Gérontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
CERPOP UMR 1295, University of Toulouse III, INSERM, UPS, Toulouse, France.
J Cachexia Sarcopenia Muscle. 2022 Oct;13(5):2331-2339. doi: 10.1002/jcsm.13042. Epub 2022 Aug 26.
Clinically meaningful changes in the five-repetition chair stand test are essential for monitoring mobility in integrated care for older people. Recommendations for the clinically meaningful change of the chair stand test are not well known. Our study aimed to estimate the absolute and relative clinically meaningful changes for older adults' five-repetition chair stand test.
We applied distribution-based and anchor-based methods in addition to receiver operator characteristics analyses to a population-based study of community-dwelling adults (SAGE Mexico study, n = 897) to derive the clinically meaningful change in the chair stand test. We used three self-reported clinical anchors: moving around, vigorous activities, and walking 1 km. Our primary outcome was the incidence of disability for basic activities of daily living (ADL). Secondly, we examined our estimates of clinically meaningful change in a clinical trial population of healthy volunteers (MAPT, France, study n = 1575) concerning the risk of incident ADL disability.
The age of SAGE Mexico participants ranged from 60 to 96 years; mean (SD) = 69.0 (6.2); 54.4% were female. Their baseline chair stand time averaged 12.1 s (SD = 3 s). Forty-eight participants (5.6%) showed incident disability over 3 years. The absolute and relative clinically meaningful change cut points found over 3 years of follow-up were 2.6 s and 27.7%, respectively. Absolute clinically meaningful change ranged from 0.5 to 4.7 s, depending on the estimation method. Relative clinically meaningful change ranged from 9.6 to 46.2%. SAGE Mexico participants with absolute and relative clinically meaningful declines (increasing 2.6 s and 27.7% from baseline time, respectively) showed an increased risk of ADL disability [aRR = 1.93; P = 0.0381; 95% CI (1.05, 3.46) and aRR = 2.27; P = 0.0157; 95% CI (1.22, 4.10)], respectively, compared with those without a clinically meaningful decline. MAPT participants [age range = 70-94; mean (SD) = 75.3 (4.4); 64.8% female; incident ADL disability over 5 years = 145(14.8%)] with a relative clinically meaningful decline (≥27.7% from baseline over 3 years) had a 74% higher risk of incident ADL disability than their counterparts [aHR = 1.74; P = 0.016; CI95% (1.11, 2.72); mean follow-up of 58 months].
Community-dwelling older adults with an increase of 3 s or 28% in chair stand test performance over 3 years (approximately 1 s or 10% per year) could be the target of interventions to enhance mobility and prevent incident disability.
在老年人综合护理中，五次重复椅立试验的临床意义变化对于监测移动能力至关重要。目前还没有关于椅立试验临床意义变化的推荐标准。我们的研究旨在为老年人的五次重复椅立试验确定绝对和相对临床有意义的变化。
我们在一项基于人群的社区居住成年人研究（SAGE 墨西哥研究，n=897）中应用了基于分布和基于锚定的方法，以及接收者操作特征分析，以得出椅立试验的临床有意义变化。我们使用了三种自我报告的临床锚定：四处走动、剧烈活动和行走 1 公里。我们的主要结局是日常生活活动（ADL）残疾的发生率。其次，我们在健康志愿者的临床试验人群（MAPT，法国，研究 n=1575）中检查了我们对临床有意义变化的估计，以了解 ADL 残疾的发病风险。
SAGE 墨西哥参与者的年龄范围为 60 至 96 岁；平均（SD）=69.0（6.2）；54.4%为女性。他们的基线椅立时间平均为 12.1 秒（SD=3 秒）。48 名参与者（5.6%）在 3 年内出现了残疾事件。经过 3 年的随访，发现的绝对和相对临床有意义的变化切点分别为 2.6 秒和 27.7%。绝对临床有意义的变化范围从 0.5 秒到 4.7 秒，具体取决于估计方法。相对临床有意义的变化范围从 9.6%到 46.2%。SAGE 墨西哥参与者的绝对和相对临床有意义的下降（分别从基线时间增加 2.6 秒和 27.7%）显示 ADL 残疾的风险增加[aRR=1.93；P=0.0381；95%置信区间（1.05，3.46）和 aRR=2.27；P=0.0157；95%置信区间（1.22，4.10）]，与没有临床有意义下降的参与者相比。MAPT 参与者[年龄范围=70-94 岁；平均（SD）=75.3（4.4）；64.8%为女性；5 年内出现 ADL 残疾=145（14.8%）]，其相对临床有意义的下降（3 年内从基线下降≥27.7%）发生 ADL 残疾的风险比其对照组高 74%[aHR=1.74；P=0.016；95%CI95%（1.11，2.72）；平均随访 58 个月]。
在 3 年内，椅立试验表现提高 3 秒或 28%（约每年 1 秒或 10%）的社区居住老年人可能是提高移动能力和预防残疾事件的干预目标。
