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RehabMeasures Instrument

Short Physical Performance Battery

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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

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 mobility disability

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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