Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
BMC Geriatr. 2022 Feb 22;22(1):147. doi: 10.1186/s12877-022-02851-9.
Little is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults.
Independent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants' mean age was 76 ± 4 years and 72% were women.
Ceiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21-56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users.
The LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults.
对于基于表现的测量结果与自我报告量表之间的关联，以及对于评估目标人群中自我管理运动干预效果的天花板效应或敏感性知之甚少。本研究旨在探讨在针对社区居住的老年人的两种自我管理的防跌倒运动干预中，使用基于表现的步态速度、功能性腿部力量和平衡以及跌倒效能和功能能力的自我报告结果的可行性。
在一项为期 4 个月的参与者偏好试验中，独立生活的社区居住老年人（n=67）使用两种自我管理的防跌倒运动计划之一进行锻炼，一种是数字计划（DP），另一种是纸质小册子（PB）。由盲法评估者进行的预评估和后评估包括简短体能测试（SPPB）和 30 秒坐站测试（30s CST）。参与者完成自我报告问卷：活动特异性和平衡信心量表（ABC）、Iconographical 跌倒效能量表（Icon-FES）、晚年功能和残疾仪器功能成分（LLFDI-FC）。此外，在评估后，参与者还自我评估了平衡和腿部力量的改善情况。参与者的平均年龄为 76±4 岁，72%为女性。
SPPB 的平衡子成分存在天花板效应，在这个功能较高的人群中，ABC 和 Icon-FES 也显示出这种效应。在 SPPB、步态速度、30s CST 和 LLFDI-FC 中，21-56%的参与者的分数没有超过最小临床重要差异（MCID）。在预评估中，所有基于表现的测试都与自我报告量表显著相关，但与变化分数没有显著相关性。显示出功能性腿部力量的表现性改善具有较大的效应量和与自我报告的运动时间的显著相关性。除了 DP 用户报告腿部力量的改善程度高于 PB 用户外，两种运动计划之间的结果没有差异。
在这个特定的人群中，LLFDI-FC 和坐站测试是可行的，并且对变化敏感。SPPB 的平衡子成分以及自我报告的 ABC 和 Icon-FES 测量结果表明存在天花板效应，并且可能不适合作为功能较高的老年人群的结果测量指标。需要开发和评估新的结果测量指标，以用于具有高功能的社区居住老年人的自我管理的防跌倒干预。
