-Wallis test was used to compare these factors across the 3 FT test outcome groups. The quadratic-weighted κ coefficient was calculated to determine the agreement between self-reported FT ability and FT test performance.
Significant differences were observed among the FT test outcome groups based on all sociodemographic and health-related factors (P < .05). Older adults who were dependent in FT were older and dependent in instrumental activities of daily living (IADL, 100%). Also, this group required some type of help during basic activities of daily living (ADL, 35.3%), which reflected a homebound status and the need for caregiver support, including the use of 2-handed assistive devices during ambulation. More than half the participants in this category had fallen at least once in the past 6 months. Conversely, older adults who were independent in FT were younger and living independently in the community (83.3%). The parallel reliability between the self-reported FT ability and actual FT test performance was 0.92 (95% confidence interval, 0.88-0.97).
Sociodemographic and health-related factors were significantly different among older adults who demonstrated varying abilities on the FT test. This study has shown that the self-reported FT ability and actual FT test performance represented reliable alternative forms to assess the ability to transfer from a standing to a supine position on the floor and then back to an erect position. Evaluation of FT ability and/or performance is recommended as a standard component of geriatric functional assessment to make more informed clinical decision in providing effective physical therapy interventions.
能够自如地下蹲和站起，或者完成地板转移（FT），是有跌倒风险的老年人一项非常重要且有用的技能。目前对于能够独立完成 FT 与无法独立完成 FT 的老年人在健康相关因素方面有哪些区别，我们知之甚少。因此，本横断面研究的具体目的是：（1）描述和比较 FT 表现独立、辅助和依赖的老年人的健康相关因素；（2）建立自我报告和实际 FT 表现之间的平行可靠性。
采用基于自我报告的 FT 能力分层抽样技术，共招募了 46 名年龄在 65 岁至 96 岁之间的社区居住成年人：独立组（n = 15）、辅助组（n = 15）或依赖组（n = 15）。要求参与者进行实际的 FT 测试，并根据测试结果分为独立组（n = 18）、辅助组（n = 10）或依赖组（n = 17）。将参与者的社会人口统计学和健康相关因素分为 3 个 FT 测试结果组。使用 Kruskal-Wallis 检验比较 3 个 FT 测试结果组之间的这些因素。使用二次加权κ系数来确定自我报告的 FT 能力和 FT 测试表现之间的一致性。
根据所有社会人口统计学和健康相关因素，FT 测试结果组之间存在显著差异（P <.05）。在 FT 方面依赖的老年人年龄较大，日常生活活动（IADL）方面依赖（100%），而且他们在基本日常生活活动（ADL）方面需要某种帮助（35.3%），这反映出他们处于居家状态，需要护理人员的支持，包括在行走时使用双手辅助设备。该组中超过一半的参与者在过去 6 个月中至少跌倒过一次。相反，在 FT 方面独立的老年人年龄较小，独立居住在社区中（83.3%）。自我报告的 FT 能力和实际 FT 测试表现之间的平行可靠性为 0.92（95%置信区间，0.88-0.97）。
在 FT 测试中表现出不同能力的老年人之间，社会人口统计学和健康相关因素有显著差异。本研究表明，自我报告的 FT 能力和实际的 FT 测试表现是评估从站立到仰卧位再回到直立位的转移能力的可靠替代形式。建议将 FT 能力评估作为老年人体能评估的标准组成部分，以便在提供有效的物理治疗干预措施时做出更明智的临床决策。
