School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
J Gerontol A Biol Sci Med Sci. 2023 Aug 27;78(9):1641-1650. doi: 10.1093/gerona/glad143.
Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work.
The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts.
The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers.
Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.
老年人早期功能变化被称为临床前期失能（PCD）。与其他失能阶段相比，PCD 研究较少，因为在临床环境中，它不太可能得到同等重视。由于它可能是预防进一步下降的最佳时机，因此它对预防和人群健康具有重大意义。需要一种标准化的 PCD 研究方法，包括共同的定义和测量方法，以推进这项工作。
确定 PCD 应如何定义和测量的过程分两个阶段进行：（1）对文献进行范围综述，这为（2）与内容专家进行的网络协商会议提供了信息。
范围综述和共识会议支持使用术语临床前期活动受限（PCML），并建议同时使用患者报告和基于表现的测量方法来测量它。会议同意，PCML 的定义应包括活动完成频率和/或方法的改变，但无明显失能，必要的活动任务包括步行（距离和速度）、楼梯和转移。
目前，很少有标准化的评估方法可以识别 PCML。PCML 是最能准确描述人们经历日常活动变化但无残疾感的阶段的术语。需要进一步评估结果测量的可靠性、有效性和反应性，以推进 PCML 的研究。
