Week 5 - Field Based Physical and Mobility Assessments

Question 1

When testing OA (vs YA), which physical parameter(s) should we focus on and why?

Answer 1

Strength to prevent sarcopenia and balance to prevent loss of balance and falls

Question 2

Performing assessments will help us identify and predict if a participant is at risk for mobility problems and disability. Is this parameter the same for OA vs YA, or is it different?

Answer 2

Different, this is more for OA.

Question 3

Performing assessments will help us determine if the program is appropriate for the older exercising population. Is this parameter the same for OA vs YA, or is it different?

Answer 3

Different, this is more for OA.

Question 4

Performing assessments will help us motivate your participants to set personal goals. Is this parameter the same for OA vs YA, or is it different?

Answer 4

The same for YA and OA. In OA that are more frial, we want to make sure they’re able to attain their goal; we want them to succeed.

Question 5

Performing assessments will help us select exercises that meet specific needs of older participants. Is this parameter the same for OA vs YA, or is it different?

Answer 5

Different, this is more for OA.

Question 6

Performing assessments will help us provide feedback to participants. Is this parameter the same for OA vs YA, or is it different?

Answer 6

The same for YA and OA.

Question 7

Performing assessments will help us document the benefits of your physical activity program. Is this parameter the same for OA vs YA, or is it different?

Answer 7

Different, this is more for OA.

Question 8

What are the 2 goals of a functional fitness framework?

Answer 8

• Identifies physical fitness parameters associated with functional mobility
• Relates functional mobility to ability and active daily living

Question 9

What are the 3 categories in the functional fitness framework?

Answer 9

• physical parameters
• function
• activity goals

Question 10

Provide some examples of physical parameters in the functional fitness framework.

Answer 10

• muscle strength/endurance
• aerobic endurance
• flexibility
• motor ability: balance, coordination, speed/agility, power

Question 11

What occurs when there is a deficiency in physical parameters?

Answer 11

Physical impairment

Question 12

What is physical impairment?

Answer 12

Loss or abnormality at the tissue, organ or body system level (definition of the WHO).

Question 13

Provide some examples of function in the functional fitness framework.

Answer 13

• walking
• stair climbing
• standing up from chair
• lifting/reaching
• bending/kneeling
• jogging/running

Question 14

What occurs when there is a deficiency in function?

Answer 14

Functional limitation

Question 15

What is a functional limitation?

Answer 15

restriction in physical behaviours such as rising from a chair, lifting or climbing stairs

Question 16

Provide some examples of activity goals in the functional fitness framework.

Answer 16

• personal care
• shopping/errands
• housework
• gardening
• sports
• traveling

Question 17

What occurs when there is a deficiency in activity goals?

Answer 17

Physical disability/dependence

Question 18

What is a physical disability?

Answer 18

any restriction or lack of ability to perform a task or an activity in the manner considered normal

Question 19

Is quadriceps muscle strength a determinant of physical function of the elderly? AKA should we made OA do squats and train their quads?

Answer 19

Yes! Some OA have to move to homes because they can’t go to the bathroom and come back because their quad muscles are too weak.

Study says: time to peak torque showed significant correlations with all measures of physical activity tests. (how much time it takes to reach maximum strength on a knee extension exercise)

Question 20

Do isometric and isokinetic torques hold significant correlations with any of the physical activity tests?

Answer 20

No.

Question 21

Which physical activity tests correlated the most with time to peak torque?

Answer 21

Stair climbing (R = 0.59) and ramp up (time to walk up the length of a 3.66m ramp, R = 0.49).

Therefore, those capable of generating peak torque force faster were the best at climbing stairs, and the fastest at walking up the ramp.

Question 22

What are common obstacles with assessments?

Answer 22

1. lack of time, space and budget
2. lack of trained personnel (for administering test or interpreting test)
3. lack of assessment tools
   4. absence of a requirement by facility management

Question 23

Are most physical activity centers for OA good at conducting field-based assessments?

Answer 23

Yes for initial assessment but not for follow up

Question 24

Give me two examples of functional tests performed in less than 2 min.

Answer 24

• Functional reach test
• four square step test (allows us to predict risk of falls in OA depending on the time taken to perform the test)

Question 25

What are the 2 major criteria for selection and devaluation of test instruments?

Answer 25

1) Practicality 2) psychometric properties

Question 26

What is practicality?

Answer 26

The "usability" of the test

Question 27

What are the factors influencing practicality?

Answer 27

**1) medical permission** *avoid* or supervision required available **2) time needed to administer and score the test** *needs to be easy, quick* **3) personnel and expertise needed to administer test** **4) level of fatigue to participant per test** *do not want them to be exhausted, especially if they're already weak* **5) is the test meaningful to your participants?** *can they understand the results/are the results explainable/interpretable?*

Question 28

What are the 4 psychometric properties?

Answer 28

reliability, validity, discrimination power, performance standards

Question 29

What is reliability?

Answer 29

Degree that 2 test scores are similar when tested under identical conditions. --> test would be free of measurement error - referred to as "Test-Re-Test Reliability" - must originate from a published protocol

Question 30

What degree of correlation of reliability of a test should we aim for?

Answer 30

higher than 0.80

Question 31

What is inter-rater reliability?

Answer 31

when scores obtained from multiple testers are very similar. Indicates high correlation

Question 32

What is validity?

Answer 32

refers to the test having shown to measure what it is intended to measure. Most important characteristic of any test.

Question 33

What is criterion-related validity and when is it used?

Answer 33

It is used in the development of a new test. It evaluates a test's validity by comparing its scores with other scores already found to be valid.

Question 34

What are the acceptable correlation values of validity?

Answer 34

higher than 0.70

Question 35

What is the predictive validity?

Answer 35

ability of a test to predict the future outcome of the test. research data must show a strong statistical prediction to the future outcome

Question 36

Which scores on the Fullerton Balance Scale is predictive of a high risk of falls?

Answer 36

Scores of 25 or less

Question 37

What is discrimination power?

Answer 37

ability of the test to detect changes in performance over time

Question 38

Which factors need to be checked to assess changes in performance over time, and define these factors?

Answer 38

- floor effect: test is too difficult for subjects - ceiling effect: test is too easy for subjects

Question 39

Which scores out of 4 would appear the most in a floor effect or ceiling effect on the Berg Balance Scale?

Answer 39

0/4 = floor, 4/4 = ceiling

Question 40

What are performance standards and provide the 2 types of performance standards?

Answer 40

interpretation of the scores (provide feedback to participants). We can use **norm-referenced standards** or **criterion-referenced standards.**

Question 41

What are norm-referenced standards?

Answer 41

Evaluates by comparing others to the same gender and age

Question 42

What are criterion-referenced standards?

Answer 42

evaluates performance in relation to a particular reference point or specific goal such as: fitness level to climb stairs or to remain functionally independent

Question 43

Recall: what is the minimal VO2 to remain functionally independent at age 85 for women and men?

Answer 43

women = 15 men = 18

Question 44

Name 2 field-based assessment tools designed to measure physical impairments and functional limitations in OA.

Answer 44

1. Short Physical Performance Battery (SPPB) Protocol 2. Fullerton Advanced Balance (FAB) Scale

Question 45

What are the 3 tests performed in the SPPB protocol and how is it scored

Answer 45

- balance tests (feet together, feet aligned heel to toe, one foot behind the other) - gait speed test - chair stand test scores are out of 4 for each test ## Footnote 0 to 3 = worst physical performance 4 - 9 = reduced physical performance 10 - 12 = best physical performance

Question 46

What are 4 good reasons for using SPPB?

Answer 46

1. **meets psychometric properties** - interrater reliability (0.81 to 0.91) - test-retest reliability (0.84) 2. **convenient and practical** (equipment, space and time requirements) 3. Allows OA to **perform the tests safely without need of medical release (sub-max effort)** 4. **evaluates physical abilities and functions**

Question 47

What is the Fullerton Advanced Balance (FAB) Scale and how is it scored?

Answer 47

**series of 10 functional tests which assess both static and dynamic balance under varied sensory conditions.** Uses a 4-point scale to measure the outcome of the test. (max pts = 40)

Question 48

What are the advantages of the FAB Scale?

Answer 48

high predictive validity, test-retest reliability, intra- & interrater reliability, content validity **excellent test for OA with no major balance issues**

Question 49

When is it better to use the Berg Balance Scale?

Answer 49

with lower functioning OA due to diseases and disabilities (e.g., stroke, frailty, Parkinson's)

Question 50

Name the first 5 tests on the FAB Scale and what they assess (P = posture, S = stepping, T = time)

Answer 50

1. Stand with feet together and eyes closed (P + T) 2. Reach forward to retrieve an object (pencil) held at shoulder height (P + S) 3. Turn 360 degree in right and left directions (P + S) 4. Step up onto and over a 6 inch bench (P) 5. Tandem walk (S)

Question 51

Name the last 5 tests on the FAB Scale and what they assess (P = posture, S = stepping, T = time)

Answer 51

6. Stand on one leg (P + T) 7. Stand on foam with eyes closed (P + T) 8. Two-footed jump (jumping) 9. Walk with head turns (P + S) 10. Reactive postural control (P + S)

Question 52

What is the cut-off score for evaluating risk for falls in the long form FAB scale?

Answer 52

Long form = all 10 tests cut-off = 25 or lower out of 40

Question 53

What is the cut-off score for evaluating risk for falls in the short form FAB scale?

Answer 53

Short form = tests 4-5-6-7 cut-off = 9 or lower out of 16

Question 54

What should we do on assessment day, prior to the test?

Answer 54

- A health and PA (physical activity) questionnaire - Informed consent form - Medical clearance (if required)

Question 55

What should participants be advised to do to prepare for assessment day?

Answer 55

- To avoid heavy exertion and alcohol use 24h before testing - To eat a light meal 1h before testing - To wear appropriate clothing for exercise

Question 56

Are OA stressed out before their assessment?

Answer 56

Yes, and this can influence their results.

Question 57

How are results interpreted on the senior fitness test (SFT)? What are performance norms?

Answer 57

Norms are based on over 7000 community-dwelling OA between 60 and 94 years of age. "Normal" defined as the middle 50% of the population

Question 58

How are results interpreted on the senior fitness test (SFT)? What are criterion standards?

Answer 58

Scores are compared to a **threshold score**. This can be used to *identify participants at risk for mobility problems, falls or disability*