RehabMeasures Instrument
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  2. Short Physical Performance Battery

Short Physical Performance Battery

Last Updated

Purpose

The SPPB is an assessment tool for evaluation of lower extremity functioning in older persons.

Link to Instrument

Instrument Details

Acronym SPPB

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$0.00

Populations

Pulmonary Diseases
Older Adults and Geriatric Care
Multiple Sclerosis
Alzheimer's Disease and Progressive Dementia

Key Descriptions

  • 3 SPPB calculation components:
    1) Ability to stand for 10 sec with feet in 3 different positions (together side-by-side, semi-tandem, and tandem)
    2) Two timed trials of a 3-m or 4-m walk (fastest recorded)
    3) Time to rise from a chair five times
  • Scoring:
    1) Minimum score: 0
    2) Maximum score: 12
    3) Gait and chair subtests scored from 0-4, cut-off scores provided for scoring
    4) Higher scores indicating better lower extremity function
  • 3 Balance Subsets:
    1) Side-by-side stand scored from 0-1
    2) Semi-tandem stance scored from 0-1
    3) Tandem stance scored from 0-2
  • Administration instructions: http://geriatrictoolkit.missouri.edu/SPPB-Score-Tool.pdf

Number of Items

5

Equipment Required

  • Chair
  • Stopwatch

Time to Administer

10 minutes

Required Training

No Training

Instrument Reviewers

Andrea Westman, PT, DPT

Professional Association Recommendation

None

Considerations

  • A score lower than 10 indicates one or more mobility limitations.

  • A score lower than 10 is predictive of all-cause mortality.

  • SPPB may not be able to distinguish performance in high functioning patients.

  • The 400m walk test may be a better test for high functioning patients (Sayers, Guralnik, Newman, Brach, & Fielding, 2006).

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Community-Dwelling Older Adults: (Perera et al., 2006; n = 492; mean age = 74.1 (5.7) years)

  • SEM = 1.42

Community-Dwelling Older Adults: (Olson et al., 2017; n = 37; mean age 88.4 (9.2) years; Norwegian version)

  • SEM = 0.68

Community-Dwelling Older Adults: (Mangione et al., 2010; n = 52; mean age = 78 (8) years; African American older adults)

  • SEM = 1.2

Minimal Detectable Change (MDC)

Community-Dwelling Older Adults: (Perera et al., 2006)

  • Small meaningful change = 0.54

  • Substantial meaningful change = 1.34

Community-Dwelling Older Adults: (Olson et al., 2017)

  • MDC = 1.88 (95); 1.59 (90)

Community-Dwelling Older Adults: (Mangione et al., 2010; African-Americans)

  • MDC = 2.9

Minimally Clinically Important Difference (MCID)

Community-Dwelling Older Adults: (Perera et al., 2006)

  • MCID = 1.0

Cut-Off Scores

Community-Dwelling Older Adults: (Vasunilashorn et al., 2009; n = 542; completed mean age = 71.6 (5.1) years; failed/unable mean age = 77.7 (6.9) years)

  • Score of ≤10 indicates increased risk of mobility disability at follow-up

Normative Data

Community-Dwelling Older Adults: (Perera et al., 2006)

  • Mean score = 8.3 (2.7)

Community-Dwelling Older Adults: (Halaweh, Willen, Svantesson, & Grimby-Ekman, 2016; n= 176; mean age = 68.15 (6.74) years)

  • Mean score of fallers (n = 109) = 8.2 (3.26)

  • Mean score of non-fallers (n = 67) = 9.5 (2.46)

  • Mean score of women < 68 (n = 66) = 9.7 (2.19)

  • Mean score of women > 68 (n = 49) = 7.5 (3.05)

  • Mean score of men < 68 (n = 31) = 10.4 (2.76)

  • Mean score of men > 68 (n = 30) = 8.4(2.82)

Community-Dwelling Older Adults: (Gómez, Curcio, Alvarado, Zunzunegui, & Guralnik, 2013; n = 150; mean age = 69.5 (3.1) years; community-dwelling older adults without severe ADL or cognitive disability; Spanish version)

  • Mean score = 9.7 (2.0)

Community-Dwelling Older Adults: (Chen, Blake, Genther, Li, & Lin, 2014; n = 22; mean age = 71.2 (9.4) years)

  • Mean score = 10.45 (1.6)

Test/Retest Reliability

Community-Dwelling Older Adults: (Olson et al., 2017; Norwegian version)

  • Excellent test-retest reliability (ICC = 0.91)

Community-Dwelling Older Adults: (Freire, Guerra, Alvarado, Guralnik, & Zunzunegui, 2012; Quebec sample, n = 60; Brazil sample, n = 64; community dwelling older adults without severe ADL functional deficits; French and Portuguese translations)

  • Excellent test-retest reliability Quebec (ICC = 0.89)

  • Excellent test-retest reliability Brazil (ICC = 0.83)

Community-Dwelling Older Adults: (Gomez et al., 2013)

  • Excellent test-retest reliability (ICC = 0.87)

Community-Dwelling Older Adults: (Mangione et al., 2010)

  • Excellent test-retest reliability (ICC = 0.81)

Internal Consistency

Community-Dwelling Older Adults: (Olson et al., 2017)

  • Adequate internal consistency (Cronbach's alphas = 0.63 to 0.66)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Community-Dwelling Older Adults: (Pavasini et al., 2016; n = 16,534; mean age = 73 (3) years; inpatient and outpatient; meta-analysis)

  • Score of <10 is predictive of all-cause mortality

Hospitalized Older Adults: (Volpato et al., 2011; n = 87; mean age = 77.4 years; Italian sample)

  • Hospital discharge score of 0-4 had a greater risk of rehospitalization or death (odds ratio: 5.38, 95% CI)

  • Score of ≤7 had a significant increased risk of rehospitalization or death (odds ratio: 4.8; 95% CI).

Community-Dwelling Older Adults: (Vasunilashorn et al., 2009)

  • Scores of ≤10 at baseline had significantly higher odds of mobility disability at follow-up (odds ratio: 3.38, 95% CI)

Construct Validity

Convergent validity:

Community-Dwelling Older Adults: (Gomez et al., 2013)

Nagi items

Able (SPPB total score)

Nagi item, difficult unable, (SPPB total score)

p-value

Pulling or pushing a large object, such as a chair

10.02 (1.36)

9.22 (2.57)

0.015

Bending, stooping or kneeling

10.24 (1.27)

9.28 (2.32)

0.003

Carrying weight less than 5 kg, such as a bag of potatoes

9.98 (1.68)

8.90 (2.52)

0.003

Going up or down a flight of stairs of at least 10 steps without rest

10.20 (1.40)

9.00 (2.43)

0.000

Walking 5 blocks (400m)

9.97 (1.73)

8.64 (2.52)

0.001

Floor/Ceiling Effects

Community-Dwelling older adults: (Sayers et al., 2006; n = 101; mean age = 80.8 (0.4) years)

  • In higher functioning older adults, a ceiling effect may occur.

Responsiveness

Community-Dwelling Older Adults (Guralnik et al., 1995; n = 1122)

  • Those scored 4-6 had a relative risk of 4.2 to develop ADL disability over a 4-year period in comparison to those who scored 10-12.

  • Those scored 7-9 had a relative risk of 1.6 to develop ADL disability over a 4-year period in comparison to those who scored 10-12.

Community-Dwelling Older Adults (Guralnik et al., 2000)

  • Relative risk of mobility-related disability for those scored 4–6 ranged from 2.9 to 4.9.

  • Relative risk of mobility-related disability for those scored 7–9 ranged from 1.5 to 2.1.

Alzheimer's Disease and Progressive Dementia

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Standard Error of Measurement (SEM)

Older Adults with Dementia: (Olson et al., 2017)

  • SEM = 0.68 pts

Minimal Detectable Change (MDC)

Older Adults with Dementia: (Olson et al., 2017)

  • MDC 1.88 (95); 1.59 (90)

Test/Retest Reliability

Community-Dwelling Older Adults with Dementia: (Olson et al., 2017)

  • Excellent test-retest reliability (ICC = 0.84)

Multiple Sclerosis

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Construct Validity

Convergent Validity:

Multiple Sclerosis: (Motl et al., 2015; n = 48; mean age = 59.5 (5.75) years; ambulatory and 50 years and older)

Category

Variable

rs

Lower extremity function

 

 

 

Timed 25-foot walk

0.77 (0.63, 0.87)

 

6-min walk

0.79 (0.65, 0.87)

 

MS walking scale 12

-0.66 (-0.46, -0.79)

 

Late-Life Function and Disability Instrument, Advanced Lower Extremity Function Subscale,

0.75 (0.60, 0.85)

 

Late-Life Function and Disability Instrument, Basic Lower Extremity Function Subscale

0.70 (0.52, 0.82)

Pulmonary Diseases

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Standard Error of Measurement (SEM)

COPD: (Medina-Mirapeix, Bernabeu-Mora, Llamazares-Herrán, Sánchez-Martínez, García-Vidal, & Escolar-Reina, 2016; n = 30; mean age = 67 (6.49) years; Spanish version)

  • SEM = 0.55

Cut-Off Scores

COPD: (Bernabeu-Mora, Medina-Mirapeix, Llamazares-Herrán, García-Guillamón, Giménez-Giménez, & Sánchez-Nieto, 2015; n = 137; mean age = 66.9 (8.3) years)

  • Score of <10 indicates one or more mobility limitations

Normative Data

COPD: (Medina-Mirapeix et al., 2016)

  • Mean score = 10.35 (1.2)

Interrater/Intrarater Reliability

COPD (Medina-Mirapeix et al., 2016; n = 30; mean age = 67 (6.49) years; Spanish version)

  • Excellent interrater reliability (ICC = 0.92)

Construct Validity

COPD: (Bernabeu-Mora et al., 2015)

  • Adequate correlation with the quadriceps test (r > 0.40)

Bibliography

Bernabeu-Mora, R., Medina-Mirapeix, F., Llamazares-Herrán, E., García-Guillamón, G., Giménez-Giménez, L. M., & Sánchez-Nieto, J. M. (2015). The Short Physical Performance Battery is a discriminative tool for identifying patients with COPD at risk of disability. International Journal of Chronic Obstructive Pulmonary Disease, 10, 2619-2626. https://doi.org/10.2147/COPD.S94377

Chen, D. S., Blake, C. R., Genther, D. J., Li, L., & Lin, F. R. (2014). Assessing physical functioning in otolaryngology: feasibility of the Short Physical Performance Battery. American Journal Of Otolaryngology, 35(6), 708-712. https://doi.org/10.1016/j.amjoto.2014.07.014

Freire, A. N., Guerra, R. O., Alvarado, B., Guralnik, J. M., & Zunzunegui, M. V. (2012). Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil. Journal of Aging and Health, 24(5), 863-878. https://doi.org/10.1177/0898264312438551

Gómez, J. F., Curcio, C., Alvarado, B., Zunzunegui, M. V., & Guralnik, J. (2013). Validity and reliability of the Short Physical Performance Battery (SPPB): A pilot study on mobility in the Colombian Andes. Colombia Medica (Cali, Colombia), 44(3), 165-171.

Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Salive, M. E., & Wallace, R. B. (1995). Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability. New England Journal Of Medicine, 332(9), 556-562. https://doi.org/10.1056/NEJM199503023320902

Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V., . . . & Wallace, R. B. (2000). Lower Extremity Function and Subsequent Disability: Consistency Across Studies, Predictive Models, and Value of Gait Speed Alone Compared With the Short Physical Performance Battery. Journals Of Gerontology Series A: Biological Sciences & Medical Sciences, 55(4), M221-M231. Find it on PubMed

Halaweh, H., Willen, C., Svantesson, U., & Grimby-Ekman, A. (2016). Physical functioning and fall-related efficacy among community-dwelling elderly people. European Journal Of Physiotherapy, 18(1), 11-17. https://doi.org/10.3109/21679169.2015.1087591

Mangione, K. K., Craik, R. L., McCormick, A. A., Blevins, H. L., White, M. B., Sullivan-Marx, E. M., & Tomlinson, J. D. (2010). Detectable changes in physical performance measures in elderly African Americans. Physical Therapy, 90(6), 921-927. https://doi.org/10.2522/ptj.20090363

Medina-Mirapeix, F., Bernabeu-Mora, R., Llamazares-Herrán, E., Sánchez-Martínez, M. P., García-Vidal, J. A., & Escolar-Reina, P. (2016). Interobserver reliability of peripheral muscle strength tests and Short Physical Performance Battery in patients with Chronic Obstructive Pulmonary Disease: A prospective observational study. Archives of Physical Medicine and Rehabilitation, 97(11), 2002-2005. https://doi.org/10.1016/j.apmr.2016.05.004

Motl, R. W., Learmonth, Y. C., Wójcicki, T. R., Fanning, J., Hubbard, E. A., Kinnett-Hopkins, D., & ... McAuley, E. (2015). Preliminary validation of the short physical performance battery in older adults with multiple sclerosis: secondary data analysis. BMC Geriatrics, 15, 1-7. https://doi.org/10.1186/s12877-015-0156-3

Olsen, C. F., & Bergland, A. (2017). Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia. BMC Geriatrics, 17(1), 1-10. https://doi.org/10.1186/s12877-017-0514-4

Pavasini, R., Guralnik, J., Brown, J. C., di Bari, M., Cesari, M., Landi, F., & ... Turusheva, A. (2016). Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Medicine, 14, 1-9. https://doi.org/10.1186/s12916-016-0763-7

Perera, S., Mody, S. H., Woodman, R. C., & Studenski, S. A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of The American Geriatrics Society, 54(5), 743-749. https://doi.org/10.1111/j.1532-5415.2006.00701.x

Sayers, S. P., Guralnik, J. M., Newman, A. B., Brach, J. S., & Fielding, R. A. (2006). Concordance and discordance between two measures of lower extremity function: 400 meter self-paced walk and SPPB. Aging Clinical And Experimental Research, 18(2), 100-106. https://doi.org/10.1007/BF03327424

Vasunilashorn, S., Coppin, A. K., Patel, K. V., Lauretani, F., Ferrucci, L., Bandinelli, S., & Guralnik, J. M. (2009). Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64(2), 223-229. https://doi.org/10.1093/gerona/gln022

Volpato, S., Cavalieri, M., Sioulis, F., Guerra, G., Maraldi, C., Zuliani, G., & ... Guralnik, J. M. (2011). Predictive value of the Short Physical Performance Battery following hospitalization in older patients. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 66A(1), 89-96. https://doi.org/10.1093/gerona/glq167

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