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PubMed2002

Homocysteine levels and decline in physical function: MacArthur Studies of Successful Aging.

PURPOSE: To test whether elevated homocysteine levels are associated with an increased risk of decline in physical function in older persons. METHODS: We performed a prospective cohort study of 499 highly functioning men and women aged 70 to 79 years who were enrolled in the MacArthur Studies of Successful Aging. We measured total homocysteine levels and performance-based physical function at baseline; physical function measures were repeated an average of 28 months later. A summary measure of physical performance from tests of balance, gait, lower body strength and coordination, and manual dexterity was developed, and a change score was calculated as the difference in scores from 1988 to 1991. RESULTS: The mean (+/-SD) homocysteine level was 11.6 +/- 4.3 micromol/L. With each SD increase in homocysteine, there was an increased risk of being in the worst quartile of decline in physical function (odds ratio = 1.5; 95% confidence interval: 1.2 to 1.9) in analyses that adjusted for age, sex, baseline physical performance, smoking status, vitamin B(12) levels, and incident stroke. Similar results were seen when change in physical performance was treated as a continuous variable. CONCLUSION: Older persons with elevated plasma homocysteine levels are at an increased risk of decline in physical function.

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PubMed2002

Body mass index and physical function in older women.

OBJECTIVE: We modified existing standardized measurement tools in the Physical Performance Test and tasks from the Frailty and Injuries: Cooperative Studies of Intervention Technique Study to evaluate physical function in older women. Our objectives were (1) to characterize physical function themes based on combinations of tasks (deriving factors or components) and (2) to quantify the correlation between derived factors and body mass index (BMI). RESEARCH METHODS AND PROCEDURES: Nutrition risk screens from enrollees in a Medicare-managed risk program served as the sampling frame. To obtain adequate representation for a range of BMI, a random sample was obtained of 90 women from the following BMI strata: BMI, 22 to <27 kg/m(2); BMI, 27 to <30 kg/m(2); and BMI, > or =30 kg/m(2). Subjects were asked to perform a series of 18 functional tasks during a home visit. RESULTS: The mean age was similar in the three BMI groups with an overall mean age of 71 +/- 4.9 years (SD). Factors characterized by lower-body function, upper-body function, coordination, and strength were responsible for 30%, 11%, 9%, and 9% of the variance in task scores, respectively. BMI, controlling for age, explained 5%, 14%, 3%, and 0% of the variation in these factors, respectively. Higher BMI is associated significantly with poorer upper- and lower-body function but is not associated significantly to strength or coordination. DISCUSSION: Higher BMI seems to differentially impede specific aspects of physical function, especially upper-body function, and to a lesser extent, lower-body function. BMI does not seem to be associated with levels of coordination or strength. Better understanding of how BMI impacts physical function will aid in the design of interventions to promote independent living in elderly, obese women.

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PubMed2004

Does payment structure influence change in physical functioning after rehabilitation therapy?

PURPOSE: To determine if there are differences by payment structure (Medicare managed care versus fee-for-service) in the duration and intensity of geriatric rehabilitation therapy treatments and measure their effect on change in physical functioning at discharge. METHODS: Sixty-eight Medicare managed care (MCO) and 32 fee-for-service (FFS) subjects from 3 skilled nursing facilities (SNFs) in Southern California answered the physical functioning dimension of the Sickness Impact Profile (SIP-PFD) before and after rehabilitation therapy. Patient characteristics at admission, therapy treatments, and discharge physical functioning were compared by payment structure using chi-square and t-tests; logistic and ordinary least squares (OLS) regressions were employed to determine significant predictors of enrollment in managed care and change in physical functioning at discharge. RESULTS: Payment structure yielded no significant differences in patient characteristics (physical functioning, socio-demographics, and clinical characteristics) at admission to rehabilitation. Compared to MCO subjects, FFS subjects received significantly more minutes per day (intensity) of rehabilitation therapy (Mean difference = - 16.90; t-test = - 4.504; p =.000). On average, all subjects reported significant, positive change in physical functioning from admission to discharge after rehabilitation (Mean change = 7.98, SD = 12.96; t-test = 6.157; p =.000); but change in physical functioning between MCO and FFS subjects was not significant. CONCLUSIONS: Payment structure did not significantly influence change in physical functioning at discharge. Future studies, using a larger sample- size, should consider the effects of structural elements, process, and patient behavior on therapy treatments and physical functioning outcomes.

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PubMed2005

Pain, lower-extremity muscle strength, and physical function among older Mexican Americans.

OBJECTIVE: To examine the relation between pain on weight bearing, lower-extremity muscle strength, and physical function among older Mexican Americans. DESIGN: Cross-sectional study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 544 noninstitutionalized Mexican-American men and women age 71 years and older. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain on weight bearing, lower-extremity muscle strength, and physical function. RESULTS: Of the 544 subjects, 244 (44.9%) reported pain on weight bearing. Mean muscle strength in men ranged from 9.3 kg for knee extension, 12.8 kg for hip flexion, to 13.0 kg for hip abduction. In women, mean strength ranged from 6.6 kg for knee extension, 9.5 kg for hip flexion, to 8.6 kg for hip abduction. Mean of physical function score was 70.7 for men and 60.6 for women. Pain on weight bearing was negatively associated with summary lower-extremity muscle strength only in women (-.05, P < .001) after controlling for all covariates. Pain on weight bearing was negatively associated with physical function in both men (-15.33, P < .001) and women (-11.03, P < .001), and lower-extremity muscle strength was positively associated with physical function in both men (37.77, P < .001) and women (73.50, P < .001), after controlling for all covariates. CONCLUSIONS: Among older Mexican Americans, the presence of pain was associated with decreased muscle strength in women and decreased physical function in both men and women. High muscle strength was associated with high physical function in both men and women.

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PubMed1992

Decline in physical function following hip fracture.

OBJECTIVE: The main objective of the study was to determine the change in physical function following hip fractures in a community-living elderly population. A secondary objective was the determination of baseline factors predictive of altered function following hip fracture. DESIGN: Prospective, cohort study. SETTING: Urban, community-living elders. PARTICIPANTS: 120 members of a cohort of 2806 individuals age 65 and older in New Haven, CT who sustained a hip fracture from 1982 to 1988 and were treated in the two New Haven hospitals. OUTCOME MEASURE: Self-reported performance of dressing, transferring, walking across a room, climbing stairs, and walking one-half mile before the fracture occurred and 6 weeks and 6 months post-fracture. Baseline factors were assessed before the hip fracture occurred. RESULTS: Of the 120 cohort members who sustained a hip fracture in the 6-year study period, 22 died within 6 months of the fracture. Among survivors there was a sustained decline in function at 6 weeks after the fracture with little improvement by 6 months. At baseline, 86% could dress independently versus 49% at 6 months; 90% could transfer independently versus 32% at 6 months; 75% could walk across a room independently versus 15% at 6 months; 63% could climb a flight of stairs versus 8% at 6 months; and 41% could walk one-half mile versus 6% at 6 months. Physical function and mental status were the only baseline factors significantly associated with physical function at 6 months after the fracture in bivariate analysis, while physical function and depression were associated in multivariate analysis. CONCLUSION: We found a substantial decline in physical function following hip fracture in a prospectively followed community-living elderly population. Only pre-morbid physical and mental function predicted this decline.

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PubMed2002

Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention.

OBJECTIVE: Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral therapy (CBT) protocol for fibromyalgia (FM). METHODS: One hundred forty-five patients with FM were randomly assigned to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of CBT aimed at improving physical functioning. Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain. Outcomes were treated dichotomously using a preestablished criterion for clinically significant success based upon the reliability of change index from baseline to one year posttreatment. RESULTS: Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups. CONCLUSION: Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM. These data suggest that the inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.

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PubMedDate not supplied

Degree of burn, location of burn, and length of hospital stay as predictors of psychosocial status and physical functioning.

The purpose of this study was to identify predictors of psychologic and physical functioning of the victim with burn injuries from initial hospitalization to discharge. Thirty-one patients admitted to a burn center participated in the study and completed the Burn-Specific Health Scale. Most patients were men between 17 and 45 years of age. Length of stay in the hospital was bimodal, i.e., although about half stayed in the hospital for less than 15 days, about one fifth were hospitalized for more than 28 days. The study hypothesized that degree of burn, location of burn, and length of hospital stay would be associated with psychologic and physical functioning at the first-alert stage (stage of first orientation after burn injury) and the predischarge stage (immediately before discharge from the hospital). At the predischarge stage, the degree of the burn strongly predicted the patient's functioning. Patients with first-degree burns reported lower physical and psychologic functioning on every area of the Burn-Specific Health Scale. Conversely, at the first-alert stage, patients with third-degree burns reported higher psychologic functioning in certain areas (mental and social domains). Having a second-degree burn was not associated with reported psychologic or physical functioning. If the burn involved either the patient's hand or head, the location of the burn predicted certain areas of physical functioning at the first-alert and predischarge stage. Length of hospital stay predicted physical functioning; patients who stayed longer in the hospital reported lower mobility and hand function.

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PubMed1998

Lower levels of physical functioning are associated with higher body weight among middle-aged and older women.

OBJECTIVE: To compare levels of physical function, across levels of body mass index (BMI), among middle- to older-aged women. DESIGN: Cross-sectional study. Physical function, body weight and other covariates were measured in 1992. SUBJECTS: 56510 women aged 45-71 y, free of cardiovascular disease and cancer, participating in the Nurses' Health Study. MAIN OUTCOME MEASURES: The four physical function scores on the Medical Outcomes Study (MOS) Short Form-36 (SF36) Health Survey: physical functioning, vitality, bodily pain and role limitations. RESULTS: After adjusting for age, race, smoking status, menopausal status, physical activity and alcohol consumption, there was a significant dose-response gradient between increasing levels of BMI in 1992 and reduced function. For example, women with a BMI between 30-34.9 kg/m2 averaged: 9.0 point lower physical functioning score (95% Confidence interval (CI) -9.5, -8.5), 5.6 point lower vitality score (95% CI: -6.1, -5.1), and 7.0 point lower freedom from pain score (95% CI: -7.6, -6.4). These declines represent an approximate 10% loss of function compared to the reference category of women with BMIs ranging from 22.0-23.9 kg/m2. For the same BMI comparison, heavier women were at 66% increased risk of limitations in ability to work or perform other roles (RR = 1.66; 95% odds ratio (OR) CI: 1.56, 1.76). These findings were replicated when the sample was restricted to women who had maintained their BMI over a ten year period. CONCLUSIONS: In addition to increasing risk of chronic health conditions, greater adiposity is associated with lower every day physical functioning, such as climbing stairs or other moderate activities, as well as lower feelings of well-being and greater burden of pain.

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PubMed1999

Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms.

This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.

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PubMed1995

Percentile curve reference charts of physical function: rheumatoid arthritis population.

OBJECTIVE: To construct percentile curve reference charts of physical function in a population of patients with rheumatoid arthritis (RA); to explore the relationship of age, gender, and disease duration on physical function using percentile curve reference charts; to explore the potential clinical applications of percentile curve reference charts. METHODS: We surveyed 358 patients with RA from a teaching hospital clinic and 4 rheumatological private practices. The study factors were age, sex, disease duration, and physical function (Health Assessment Questionnaire). The sample percentiles were derived empirically, using the weighted average method, and their distribution-free confidence limits were calculated. Cubic spline interpolation curves were used to smooth the percentile lines. RESULTS: We constructed percentile curve reference charts of physical function. The best time-dependent variable was increasing disease duration rather than increasing age. There was no overlap of the 95% confidence limits for the 10th, 50th, and 90th percentile curves. CONCLUSION: Percentile curve reference charts could be used (1) to describe the distribution of health status in a defined population; (2) as an index of change, enabling clinicians to judge the success or failure of therapeutic interventions in terms of movement of their patients' values across percentiles of function; and (3) to set RA management objectives developed from population based norms.

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PubMed2001

An evaluation of the effects of Tai Chi exercise on physical function among older persons: a randomized contolled trial.

This study was designed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy, physically inactive older individuals. Ninety-four community residents ages 65 to 96 (Mage = 72.8 years, SD = 5.1) volunteered to participate in the study. Participants were randomly assigned to either a 6-month experimental (Tai Chi) group (n = 49), which exercised twice per week for 60 min, or a wait-list control group (n = 45). A 6-item self-report physical functioning scale, assessing the extent of behavioral dysfunction caused by health problems, was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention. Results indicated that compared to the control group, participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention. Overall, the experimental group had 65% improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running. It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy, physically inactive older adults. A self-paced and self-controlled activity such as Tai Chi has thepotential to be an effective, low-cost means of improving functional status in older persons.

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PubMed1994

Exercise classes in rest homes: effect on physical function.

AIM: To determine if regular exercise classes, planned and supervised by a physiotherapist, improved physical function in a sample of frail institutionalised elderly. METHOD: Weekly one hour and twice weekly 10 minute exercise classes were given by a physiotherapist, to a group of 34 residents who consented from randomly selected rest homes. The study took place over a period of one year. At entry, 4, 9 and 12 months the physical function was compared with the matched control group who received regular rest home activities, without physiotherapy input. The study used a sit stand test to measure change in physical function. This was indicated by recording (a) the time taken and (b) the hand assistance required to stand up. RESULTS: Compared with the control group, the study group showed statistically significant improvement (p < 0.05) in physical function as measured by sit stand time. The sit stand hand assistance test was found to be too insensitive to measure improvement or to differentiate between the two groups. The programme was enjoyable and had no health complications. CONCLUSION: Regular exercise classes planned and supervised by a physiotherapist are safe and improve the physical functioning and daily activity levels of the frail, institutionalised elderly. They are a cost effective use of the physiotherapist's limited time.

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PubMed2001

Tests for physical function of the elderly with knee and hip osteoarthritis.

This study reports the results of a battery of physical function tests used to assess physical function of older patients with clinical knee and/or hip osteoarthritis (OA), and the correlation to the WOMAC Index (disease-specific questionnaire). A total of 106 sedentary subjects, aged >60 years (mean 69.4, S.D. 5.9) with hip and/or knee OA (mean 12.2 yrs, S.D. 11.0) participated in the study. Mobility, joint flexibility and muscle strength were evaluated by recording time to: walk a distance of 8', ascend/descend 4 stairs, rise from/sit down from a chair (5 times). Hip/knee flexion and isometric quadriceps strength were also measured. Categories of performance were formed by dividing data into quartiles for each test (1=highest, 4=lowest score, 5=unable to complete) and, by summing the category scores, a total summary score (TSS) was obtained. The battery of physical function tests showed an acceptable test-retest reliability (ICC of all tasks > or =0.80) and internal consistency (Cronbach's alpha > or =0.80). Performance scores on walking, stair climb, chair-rise and ROM of affected OA joints were significantly correlated with each other, and with the WOMAC Index (P<0.05, Spearman's correlation). Lower scores on the TSS were associated with lower scores on all the WOMAC Index items (P<0.001). This study shows that a simple battery of physical function tests in combination with the WOMAC Index are reliable and may be useful outcome measures in the evaluation of therapeutic interventions and geriatric rehabilitation.

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PubMed2000

Symptomatology and loss of physical functioning among geriatric patients with lung cancer.

In this study of 129 geriatric patients with lung cancer, we investigated how symptom severity varied according to treatment type, stage of disease, and gender; how change in physical functioning (prediagnosis versus post-hospital discharge) was predicted by symptomatology, prior physical functioning, comorbidity, and age; and whether differences exist according to stage of disease, treatment status, or gender. Data were gathered through patient interviews and audits of patient records. Analysis of variance (ANOVA) techniques revealed that there were no significant differences in average symptom severity scores by gender, treatment categories, or stages of disease. Significant predictors of loss of physical functioning were symptom severity, prior physical functioning and patient age. Characteristics of a profile for elderly lung cancer patients at high risk of suffering substantial losses in physical functioning include higher prior levels of physical functioning, higher levels of current symptomatology, and lower age.

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PubMed2001

The association of menopause and physical functioning in women at midlife.

OBJECTIVES: To determine whether the characteristics of menstrual bleeding and the menopausal transition are associated with physical functioning in women age 40 to 55, after considering ethnicity, ability to pay for basics, body size, and age. DESIGN: Cross-sectional study. SETTING: Seven geographically dispersed community samples in the United States. PARTICIPANTS: The 14,427 respondents were Caucasians (46.9%), African Americans (28.7%), Chinese (4.0%), Japanese (5.3%), and Hispanics (12.6%) from the Study of Women's Health Across the Nation (SWAN) Cross-sectional Study, a study of the menopausal transition, including surgical menopause. MEASUREMENTS: The dependent variable was a three-category variable based on the physical functioning scale of the Medical Outcomes Study. Explanatory variables included menstrual and menopausal status. RESULTS: Eighty percent (80.8%) of women reported no limitation in physical functioning, whereas 10% of women had some limitation, and 9.2% of women indicated having substantial limitation. Women with substantial limitation in physical functioning had double the prevalence odds ratio (POR = 2.02; 95% confidence interval (CI) = 1.64-2.49) of having surgical menopause and 76% greater odds (POR = 1.76; 95% CI = 1.38-2.24)) of using hormones, compared with women with no limitation. Compared with those without limitation, women with substantial limitation in physical functioning had 56% greater odds (POR = 1.56; 95% CI = 1.23-1.97)) of being naturally postmenopausal and a 41% greater odds (POR = 1.41; 95% CI = 1.17-1.70) of being perimenopausal, relative to being premenopausal and after adjusting for other variables. CONCLUSION: Even at the relatively early age of 40 to 55, approximately 20% of women self-reported limitation in physical functioning. Surgical menopause and the use of hormones were more frequently observed in women with some and substantial physical limitation than in women with no limitation, even after adjusting for economic status, age, body mass index, and race/ethnicity.

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PubMed1995

Relationship between physical performance and self-perceived physical function.

OBJECTIVE: The objective of this study was to compare two methods of measuring physical function in subjects with a broad range of abilities and to evaluate the effects of cognitive, social, educational, and age factors on the relationship between the two methods. DESIGN: Multiple regression analysis was used to compare self-perceived (dependent variables) with performance measures (independent variables). Covariates included age, gender, Mini-Mental State Exam score, education, living status, and depression score. SETTING: Five community-dwelling and two nursing home sites. PARTICIPANTS: 417 community-dwelling subjects and 200 nursing home residents aged 62-98 years. MEASUREMENTS: Self-perceived physical function was assessed with the physical dimension summary score of the Sickness Impact Profile, which comprises three subscales: ambulation, mobility, and body care and movement. Physical performance was evaluated by self-selected gait speed, chair-stand time, maximal grip strength, and a balance score. RESULTS: Nursing home residents and community-dwellers were significantly different (P < .0001) in all variables except age and gender. Self-perceived and performance-based measures were moderately correlated, with a range from r = -.194 to r = -.625 (P < .05). Gait speed was the strongest independent predictor of self-perceived physical function in both groups. Symptoms of depression were also an independent predictor of self-perceived function in nursing home residents; subjects who had such symptoms report more self-perceived dysfunction than would be predicted based on performance tests. CONCLUSIONS: Self-selected gait speed is a global indicator of self-perceived physical function over a broad range of abilities. External determinants (depressive symptoms, cognitive function, marital status, etc.) affect self-perceived function in both groups, but gait speed is the greatest single predictor of self-perceived function. In nursing home residents depressive symptomatology is related to self-perceived.

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PubMed2002

Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery.

This study investigated the psychometric properties of a battery of physical performance tests, characterized physical function in patients with cancer referred for rehabilitation, and provided normative standards against which to compare disease progression and/or future treatment effectiveness. A total of 109 patients with cancer (55 women and 54 men) and 105 control subjects (66 women and 39 men) participated. Subjects completed self-report questionnaires regarding pain, physical function, and fatigue, and also performed nine physical performance tests: the time taken to complete various tasks (picking up coins, tying a belt, reaching up, putting on a sock, standing from sitting, a 50-foot fast walk, a 50-foot walk at preferred speed), the distance walked in 6 minutes, and the distance reached forward while standing were measured. Inter-tester and test-retest reliability was good to excellent for all tests (ICC(11) 0.69 to 0.99). Known group analyses controlling for age were significant (P < 0.001) for all physical performance tests. Control subjects significantly and systematically outperformed those with cancer by a factor of two or three. Examination of the correlation matrices showed relatively low correlations between performance and external measures (r = 0.01 to 0.45). In contrast, correlations among performance measures were generally in the range of r = 0.25 to 0.85. Correlations between self-report of function and performance of functional tests were moderate, suggesting that the two methods of measuring function are complementary and both should be used for assessment and as outcome measures.

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PubMed1996

Pain, disability, and physical functioning in subgroups of patients with fibromyalgia.

OBJECTIVE: To investigate (1) whether patients with fibromyalgia (FM) could be subgrouped on the basis of psychosocial and behavioral responses to pain, and (2) the relationships among pain severity, perceived disability, and observed physical functioning, as measured by cervical spinal mobility. METHODS: 117 patients with FM received a comprehensive examination, underwent physical performance tasks during the evaluation, and completed self-report inventories. RESULTS: About 87% of the patients could be classified into the Multidimensional Pain Inventory clustering groups identified and validated in patients with a range of chronic pain problems (Dysfunctional, Interpersonally Distressed, and Adaptive Copers). Although the 3 groups exhibited comparable levels of physical functioning, the Dysfunctional and Interpersonally Distressed patients reported higher levels of pain, disability, and depression. Interpersonally Distressed patients also reported significantly lower levels of marital satisfaction than the other 2 subgroups. There were significant associations between pain severity and perceived disability, and pain severity and physical functioning, defined by spinal mobility tests. The relationship between disability and physical functioning did not reach statistical significance. Correlational analyses by subgroups revealed a significant association between patient perceived disability and physical functioning in the Adaptive Copers, but not the Dysfunctional or Interpersonally Distressed patients. CONCLUSIONS: Patients with FM can be classified into 3 subgroups based on psychosocial and behavioral characteristics. These subgroups show substantial differences in clinical presentation of their symptoms. Although the results should be considered preliminary due to the narrow range of physical functioning, the differential relationships between perceived disability and physical functioning across cluster groups suggest the importance of FM syndrome as a heterogeneous disorder. Treating patients with FM as a homogeneous group may compromise research results, impede understanding of the mechanisms underlying this condition, and deter development of effective treatment.

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