Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures

Abstract

ObjectiveTo verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD).MethodsA cross-sectional study of 99 patients with stage 4–5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton–Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed.ResultsOnly IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL.ConclusionPerformance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.

Sarcopenia is associated with mild-to-moderate chronic kidney disease in Chinese community-dwelling older men but not in women

“…Similarly, a previous cross-sectional study found that muscle strength wasn’t associated with poor performance-based instrumental activities of daily living disability in a population with advanced CKD. 11 Several factors may have contributed to the result. One consideration is that patients with mild-to-moderate CKD may have delayed muscle strength decline in the present study due to farming activities (the present population showed a similar proportion of farmers between those with and without mild-to-moderate CKD; 73.9% versus 73.8%, P = 0.982).…”

“…10 In contrast, another study found that muscle strength wasn’t associated with poor performance-based instrumental activities of daily living disability in a CKD population. 11 Furthermore, it has been suggested that functional skills are best assessed using gait speed, while some researchers have failed to find an association between slow gait speed and CKD. 12 Therefore, the associations between physical performance and mild-to-moderate CKD require further investigation.…”

Physical Fitness in Hospitalized Frail Elderly Patients

“…Although performance-based measurements for use in clinical settings are less accurate than laboratory-based tests, they have been shown to be applicable and valuable in detecting impairments at an early stage, before they affect overall physical function and become visible in an ADL index 152 . Performance-based measurements have also been found to be able to discriminate across a larger spectrum of physical fitness and to be capable of measuring changes over time to a greater extent, compared with a self-reported ADL-index 150 .…”