Outcome Measures in Cardiopulmonary Physical Therapy: Short Physical Performance Battery

In the last edition of the Research Corner, gait speed was presented as a functional assessment tool for patients with cardiovascular and pulmonary (CVP) disease. The benefits of this assessment tool included good reliability, validity, and responsiveness, making it a useful tool for measuring outcomes in patients with cardiovascular and/or pulmonary conditions. Additionally, gait speed is easy to measure, takes less than 2 minutes to complete, and requires minimal training for the tester. Outcomes of physical function may be enhanced by the use of tools that address other aspects of lower extremity performance, such as the Short Physical Performance Battery (SPPB). The SPPB is a simple test to measure lower extremity function using tasks that mimic daily activities. The SPPB examines 3 areas of lower extremity function; static balance, gait speed, and getting in and out of a chair. These areas represent essential tasks important for independent living and are thus an important outcome measure for patients with CVP disease. Detailed instructions for the SPPB are listed in Appendix 1 and a sample score sheet is given in Appendix 2. To assess static balance, the patient is asked to maintain up to 3 hierarchical standing postures for up to 10 seconds. First, the patient stands with feet together. If the patient can maintain this posture for 10 seconds, he or she then performs a semitandem stance position. If semitandem is held for 10 seconds, it is followed by a tandem stance posture. For the 4 meter walk test, the patient is asked to walk at his or her comfortable speed across a 4 meter distance. Timing starts on the “begin” command and ceases when one foot crosses the end of the course. No room is provided for acceleration. After assessment of gait speed, the patient is asked to stand from a standard chair without upper extremity assistance. If the patient can stand 1 time, then he or she is instructed to complete 5 sit to stands as quickly as possible without upper extremity assistance. The time taken to complete the 5 sit to stands is recorded. Each subscale is scored 0-4 with 0 being “unable to complete the task” and 4 being the “highest level of performance.” Scores from each subscale are added to create a summary score between 0 and 12. Table ​Table11 lists how patients can be classified with severe, moderate, mild, or minimal limitations based on their SPPB scores.1 Table 1 Classification of Limitations Based on Short Physical Performance Score Subscale scores can also be used separately. Balance subscale performance can provide a quick screen of balance abilities. Performance on the 4 meter walk test can be used to calculate gait speed. The time in seconds to complete the 5 sit to stands can be used to assess lower extremity strength and power.2–4 As part of the Women's Health and Aging Study, normative data on subscale performance for the SPPB has been published and is available at http://www.grc.nia.nih.gov/branches/ledb/whasbook/chap4/chap4.htm. Therapists can use this information to gain more insight on their patients' performance and to assist in writing goals. Intended Population The populations used to create and establish the SPPB were community dwelling older adults who participated in the Established Populations for Epidemiologic Studies of the Elderly (EPESE). The subjects involved in this longitudinal study were described as mostly Caucasian with higher than average education and income levels.1 However since the inception of the SPPB, it has been used successfully in more diverse populations.5–7 Investigators primarily have used community dwelling individuals when studying the SPPB.1,8,9 Only 1 article was found that involved patients in the acute care setting.10 To this author's knowledge, there are no published studies that have examined the psychometric properties of the SPPB in a specific population of patients with CVP diseases. However, subjects with histories of CVP disease were included in many of the studies that established the psychometric properties of the SPPB.5,8,11 One example is in a study of 1002 women, 14.6% had a history of myocardial infarction, 10.5% had a history of heart failure, and 7% a history of a stroke.5 Another study was found that used SPPB to examine differences in function between individuals with peripheral arterial disease (PAD) and those without PAD.12 Based on this information readers should feel comfortable using the SPPB as an outcome measure for their patients with CVP disease, especially if the patients are community dwelling and/or older adults.