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Physical_Functioning_10042008_SN.ppt

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Published on November 26, 2008

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Measurement of Physical Functioning in National HESs : Measurement of Physical Functioning in National HESs Workshop on Health Examination Surveys Luxembourg 10th April 2008 Sanna Natunen Recommendations on Measurement of Physical Functioning Natunen S., Viet L., Verscuren M. Content : Content Why to measure How to measure 1. Grip strength 2. Walking speed 3. Standing balance 4. Single-leg stand 5. Timed chair stand Open questions Why to measure : Why to measure Demographic changes – Aging population Used extensively in population studies/surveys NHANES Health Surveys for England Mini-Finland, Health 2000-surveys etc. Add valuable information over self report Predict subsequent disability, need of assistance, falls, nursing home admission and mortality  e.g. targeting the interventions /prevention initiatives How to measure : How to measure No international standards / recommendations FEHES review on measurement of physical functioning Used methods in previous HES Feasibility with in general health surveys Valid and reliable methods Administrable in different settings (home/clinics) Not expensive equipments Not extensive training Not time consuming Why to measure : Why to measure Theoretical advantages and disadvantages of performance versus self-report measures of physical functioning ____________________________________________________________________________________ Advantages _______________________________________________________________________ Face validity clear for task being performed Better reproducibility Greater sensitivity to change Usual activity vs. maximal capacity Influenced less by poor cognitive functioning Influenced less by culture, language, and education _______________________________________________________________________________ Disadvantages _______________________________________________________________________ More time consuming Adequate space and special equipment needed Special training of examiners Modifications necessary for home surveys Potential injuries Simple tests may not reflect performance on complex tasks or adaptation to environment in daily life _______________________________________________________________________________ Guralnik et al. Physical Performance Measures in Ageing Research. Journal of Gereontology: Medical Science. 1989:44(5): M141-M146. Grip strength : Grip strength Grip strength : Grip strength Grip strength : Grip strength Strength of the dominant hand from 30 years and older Selection of the measurement device Hydraulic dynamometer Position of the participant Recommendation of American Hand Therapist Sitting in a straight-backed chair Shoulders adducted in neutral, elbows flexed at 90 degrees Procedure: Test on the dominant hand Repeat the test three times and record the result after each time 3 to 5 minutes to perform Walking speed : Walking speed Walking speed : Walking speed Walking speed : Walking speed Review  Guralnik et al 1994, Curb et al 2006 Measure normal walking speed from all 50 years and older Equipment: Stopwatch and measurement tape Procedure A distance of 4 meters (Guralnik et al 2000) Normal walking speed The time is recorded to the nearest 0.1 second If any walking aid (cane, walker, etc.) is used during the test, this is recorded on the collection form 1 minutes to perform Standing Balance : Standing Balance Standing balance : Standing balance No previous international recommendations for standardized protocol exist Measure standing balance from 60 years and older Procedure Adapted from Guralnik et al 1994 Semi-tandem stand (10s) Side-by-side stand (10s) / Full-tandem stand (10s) 5 minutes to perform Unassisted singel leg stand : Unassisted singel leg stand No previous international recommendations for standardized protocol exist Measure balance and other domains of functioning 30 years and elderly Protocol One leg standing position for 30 seconds Participant can choose the foot to raise 3 minutes to perform Timed chair stand : Timed chair stand Chair stand : Chair stand Timed chair stand : Timed chair stand No previous international recommendations for standardized protocol exist For all 30 years and older Equipment Stopwatch Armless chair (height: 45 cm) with straight back Procedure Rise from the chair without the help of arms If successful, proceed to the next step of chair rises Rise from the chair without the help of arms (arms folded across chest), 10 times 2 to 3 minutes to perform Open questions : Open questions Grip strength Dominant hand / both? Walking speed Normal walking speed / maximal walking speed? Standing balance Some more discriminating test also for highly functioning population? Timed chair stand 10 times, but is also time for 5 times rise needed? Conclusions : Conclusions Importance and public health relevance Feasible: HIS/HES Future development EUNAAPA http://www.eunaapa.org/index.php ALPHA http://www.thealphaproject.eu/ PROFANE http://www.profane.eu.org/ National networks for example in Finland: http://www.toimia.fi Other? If you would be told this you might not believe it…But if you see it you believe it!!!! : If you would be told this you might not believe it…But if you see it you believe it!!!!

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