Trajectories of Short Physical Performance Battery Are Strongly Associated with Future Major Mobility Disability: Results from the LIFE Study

Abstract

Short Physical Performance Battery (SPPB) assessment is a widely used measure of lower extremity function, strength, and balance. In the Lifestyles Interventions and Independence for Elders (LIFE) Study, baseline SPPB and changes throughout the trial were strongly associated with major mobility disability (MMD). This study further investigated this association by identifying trajectories of SPPB and evaluating the predictive validity of SPPB trajectories for future MMD. Participants (n = 1635) aged 70–89 years were randomized to a physical activity or health education intervention and assessed every 6 months for MMD. We used group-based trajectory models (GBTMs) to identify trajectories of a binary outcome for a decrease from baseline SPPB of ≥1. Multinomial logistic regression explored baseline factors associated with group membership. Survival analyses evaluated the association between trajectories with MMD. The GBTM identified a 3-group model which included a “No Decline” group (46.0%), “Late Decline” group (27.7%), and an “Early Decline” group (26.3%). Adjusting for all other baseline characteristics, group assignment during the previous follow-up visit was strongly associated with MMD at the subsequent period. Comparisons between groups showed a 2-to-3-fold increase in MMD comparing the “Late” to “No” decline group and a 4-to-5-fold increase in MMD comparing the “Early” to “No” decline group. Group membership and impact on MMD was not different between intervention arms. Group-based trajectories of SPPB scores identified distinct subgroups in LIFE Study participants. Using these group assignments in outcome models were highly associated with MMD. GBTMs have potential to identify and improve prediction of aging-related decline to better design and identify patients for interventions.

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“…Group-based trajectories of SPPB scores identified distinct subgroups in LIFE Study participants, and using these group assignments in outcome models, a significant association with major mobility disability was observed ( 46 ). SPPB is a parameter of physical frailty, recently included as the primary outcome measure in the REHAB-HF clinical trial on older patients with heart failure ( 47 ).…”

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“…The SPPB was developed to measure physical capability and to assess the lower extremity physical performance status of an older individual [ 19 ]. SPPB has been shown to predict several negative outcomes in older adults, such as all-cause mortality [ 20 ], falls [ 21 ], and disability [ 22 ]. The SPPB consists of three tasks: standing balance, gait speed, and a chair rise task.…”

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“…The group discussed the paucity of appropriate outcome measures to assess physical frailty in Alzheimer's clinical syndrome and drafted a statement on this topic, but consensus was not reached in the final vote with only 63% in agreement (70% was required for consensus). The group agreed on the importance of assessing not only ADLs and IADLs but also motor function, as assessed by means of walking speed or other standardized performance measures, such as the Short Physical Performance Battery 43,44 . It should be noted again that a major caveat for the use of these scales is that they were developed, validated, and standardized in groups of Western white people and may not apply to other groups and cultures.…”

“…The group agreed on the importance of assessing not only ADLs and IADLs but also motor function, as assessed by means of walking speed or other standardized performance measures, such as the Short Physical Performance Battery. 43,44 It should be noted again that a major caveat for the use of these scales is that they were developed, validated, and standardized in groups of Western white people and may not apply to other groups and cultures. In addition, some scales require caregiver / informant input, but this may not always available in primary care, which might influence the choice of outcome measure.…”