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PubMed1981

Physical function assessment in patients with advanced cancer.

Accepted physical therapy assessment techniques were compared with the Karnofsky Performance Status scores in a group of patients with advanced cancer. Assessment of patients' physical functioning by physical therapy evaluation techniques was highly correlated with the Karnofsky Performance Status score. The KPS has been demonstrated to be a reliable assessment tool and is a good indicator of those patients most likely to maintain independent physical function. Extensive physical therapy measures in this patient population appear to offer no advantage over the KPS as an evaluation tool for studies.

Activities of Daily Living↗

PubMed2001

Effect of resistance training on self-reported physical functioning in HIV infection.

PURPOSE: To assess whether progressive resistance training (PRT) improves functional status, measured using a validated Physical Function Scale, in both wasted and nonwasted patients with HIV infection, and to compare the relative contributions of increased lean body mass (LBM) and increased strength with the change in physical function. METHODS: Six patients with AIDS wasting and 19 patients with HIV but without wasting trained three times per week for 8 wk, followed by 8 wk of usual activity. Physical function, strength, and LBM were measured at 0, 8, and 16 wk. Self-reported physical functioning was measured using the physical functioning subscale of the Medical Outcomes Study (MOS) Short Form-36 (SF-36) questionnaire. RESULTS: Significant improvements occurred in strength (1-RM averaged for four machines increased 44% in the nonwasted and 60% in the wasted patients, each P < 0.0001) and LBM (2.3% increase in the nonwasted and 5.3% in the wasted patients, each P < 0.05) with resistance training. Physical function increased significantly in the wasted subjects (6 points, P < 0.02) but not in the nonwasted subjects, so that at 16 wk the wasted subjects functioned at a higher level than the nonwasted patients (P < 0.05). Both increase in LBM (P < 0.001) and increase in strength (P < 0.001) were significantly and independently associated with increase in physical function. CONCLUSION: PRT increases functional status in patients with HIV wasting, both by increasing strength and by increasing LBM.

Activities of Daily Living↗

PubMed2006

Balance self-efficacy and its relevance to physical function and perceived health status after stroke.

OBJECTIVES: To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status. DESIGN: Secondary analysis of baseline, postintervention, and 6-month follow-up data from a randomized trial. SETTING: General community. PARTICIPANTS: Ninety-one subjects with a first or recurrent stroke, discharged from rehabilitation therapy with a residual walking deficit. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Activities-Specific Balance Confidence (ABC) Scale, Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale, and the EQ-5D visual analog scale of perceived health status. RESULTS: Average balance self-efficacy was 59 out of 100 points on the ABC scale (95% confidence interval, 55-64; n=89). After adjusting for age and sex, functional walking capacity explained 32% and 0% of the respective variability in physical function and perceived health status scores obtained 6 months later. After adjustment for age, sex, and functional walking capacity, balance self-efficacy explained 3% and 19% of variation in 6-month physical function and perceived health status scores, respectively. CONCLUSIONS: Subjects living in the community after stroke experience impaired balance self-efficacy. Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement, primarily in perceived health status, but also in physical function, than the enhancement of functional walking capacity alone.

Activities of Daily Living↗

PubMed2005

Prospective study of physical activity and physical function in early old age.

BACKGROUND: In the elderly, higher levels of physical function have consistently been associated with higher levels of physical activity. In this study, we test the hypothesis that physical activity earlier in the life course preserves high physical function over an extended period of time, before the onset of major age-related declines in physical function. METHODS: A cohort study with an average of 8.8 years of follow-up (1991-1993 to 2001). Logistic regression analyses were conducted adjusting for long-standing illness, baseline physical function, smoking, body mass index, and employment grade. Participants were 6398 London-based civil servants aged 39 to 63 years at baseline, 90% of whom were working. The main outcome measure was physical function measured by the Short Form (SF-36) General Health Survey. RESULTS: Relatively fit and healthy, mainly working, middle-aged men and women who were physically active at recommended levels, were more likely to report high physical function at follow-up, compared to their sedentary counterparts (odds ratio 1.63, 95% confidence interval 1.32-2.00). The association between initial level of physical activity and high physical function at follow-up remained after adjustment for baseline level of physical function and the presence of long-standing illness. CONCLUSIONS: Participation in a physically active lifestyle during mid-life appears to be critical to the maintenance of high physical function in those who are fit and well enough to work and do or do not report any long-standing illness.

Adult↗

PubMed2004

The relationship among physical activity, obesity, and physical function in community-dwelling older women.

BACKGROUND: The relationship between obesity and physical function is not well understood. Physical activity may be a key factor impacting on the relationship between obesity and physical function. METHODS: Subjects included 171 community-dwelling women (mean age = 74.3, SD = 4.3) participating in a 14-year follow-up study to a walking intervention trial. Measures of obesity [body mass index (BMI)] and physical activity (Modified Paffenbarger Questionnaire) were collected in 1982, 1985, 1995, and 1999. Physical function was assessed in 1999 using the Functional Status Questionnaire (FSQ) and gait speed. RESULTS: Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999. However, hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995, and not obesity from 1982 to 1995, was an independent predictor of physical function (FSQ: adjusted R2 = 0.09, F = 4.68, P < 0.001; gait speed: adjusted R2 = 18.0, F = 9.41, P < 0.0001. CONCLUSION: Physical activity appears to be as important if not more important than body weight in predicting future physical function.

Activities of Daily Living↗

PubMedDate not supplied

Distal radius fracture in adults: self-reported physical functioning, role functioning, and meaning of injury.

PURPOSE: To identify physical function, role function, and meaning of injury in adults with a distal radius fracture. SAMPLE: Convenience sample of 60 adults with an isolated distal radius fracture. METHOD: Repeated measures of analysis of variance were used to test the relationship of gender, age, education, hand dominance, preinjury physical health, and treatment modality to physical function, role function, and meaning of illness/injury. The independent variable is time and the dependent variables are physical function, role function, and meaning of illness/injury. FINDINGS: Although improvement occurred with time, older adults had significantly lower physical functioning than younger adults while their wrist was immobilized, and middle-age adults had significantly lower role functioning compared to younger and older adults. Physical function was influenced by age, and role function was influenced by both age and education. CONCLUSION: The identified need for additional guidance and physical and emotional support with the standard treatment of distal radius fractures highlights the need for nursing care during the early recovery period.

Activities of Daily Living↗

PubMed2001

A global measure of physical functioning: psychometric properties.

OBJECTIVE: To examine the psychometric properties of a global physical functioning scale (GPFS) developed as a self-report measure and constructed to scale physical functioning from very poor (1) to excellent (100). DATA SOURCES: Data collection took place between January 1997 and September 1999. It consisted of self-ratings of surgical patients and the ratings of clinicians. The setting was the surgical department at a university hospital. STUDY DESIGN: Test-retest reliability and the convergence of the scores of patients and clinicians were examined in 106 patients before elective coronary or gastrointestinal surgery. Inter-rater reliability was tested in 36 hospitalized patients with cardiologic or vascular surgical diseases who were rated by random selection from a pool of 91 clinicians. The patients also rated their physical functioning. Discriminative validity, sensitivity to change, ceiling and floor effects, and influence of emotional state upon the scores were tested in 127 patients in six diagnostic groups who scored the GPFS before and subsequent to surgery. The concurrent validity was examined in 101 patients who scored the GPFS and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) before elective coronary surgery. PRINCIPAL FINDINGS: The test-retest correlation (.90), correlation of the scores of the clinicians and patients (.87), and rater intraclass correlation coefficient (.82) were high. The GPFS discriminated among patients with different levels of physical functioning, and it was sensitive to change following coronary surgery. There were moderate ceiling and no floor effects. The correlation with the physical functioning scale of the SF-36 (PF-10) was .67. The GPFS differentiated patients with middle levels of physical functioning better than did the PF-10. CONCLUSIONS: The psychometric properties of the GPFS appeared adequate as a measure of general physical functioning. The scale is easy to use and also appears suitable for outcome studies following substantial changes in physical functioning as after coronary surgery.

Activities of Daily Living↗

PubMed1999

Physical functioning: definitions, measurement, and expectations.

The nephrology community has begun to recognize the importance of physical functioning in the overall treatment of their patients. Physical functioning is highly associated with such outcomes as hospitalization, nursing home admission, falling, level of dependency, and death in older individuals. Because there are many terms used to refer to physical functioning, this report classifies physical functioning into basic actions and complex activities; activities considered essential for maintaining independence, and those considered discretionary that are not required for independent living, but may have an impact on quality of life. We also present a model of the determinants of physical functioning, which goes beyond the presence or absence of disease and considers physical, sensory, environmental, and behavioral factors. Measurement of physical functioning can be complicated and ranges from self-report questionnaires to performance measures of specific tasks to vigorous laboratory measures. There are limitations to each of the measurement methods; however, some level of assessment provides information about the patient that is not otherwise available. Valid and reliable tests of physical performance are available that are easily administered and provide valuable information about the patient. Just as the patient's nutrition, medications, and adequacy of dialysis are monitored, baseline and subsequent physical functioning assessments allow us to monitor the patient's clinical course as it relates to their physical ability. Such measurement also allows for the identification of patients with lower functioning who would benefit from physical therapy or other exercise intervention.

Exercise↗

PubMed2004

Pharmacoepidemiology and disability in older adults: can medications slow the age-related decline in physical function?

Age-related disability and loss in physical function are growing public health priorities. Loss in physical function seriously threatens the independence and quality of life of older adults and has a significant social and economic impact on our society. Despite the fact that the negative impact of adverse drug reaction and inappropriate drug use on disability has been widely studied, there is limited evidence regarding the efficacy of pharmacological interventions to prevent decline in physical function among older populations. The effect of statins, angiotensin-converting enzyme inhibitors and testosterone on physical performance in older adults are reviewed. In clinical studies these drugs have recently shown promising effects on the prevention of disability and decline in physical function in older adults. The findings of these studies are not definite and need to be confirmed in large clinical trials.

Aging↗

PubMed2004

Physical function in men with and without hip osteoarthritis.

OBJECTIVES: To assess the subjective joint pain and function and the objective physical function of lower extremities in men with hip osteoarthritis (OA), to compare the results with those from age- and sex-matched controls, and to evaluate the reproducibility of the functional tests. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Twenty-seven volunteer men (age range, 47-64 y) with hip OA and 30 randomly selected, healthy age-matched men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, passive range of motion (ROM) of the hip joint measured with a standard goniometer, and physical functioning evaluated with a test battery. RESULTS: The function and the composite scores of the WOMAC correlated (P<.05) with the degree of radiographically estimated severity of OA. The hips of the control subjects were 13% to 52% more flexible (P range, <.0001-.001) than those of the OA patients. The more the hip was deteriorated, the lower the ROM of the hip was in abduction and in both internal and external rotations. The reproducibility of marching on-the-spot and walking up and down stairs was good in both groups, but in other functional tests the reproducibility was poorer. The controls were significantly (P range, <.05-.01) better at marching, ascending and descending stairs, performing a 25-m walk, and in flexion-extension and abduction-adduction movements compared with the hip OA patients. Most of the WOMAC items were significantly (P<.05) related to the performance tests. CONCLUSIONS: The WOMAC and the ROM can be considered useful hip OA indicators. Marching on-the-spot and walking up and down stairs are the most reproducible physical functioning tests and can thus be recommended for use for patients with hip OA.

Cross-Sectional Studies↗

PubMed2006

Performance-based physical function and future dementia in older people.

BACKGROUND: The association of physical function with progression to dementia has not been well investigated. We aimed to determine whether physical function is associated with incident dementia and Alzheimer disease (AD). METHODS: We performed a prospective cohort study of 2288 persons 65 years and older without dementia. Patients were enrolled from 1994 to 1996 and followed up through October 2003. Main outcome measures included incident dementia and AD. RESULTS: During follow-up 319 participants developed dementia (221 had AD). The age-specific incidence rate of dementia was 53.1 per 1000 person-years for participants who scored lower on a performance-based physical function test at baseline (< or = 10 points) compared with 17.4 per 1000 person-years for those who scored higher (> 10 points). A 1-point lower performance-based physical function score was associated with an increased risk of dementia (hazard ratio, 1.08; 95% confidence interval, 1.03-1.13; P < .001), an increased risk of AD (hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .01), and an increased rate of decline in the Cognitive Ability Screening Instrument scores (0.11 point per year; 95% confidence interval, 0.08-0.14; P < .001) after adjusting for age, sex, years of education, baseline cognitive function, APOE epsilon4 allele, family history of AD, depression, coronary heart disease, and cerebrovascular disease. CONCLUSIONS: Lower levels of physical performance were associated with an increased risk of dementia and AD. The study suggests that poor physical function may precede the onset of dementia and AD and higher levels of physical function may be associated with a delayed onset.

Aged↗

PubMed2004

Association between baseline radiographic damage and improvement in physical function after treatment of patients with rheumatoid arthritis.

OBJECTIVES: To identify factors associated with poor physical function in rheumatoid arthritis and to assess whether baseline joint damage has an impact on improvement in physical function during infliximab treatment. METHODS: 428 patients with active rheumatoid arthritis despite methotrexate treatment received methotrexate alone or with infliximab (3 mg/kg or 10 mg/kg every four or eight weeks) for 54 weeks (the ATTRACT trial). Data on clinical outcomes and physical function (assessed by the health assessment questionnaire (HAQ)) were collected. Structural damage was assessed using the van der Heijde modification of the Sharp score. Odds ratios (OR) for factors associated with severe functional disability (HAQ > or =2.0) at baseline were estimated using multiple logistic regression analyses, and baseline factors related to the change in physical function after treatment at week 54 were determined. RESULTS: Baseline radiographic scores were correlated with baseline HAQ scores. After adjustment for demographic characteristics in the logistic regression model, baseline disease activity scores, radiological joint damage, fatigue, and morning stiffness were found to be associated with severe functional disability (HAQ >2.0), with OR values of 2.00 (1.53 to 2.63), 1.82 (1.15 to 2.87), 1.19 (1.05 to 1.34), and 1.07 (1.01 to 1.13), respectively. In multiple linear regression analysis, physical disability, joint damage, and fatigue at baseline were correlated with less improvement in physical function after treatment. Infliximab treatment was associated with greater improvement in physical function. CONCLUSIONS: Greater joint damage at baseline was associated with poorer physical function at baseline and less improvement in physical function after treatment, underlining the importance of early intervention to slow the progression of joint destruction.

Antibodies, Monoclonal↗

PubMed2002

Maintaining and improving physical function in elders.

This chapter reviews 60 published research reports about maintaining and improving physical function in elders. Reports were identified through searches of MEDLINE and CINAHL using the following search terms: Activities of Daily Living, aged, nursing care, nurse-patient relations, geriatric nursing, nursing assessment, geriatric assessment, behavior therapy, disability evaluation, exercise, and physical. Reports were included if published in English between 1985 and 2000, if conducted in adults over age 60, and if the first author was a nurse or the reported intervention was implemented by nurses. Descriptive and experimental studies of physical function in elders were included. The results of this synthesis showed that nurse scientists have developed new instruments to measure physical function, including scales sensitive to changes in physical function caused by dementia. Nursing studies have described many of the physical and psychological factors associated with poor physical function in elders, though environmental factors and ethnic differences in physical function merit further study. Many nurse scientists are currently investigating behavioral interventions, exercise interventions, and changes in nursing care that could improve the physical function of both community-dwelling elders and those who live in residential facilities.

Activities of Daily Living↗

PubMed2006

Assessment of physical function and secondary complications after complete spinal cord injury.

PURPOSE: Two physical function questions on the widely used SF-12 Health Related Quality of Life questionnaire appear less than optimal for people with complete spinal cord injury (SCI). Physical function questions typically receive the lowest score unless the individual is ambulatory. Additionally, the influence of secondary complications of SCI on quality of life is largely unknown. The purposes of this report are: (1) to determine whether two SF-12 physical function follow-up questions provide increased information in subjects with complete SCI; and (2) to describe the secondary complications of SCI in this group. METHOD: Ten subjects with complete SCI completed two survey instruments (the SF-12 and a Secondary Complications survey) every 3 months. The SF-12 included two physical function follow-up questions designed to improve the sensitivity and appropriateness of the SF-12 for a population with complete SCI. RESULTS: The SF-12 follow-up questions revealed differences in physical function that did not appear with the original SF-12 items. With the new questions, subject scores approximated population normative values. The most common secondary complications (back pain, shoulder pain, leg spasms, leg joint stiffness, and difficulty coughing) were the most likely to be rated as moderately or greatly bothersome. CONCLUSION: We advocate the use of follow-up questions for the SF-12 in complete SCI populations that are not ambulating to better discriminate changes in physical function. Secondly, we advocate further investigations to better understand the incidence and the severity of secondary complications after SCI.

Adolescent↗

PubMed1996

Prestroke physical function predicts stroke outcomes in the elderly.

OBJECTIVE: To determine whether physical function before stroke is an independent predictor of physical function and institutionalization 6 months after discharge from hospital in elderly stroke patients. DESIGN: Population-based prospective cohort design where incidence of stroke was monitored from 1982 through 1988. Baseline demographic and health information including prestroke function was collected prospectively. Eligible subjects who had a stroke were interviewed 6 months after discharge from hospital to assess outcomes. SETTING: New Haven, Connecticut. PATIENTS: Subjects were recruited from an initial sample of 2,812 older adults. Of 79 subjects who survived a first stroke at 6 months postdischarge, complete follow-up data were obtained on 63 subjects. MAIN OUTCOME MEASURE: Physical function as measured by the Katz scale and institutionalization. RESULTS: Fewer limitations in activities of daily living before stroke were associated with fewer limitation in physical function after stroke controlling for stroke severity and other relevant health and sociodemographic conditions (p < .01). Fewer limitations in gross mobility function before stroke were also independently associated with a lower risk of institutionalization (p < .05). CONCLUSION: This study provides useful information in assessing the prognosis of elderly stroke patients upon admission to hospital. It also supports the concept of general frailty being a risk factor for poorer health and institutionalization overall in aged persons. Studies have shown that factors related to physical frailty, such as decline in muscle function, can be reversed. The effect of interventions aimed at improving the physical function of the elderly on stroke incidence, stroke outcomes, and all-cause mortality, however, needs to be determined.

Activities of Daily Living↗

PubMed2005

Predictors of physical functional disability at 5 to 6 years after heart transplantation.

BACKGROUND: Few reports were found in the literature that examined predictors of physical functional disability after heart transplantation. Therefore, the purpose of this study was to (1) describe physical functional disability, (2) identify differences in physical functional disability by demographic and clinical variables, and (3) identify predictors of physical functional disability at 5 to 6 years after heart transplantation. METHODS: A nonrandom sample of 311 patients (approximately 60 years of age, 78% male, and 90% Caucasian) who were 5 to 6 years post-heart transplantation were investigated. Patients completed 8 reliable and valid quality-of-life instruments via self-report. Data analyses included descriptive statistics, chi-square, independent t-tests, correlations, and stepwise multiple regression. Level of significance was set at p = 0.05. RESULTS: The level of physical functional disability was low at 5 to 6 years after heart transplantation, yet 59% of patients reported having physical disability. Women experienced more functional disability than men, and patients with comorbidities (i.e., diabetes mellitus and orthopedic problems) experienced more functional disability than patients without these comorbidities. At 5 to 6 years after heart transplantation, 70% of variance in physical functional disability was explained by activities of daily living, symptoms, comorbidities, psychologic status, and resource utilization variables. CONCLUSIONS: At 5 to 6 years after heart transplantation, most patients experienced low levels of physical functional disability. Differences in physical functional disability were identified by both demographic characteristics and clinical variables. Predictors of physical functional disability included activities of daily living and symptoms, and clinical, psychologic, and resource utilization variables. Knowledge of factors related to physical disability long-term after heart transplantation provides direction for the development of strategies to assist patients to reduce their level of disability or function adequately despite their disability.

Activities of Daily Living↗

PubMed2005

Evaluating physical function in an adolescent bone tumor population.

BACKGROUND: Survival rates for patients with bone tumors have increased dramatically over the past few decades. Unfortunately, many patients face functional limitations resulting from disease management, but there is little evidence regarding physical functioning in adolescents with bone tumors. This lack is largely due to the absence of a standardized measure for evaluating adolescent sarcoma physical functioning. This review discusses considerations in searching for a measure of adolescent physical functioning, evaluates measures previously used in assessing functional outcome in young sarcoma patients, reviews self-report measures of pediatric physical functioning, and makes recommendations for future research. PROCEDURE: Electronic databases were searched for studies published between 1980 and 2004. Studies examining physical functioning in adolescent sarcoma patients and those describing measures of pediatric physical functioning were included. RESULTS: The study includes measures previously used in the adolescent bone tumor literature (Musculoskeletal Tumor Society, Mankin, Groningen Activity Restriction Scale, Toronto Extremity Salvage Score [TESS]), and three measures of pediatric physical function (Functional Disability Inventory, Pediatric Outcomes Data Collection Instrument [PODCI], Activities Scale for Kids [ASK]). The TESS, PODCI, and ASK each met at least four of the outlined applicability and feasibility components. CONCLUSION: The search for a measure of physical functioning for adolescent sarcoma patients requires an exploration of many developmental and measurement issues. Based on the sensibility review presented, the TESS, PODCI, and ASK are recommended for further evaluation of content and of the measurement properties of reliability, validity, and responsiveness, prior to their use in evaluating adolescent sarcoma patients.

Activities of Daily Living↗

PubMed2001

The impact of physical function and pain on work status at 1-year follow-up in patients with back pain.

STUDY DESIGN: A randomized, controlled trial. OBJECTIVE: To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. SUMMARY OF BACKGROUND DATA: Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. METHODS: Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). RESULTS: At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. CONCLUSIONS: Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

Adult↗