measurement of physical functioning in national hess workshop on health examination surveys...
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Measurement of Physical Functioning in National
HESs
Workshop on Health Examination SurveysLuxembourg 10th April 2008
Sanna Natunen
Recommendations on Measurement of Physical Functioning Natunen S., Viet L., Verscuren M.
Content
Why to measureHow to measure1. Grip strength2. Walking speed3. Standing balance4. Single-leg stand5. Timed chair stand
Open questions
Why to measure
Demographic changes – Aging populationUsed extensively in population studies/surveys
NHANESHealth Surveys for EnglandMini-Finland, Health 2000-surveys etc.
Add valuable information over self reportPredict subsequent disability, need of assistance, falls, nursing home admission and mortality e.g. targeting the interventions /prevention initiatives
How to measure
No international standards / recommendationsFEHES review on measurement of physical functioningUsed methods in previous HES
Feasibility with in general health surveysValid and reliable methodsAdministrable in different settings (home/clinics)Not expensive equipmentsNot extensive trainingNot time consuming
Grip strengthGrip strength
CountryCountry SurveySurvey Device Device ProtocolProtocol Age groupAge group
FinlandFinland Health Health 20002000
Electric grip Electric grip strength meterstrength meter
Sitting positionSitting positionDominant (writing) handDominant (writing) handTwice (3rd measurement Twice (3rd measurement if needed) if needed)
30+30+
United United KingdomKingdom
Health Health Survey for Survey for England England 20052005
GripometerGripometer Standing positionStanding positionBoth handsBoth handsThree times (alternating Three times (alternating hands between trials, hands between trials, starting from non-starting from non-dominant hand)dominant hand)
65+65+
CanadaCanada Canadian Canadian Health Health Survey Survey 20072007
Hand Hand dynamometrdynamometr
Standing positionStanding positionBoth handsBoth handsTwice (alternating hands Twice (alternating hands between trials)between trials)
6 - 786 - 78
Grip strengthStrength of the dominant hand from 30 years and older Selection of the measurement device
Hydraulic dynamometer
Position of the participantRecommendation of American Hand Therapist
Sitting in a straight-backed chairShoulders adducted in neutral, elbows flexed at 90 degrees
Procedure:Test on the dominant handRepeat the test three times and record the result after each time
3 to 5 minutes to perform
Walking speedWalking speed
CountryCountry SurveySurvey ProtocolProtocol Age Age groupgroup
FinlandFinland Health 2000Health 2000 6.1 m6.1 mMaximal walking Maximal walking speedspeed
55+55+
United United KingdomKingdom
Health Survey Health Survey for England 2005for England 2005
2,44 m2,44 mNatural paceNatural pace
65+65+
Walking speedReview Guralnik et al 1994, Curb et al 2006Measure normal walking speed from all 50 years and olderEquipment: Stopwatch and measurement tapeProcedure
A distance of 4 meters (Guralnik et al 2000)Normal walking speedThe time is recorded to the nearest 0.1 secondIf any walking aid (cane, walker, etc.) is used during the test, this is recorded on the collection form
1 minutes to perform
CountryCountry SurveySurvey Protocol Protocol Age groupAge group
FinlandFinland Health 2000Health 2000 Computer based meterComputer based meterStanding 30 sec. eyes open and eyes Standing 30 sec. eyes open and eyes closed, 20 sec. semi-tandem and tandemclosed, 20 sec. semi-tandem and tandem
PositionPosition
55+55+
Guralnik et al 1994Guralnik et al 1994 semi-tandem, tandem and foot side by semi-tandem, tandem and foot side by side for 20 sec.side for 20 sec.
Sub-sampleSub-sample
65-7465-74
Finrisk 2007Finrisk 2007 Standing 20 sec on tandem and one Standing 20 sec on tandem and one leg position; eyes open and eyes closed, leg position; eyes open and eyes closed, eyes open and closed on the foameyes open and closed on the foam
Sub-sample 25-Sub-sample 25-7474
United United KingdomKingdom
Health Survey for Health Survey for England 2005England 2005
Side by side stand (10sec)Side by side stand (10sec)Semi-tandem stand(10sec)Semi-tandem stand(10sec)
65+65+
Full tandem stand (30 sec)Full tandem stand (30 sec)One leg stand (30 sec)One leg stand (30 sec)
65-6965-69
United StatesUnited States NHANES 2003NHANES 2003 Romberg testRomberg testIn a normal support surface eyes open In a normal support surface eyes open and closed (15 sec)and closed (15 sec)Compliant surface support with eyes Compliant surface support with eyes open and closed (15 sec)open and closed (15 sec)
40-6940-69
Standing balance
No previous international recommendations for standardized protocol existMeasure standing balance from 60 years and olderProcedure
Adapted from Guralnik et al 1994Semi-tandem stand (10s)Side-by-side stand (10s) / Full-tandem stand (10s)
5 minutes to perform
Unassisted singel leg stand
No previous international recommendations for standardized protocol existMeasure balance and other domains of functioning 30 years and elderlyProtocol
One leg standing position for 30 secondsParticipant can choose the foot to raise
3 minutes to perform
Chair standChair stand
CountryCountry SurveySurvey ProtocolProtocol Age groupAge group
FinlandFinland Health Health 20002000
One chair stand (1)One chair stand (1)Timed chair rise (5)Timed chair rise (5)Chair 43cm highChair 43cm high
55+55+
United United KingdomKingdom
Health Health Survey for Survey for EnglandEngland
One chair rise (1)One chair rise (1)Timed chair rise (5)Timed chair rise (5)
70+70+
One chair rise (1)One chair rise (1)Timed chair rise (5/10)Timed chair rise (5/10)
65-6965-69
Timed chair standNo previous international recommendations for standardized protocol existFor all 30 years and olderEquipment
StopwatchArmless chair (height: 45 cm) with straight back
ProcedureRise from the chair without the help of armsIf successful, proceed to the next step of chair risesRise from the chair without the help of arms (arms folded across chest), 10 times
2 to 3 minutes to perform
Open questions
Grip strengthDominant hand / both?
Walking speedNormal walking speed / maximal walking speed?
Standing balanceSome more discriminating test also for highly functioning population?
Timed chair stand10 times, but is also time for 5 times rise needed?
Conclusions
Importance and public health relevanceFeasible: HIS/HESFuture 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?
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