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 strength

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 speed

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

Standing Balance

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

Timed chair stand

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?

If you would be told this you

might not believe it

…But if you see

it you believe

it!!!!