International Psychogeriatrics rR Fo ! '( ) '( ) ev " #$ % & - , $ , + ) $ , . $ , $ + '% / $ ( ) ( ) + * $ * 0 1 , + $ $" ie . ' * + 2$ $ 3# w ly On http://mc.manuscriptcentral.com/ipg $ Page 1 of 22 TITLE: Relative and absolute reliability of functional performance measures for adults with Dementia living in residential aged care. AUTHORS: Mr Benjamin Fox; PhD Candidate 12 Dr Timothy Henwood; Research Fellow 1 2 3 Associate Professor Christine Neville; Deputy Director 2 4 Fo Dr Justin Keogh; Associate Professor 3 5 6 rR 1 University of Queensland/Blue Care Research and Practice Development Centre, Toowong 2 School of Nursing and Midwifery, University of Queensland, St Lucia ev 3 Faculty of Health Sciences and Medicine, Bond University, Gold Coast ie 4 Ipswich Clinical School, University of Queensland, Ipswich w 5 Human Potential Centre, AUT University, Auckland, New Zealand 6 Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast Mr Benjamin Fox ly CORRESPONDING AUTHOR: On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics UQ/BC RPDC 56 Sylvan Road, Toowong, QLD 4066 E: ben.fox@uqconnect.edu.au P: +617 3720 5617 http://mc.manuscriptcentral.com/ipg International Psychogeriatrics ABSTRACT Background This pilot investigation aimed to assess the relative and absolute test-retest reliability of commonly used functional performance measures in older adults with dementia residing in residential aged care facilities. Methods A total of twelve participants were tested on two functional performance batteries; the Fo Short Physical Performance Battery (SPPB) and the Balance Outcome Measure for Elder Rehab (BOOMER), hand grip strength and anthropometric measures; BIA and BMI. This rR study utilised a seven day test-retest evaluation. Intra-class Correlation Coefficients (ICC) were used to assess relative reliability, Typical Error of Measurements (TEM) were used to ev assess the absolute reliability and Bland-Altman plots were used to assess group and individual levels of agreement. w Results ie With the exception of Standing Balance (ICC = 0.49), 2.4m walk (ICC = 0.68), functional reach On (ICC = 0.38) and static timed standing (ICC = 0.47), all measures demonstrated acceptable (>0.71) ICCs. However, only the anthropometric measures demonstrated acceptable levels ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 of absolute reliability (>10% TEM). Bland-Altman analysis showed non-significant (p>0.05) mean differences, and 8 out of the 17 measures showing wide Limits of Agreement (LoA). Conclusions Current measures of functional performance are demonstrably inappropriate for use with a population of older adults with dementia. Authors suggest aligning current measurement strategies with Item Response Theory as a way forward. http://mc.manuscriptcentral.com/ipg Page 2 of 22 Page 3 of 22 RUNNING TITLE: Measurement Reliability in Dementia KEY WORDS: Dementia, Alzheimer’s, reliability, psychometrics, mobility, balance, strength, measurement w ie ev rR Fo ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics http://mc.manuscriptcentral.com/ipg International Psychogeriatrics Introduction Exercise undertaken regularly can have pronounced physical and functional benefits for adults with dementia (Ahlskog et al., 2011, Littbrand et al., 2011). To understand these benefits, we are reliant on the sound psychometric properties of the measures utilised to assess functional and physical capacity. However, most psychometric assessments of these measures have been done among adults with no cognitive impairment. For those with dementia impaired balance confidence, elevated anxiety towards new or foreign tasks, Fo decreased comprehension and increased confusion may impede the individual’s ability to follow instructions and complete the protocol, thereby significantly reducing the reliability rR of the measures (Brill et al., 1995). Data in current literature investigating the reliability of common exercise intervention measures with older adults with dementia are mixed and inconclusive. ie ev While some studies reported the relative reliability of physical performance measures w among adults with dementia (Conradsson et al., 2007, Rockwood et al., 2000, Lin et al., 2004, Tappen et al., 1997, Blankevoort et al., 2012, Suttanon et al., 2011, Ries et al., 2009, On Thomas and Hageman, 2002, Binder et al., 2001, van Iersel et al., 2007, Blankevoort et al., 2010), most have failed to assess the absolute reliability, the measure of magnitude of ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 change and individual variability. Identifying or developing appropriate measures that can be employed with older adults with dementia will allow the accurate assessment of outcomes in exercise interventions aimed at improving functional wellbeing in this population. The aim of this pilot study was to gain preliminary insight into the relative and absolute reliability of functional performance measures that have been commonly used in http://mc.manuscriptcentral.com/ipg Page 4 of 22 Page 5 of 22 studies involving cognitively sound older adults, among a group of adults with dementia who live in residential aged care facilities. Methods Design and Participants This study was undertaken to establish the feasibility of conducting a larger, powered study of functional performance test-retest reliability among adults with dementia. Participants were recruited from two residential aged care facilities (RACFs) in South-East Queensland, Fo Australia. The inclusion criteria were: a diagnosis of dementia, not wheel chair bound, and no unstable or terminal disease. Those with walking aids (frame or stick) were included as rR long as they could ambulate at least 10 metres (m). Participants with pacemakers were excluded due to BIA measurement. All participants were required to assent, medical ev practitioner or RACF registered nurse health status approval and substitute decision maker ie informed consent was supplied. The study was approved by (identified after review) Ethics Committee. On Procedures w Prior to the reliability assessment, background data were collected by the research manager from RACF staff and RACF records consulted. Variables included date of birth, gender, ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics length of time in RACF, level of dementia, comorbidities and medications. A number of common functional performance, grip strength and anthropometric measures that have been found to be highly reliable in older, cognitively sound adults were collected from participants in two sessions undertaken seven days apart. Assessment times, location and order of testing were kept constant for both occasions. Measurement administrators, trained in the prescribed measures by a qualified exercise physiologist, experienced in measuring functional capacity in older adults, were assigned specific measures throughout http://mc.manuscriptcentral.com/ipg International Psychogeriatrics to minimise inter tester error. RACF staff assisted with moving clients between measures, and under the guidance of the assessor helped maintain client safety during measures that involved standing, walking or balancing. To ensure safety, the measurer and a staff member stayed close to the participants during the standing measures and the participants were encouraged to sit and rest between trials. Prior to the assessments, participants were familiarised to the measure by both demonstration and verbal description. Measures Anthropometry Fo Height and weight were measured by stadiometer (Charder Electronic Co, Ltd., Taichung rR Hesin, Taiwan) and electronic scale (SECA Medical Scales and Measuring Systems, Birmingham, UK), respectively. Percent body fat, lean mass, total body water and body ev mass index (BMI) (kg/m2) were measured by Maltron 906 50 kHz tetrapolar bio-electrical ie impedance analysis (BIA) (Maltron International Ltd., Rayleigh, UK). Participants were w instructed to lie supine with their hands and legs slightly apart, and four electrodes were applied to the right side of the body at the hand, wrist, foot and ankle. Parameters specific On to each client were entered and a non-invasive analysis undertaken. Performance-based measures ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Participants undertook two standardised physical performance battery measures designed to assess balance and functional capacity in older adults, and a measure of muscle strength. Measure protocols have been given in detail previously. The Short Physical Performance Battery (SPPB) (Guralnik et al., 1994) is an assessment of functional capacity and contains three measures: A hierarchal measure of standing balance, a timed 2.4m walk at habitual speed and a timed repeated (5) chair stands. Measures are scored individual and an overall summary score is also obtained. The http://mc.manuscriptcentral.com/ipg Page 6 of 22 Page 7 of 22 BOOMER (Haines et al., 2007) is a measure of agility, dynamic and static balance consisting of four measures: a maximum step test in 15 seconds, the Timed Up and Go (TUG) test, the static timed standing test and a measure of functional reach. Hand grip muscle strength (kg) was measured using a Jamar dynamometer (Sammons Preston Roylan, Bolingbrook, USA). Participants were seated with their elbow at their side and at 900. When given a ‘GO’ signal, participants squeezed the dynamometer as hard as they could. Both the left and right hand were tested (Taekema et al., 2010). Fo Notes were also taken during measurement, which included: deviations from the protocol, the use of additional verbal or physical assistance, difficulties in comprehension rR for participants, confusion and behavioural issues, and any other anomalies from the testing protocol. This information was used to draw subjective conclusions regarding the ev appropriateness and applicability of the measures and methods of assessment. ie Statistical Analysis w Data were analysed using SPSS 21 (SPSS Inc., Chicago, IL, USA). Interclass Correlation Coefficient (ICC) determined the relative test-retest reliability of measures. On Relative reliability was deemed acceptable if the ICC statistic was greater than 0.71 (Thomas and Nelson, 2001). Absolute reliability was assessed by measuring the typical error of ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics measurement (TEM) (Domholdt, 2000) and was deemed acceptable if the TEM value was less than 10% the mean cumulative test-retest scores (Schwenk et al., 2012). ***INSERT FIGURE 1 ABOUT HERE *** CAPTION Figure 1. Typical Error of Measurement (TEM) equations. Bland and Altman plots were used as a visual representation of pre-post agreement, with mean difference (MD) and Limits of Agreement (LoA) (±1.96 SD) imposed on the plots for each measurement. LoA represents the expected difference between pre and post http://mc.manuscriptcentral.com/ipg International Psychogeriatrics measurement to a 95% confidence level. Mean Difference is a function of the average difference between test and retest measurement scores. As a function of the difference between test-retest measurement result and the score during pre-testing, Bland-Altman plots helped establish whether there was good agreement at the group level (a mean difference close to zero), and at the individual level (narrow bands of LoA). A one sample T-test was used to determine if mean differences significantly deviated from 0. Acceptable LoA values were determined by expected variance of Fo comparative measures (Schwenk et al., 2012). All analyses were two-tailed and a value of p < .05 was required for significance. All values were expressed as mean standard deviation. Results rR Twelve participants completed the test retest measurements and have been included for ev statistical analysis. Of those who did not complete the retest measurement, one was ie removed from the study after becoming extremely agitated during the initial measurement, w with another removed under similar circumstances during retest measurement, and the remaining four either did not feel well or did not give verbal assent on the day. On Participants were 83.25 ± 9.94 years of age. Increased time to complete the TUG and ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 5 repeated chair stands measures, low walking speeds and low SPPB summary scores indicate a low level of function in this sample (Bohannon, 2006, Cesari et al., 2005, Bean et al., 2002, Guralnik et al., 1994, Guralnik et al., 1995). ***INSERT TABLE 1 ABOUT HERE*** Acceptable levels of reliability were shown for all anthropometric measures, grip strength, chair stands, the SPPB summary score, TUG test and the Step Test (left). Step Test (Right) approached acceptable levels. Acceptable levels of absolute reliability were shown http://mc.manuscriptcentral.com/ipg Page 8 of 22 Page 9 of 22 for five of the six anthropometric measures (Height, Weight, BMI, Lean Mass, and Total Body Water) and approached acceptable for Body Fat % (10.70%). Grip Strength (L and R) approached acceptable levels (10.00% and 11.66% respectively). All other measures showed unacceptable levels of absolute reliability (12.76% for Chair Stands to 43.33% for Step Test [Right]). All test–retest, TEM and ICC data are presented in Table 1. ***INSERT TABLE 2 ABOUT HERE*** Bland-Altman analysis results are presented in Table 2. There were no significant Fo differences between group means and the expected value of zero for all 17 measures. The TUG (M = 4.77, p =0.090) approached significance, while the functional reach (M = -4.08cm, rR p = 0.146) had a large non-significant deviation from zero. Figure 1 is the Bland-Altman plot for the Grip Strength Right, with MD and LoA superimposed. With a zero mean (M = 0.17kg) ev and narrow LoA (-4.55-4.88kg), it is possible to conclude that the Grip Strength Right is an ie appropriate measure in this population. By contrast, the Bland-Altman plot for the TUG is w presented in Figure 2. Large, non-significant deviation of the mean and wide LoA (-11.7421.29s) suggests that this measure may be inappropriate for use in a group of adults with On dementia residing in a RACF. Body Fat percentage, total body water, standing balance, 5 repeated chair Stands, Step Test, TUG, Functional reach and Static timed standing all had ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics unacceptable LoA. ***INSERT FIGURE 2 ABOUT HERE*** ***INSERT FIGURE 3 ABOUT HERE*** A number of participants appeared to have reduced capacity in many of the assessments both as a component of dangerously reduced balance and balance confidence, and their ability to translate protocols to accurately undertake the measure. Deviations http://mc.manuscriptcentral.com/ipg International Psychogeriatrics from strict protocol were also noted (including extra prompts) and are addressed in detail in the discussion. Generally, participants required extra prompts to be reminded of protocol (i.e. would forget what it was), or constant cueing throughout to be able to successfully complete the measure. Participants often required the contact with the arms of the chair to complete chair stands and TUG test, which is outside the protocol, and required assistance in balancing during the step test. Many challenges also exist for participant with their comprehension of what the task was requiring of them often poorly translated to the Fo movement or stance required of them. For example, the SPPB’s semi-tandem position proved impossible to achieve for a percentage of participants, even with extensive rR assistance and prompting from researchers. Discussion ev This study appears to be one of the first to examine the psychometric properties of two ie commonly used measures of functional performance and common anthropometric w measures in RACF adults with dementia. Results indicated acceptable levels of relative and absolute reliability for most anthropometric measures, while showing acceptable relative On reliability at the group level and TEM values slightly above acceptable limits. In contrast, the functional performance measures of the SPPB, the BOOMER and hand grip appear less ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 reliable. While Grip Strength, TUG, Step Test (L), SPPB Summary Score and chair stands had demonstrably acceptable levels of relative reliability, unacceptably high TEM values question the applicability and usefulness of such tests in clinical practice and research. This data have significant implication for clinicians and researchers when deciding which measures are best used with a cognitively challenged older cohort. Bland Altman plots confirmed that while group means do not significantly deviate from zero, demonstrating their applicability within a population setting, high levels of variability and wide LoA http://mc.manuscriptcentral.com/ipg Page 10 of 22 Page 11 of 22 confirmed that, at an individual level, significant shortcomings exist in the measurement of functional performance in older adults with dementia living in RACFs. Our data suggested careful consideration is required in choosing measures, and that there is scope for validating adaptations of the present measures to make allowances for the support required for the very old, low functioning adult with dementia. Currently no literature exists which examines the reliability (both relatively and absolutely) of anthropometric measures and grip strength in adults with dementia. Our data Fo suggests that these measures are acceptable in terms of relative reliability and absolute reliability and demonstrated good levels of group and individual agreement. These rR measures were reliable and can be used with this population. This also seems to be the first study to examine the reliability of the SPPB and ev BOOMER functional performance batteries with adults with dementia, although, studies ie have attempted to establish the reliability of the individual test items with varying success w (Conradsson et al., 2007, Lin et al., 2004, Blankevoort et al., 2012, van Iersel et al., 2007). Some authors have only examined the ICC statistic and concluded tests are suitable for use On within this population (Tappen et al., 1997, Binder et al., 2001, Lin et al., 2004, van Iersel et al., 2007). While the relative reliability determines if differences exist at the group level ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics (Suttanon et al., 2011), it is necessary to examine the absolute reliability and variability of these measures in order to ascertain the consistency of the measurement and determine the magnitude of statistical relevant changes in a measure (Suttanon et al., 2011). Both forms of reliability are necessary to determine the applicability of measures. The TUG (Ries et al., 2009, Rockwood et al., 2000, Tappen et al., 1997, Blankevoort et al., 2010, Suttanon et al., 2011, Thomas and Hageman, 2002), Step Test (Suttanon et al., 2011), Functional Reach (Suttanon et al., 2011, Rockwood et al., 2000), chair stands http://mc.manuscriptcentral.com/ipg International Psychogeriatrics (Blankevoort et al., 2012, Suttanon et al., 2011, Binder et al., 2001), walking speed tests (Binder et al., 2001, Ries et al., 2009, Blankevoort et al., 2012) have all been shown to have acceptable ICC values in dementia populations. While our data showed lower ICC for our walking test, Step Test and Functional Reach than has been shown previously, Bland-Altman plots demonstrated their applicability at the group level. Low TEM values could be a function of the lower cognitive processing ability of the participants within this study. Our findings are consistent with previous research that unacceptable levels of absolute reliability Fo limit the individual applicability of these measures in this population (Blankevoort et al., 2012, Ries et al., 2009, Suttanon et al., 2011) . rR Part of this study was to qualitatively evaluate the ability of participants to comprehend and complete the measures prescribed. The ability of participants to complete ev the tasks was compromised by their inability to comprehend or maintain attention ie throughout, or require physical assistance to successfully complete the task. As consistent w with previous research, participants needed constant cueing to remind them of the task, extra prompts to be able to comprehend the task or physical assistance (i.e. using the arms On of a chair to stand or help from the researchers in ambulating) (Blankevoort et al., 2012, van Iersel et al., 2007). This has severe implications for the reliability and validity of measures. ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Hauer and Oster (2008) outlined similar difficulties of working within this population and have stated previously that acceptable relative reliability does not guarantee measure appropriateness. This is further evidenced by our lack of acceptable absolute reliability, the practicalities of which undermine the validity of the measures. Therefore, drawing any form of meaningful conclusion or comparison is difficult from using the SPPB or BOOMER tools and implies a paradigm shift away from protocol driven measures may be necessary if an http://mc.manuscriptcentral.com/ipg Page 12 of 22 Page 13 of 22 accurate assessment of functional performance in older adults with dementia is to be achieved. While this study demonstrated the poor psychometric properties of common measures of functional performance in this population, it operates under a protocol driven measurement theory, which is considered out-dated in the field of psychology (Embretson and Reise, 2000). The authors believe that an Item Response Theory approach would provide an improved alternative in the assessment of functional performance in adults with Fo dementia (Embretson and Reise, 2000). Item Response Theory is a mathematical probabilistic model which attempts to take an individual’s response to measurement items rR and equate them on a spectrum of ability. The theory is not group specific, so tests can be calibrated on a wide range of the functional abilities, including among those with and ev without dementia. Moreover, the theory allows for mixed methodology assessments. ie Therefore, in a group of adults with moderate to severe dementia, a proxy survey could be w completed and compared to individuals who were physically able to complete a functional assessment. However, while direct comparisons of, for example, balance could not be On made, individuals would be compared on a latent trait spectrum of functional ability, in a similar way that intelligence is measured in the field of psychology (Embretson and Reise, 2000). ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics While this does not negate the issue of reliability, it does provide a flexible framework that allows for measures not being completed due to cognitive or behavioural issues, yet still provide information that can be assessed against functional improvement or decline. There are several limitations to the present study. First is the sample size, which reduces the statistical power of the analyses. However, as a pilot, the study that mirrored sample sizes from recent exercise intervention trials among adults with dementia (REF). http://mc.manuscriptcentral.com/ipg International Psychogeriatrics Another limitation to this pilot is the aforementioned deviations to protocol. Hauer and Oster (2008) suggested that levels of reliability may be more a function of additional prompts and continuous cueing than the actual measure itself. Finally, data was not collected on level of dementia (MMSE score or equivalent) and aetiology of disease and, therefore, were not controlled for. While not crucial to the current investigation, it is entirely plausible that both these factors may affect the relative and absolute reliability. This study adds further weight of evidence of the difficulties of measuring functional Fo performance in adults with dementia and establishes the inappropriateness of two common measurement batteries of functional performance. This is due to low levels of absolute rR reliability and high variance at the individual level. These measurement batteries, perhaps, are better employed in group comparisons, but caution must be extended at an individual ev level. Dementia should not preclude older adults from participation in interventions to ie improve functional performance. However, we suggest that future research investigate w other assessment methods and that the use of Item Response Theory might be an applicable and useful alternative. Conflicts of Interest Description of Authors roles ly None. On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Benjamin Fox carried out the study, analysed the data, wrote the article and edited the article. Timothy Henwood formulated the research question, designed the study, carried out the study, and proofed the article. Christine Neville formulated the research question, designed the study, carried out the study and proofed the article. Justin Keogh designed the study, analysed the data and proofed the article. Acknowledgements: http://mc.manuscriptcentral.com/ipg Page 14 of 22 Page 15 of 22 The authors would like to thank Carinity and Churches of Christ for their assistance throughout the project. w ie ev rR Fo ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics http://mc.manuscriptcentral.com/ipg International Psychogeriatrics References AHLSKOG, J. E., GEDA, Y. E., GRAFF-RADFORD, N. R. & PETERSEN, R. C. 2011. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc, 86, 876-84. BEAN, J. F., KIELY, D. K., HERMAN, S., LEVEILLE, S. G., MIZER, K., FRONTERA, W. R. & FIELDING, R. A. 2002. The relationship between leg power and physical performance in mobility-limited older people. J Am Geriatr Soc, 50, 461-7. BINDER, E. F., MILLER, J. P. & BALL, L. J. 2001. 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Reliability of physical performance measures in nursing home residents with Alzheimer's disease. J Gerontol A Biol Sci Med Sci, 52, M52-5. THOMAS, J. R. & NELSON, J. K. 2001. Research Methods in Physical Activity, Champaign, IL, Human Kinetics. THOMAS, V. & HAGEMAN, P. 2002. A Preliminary Study on the Reliability of Physical Performance Measures in Older Dayare Center Clients With Dementia. International Psychogeriatrics, 14, 17-23. VAN IERSEL, M. B., BENRAAD, C. & RIKKERT, M. 2007. Validity and reliability of quantitative gait analysis in geriatric patients with and without dementia. JAGS, 55, 632-633. w ie ev rR Fo ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics http://mc.manuscriptcentral.com/ipg International Psychogeriatrics TABLE 1 Number 12 12 11 11 11 10 Test (±SD) 156.78 (±7.03) 62.91 (±14.24) 25.91 (±5.13) 36.52 (±9.77) 39.60 (±5.53) 29.41 (±4.01) Retest (±SD) 157.78 (±7.24) 63.26 (±14.91) 26.93 (±5.28) 37.23 (±8.83) 40.16 (±7.25) 30.97 (±6.21) TEM (%) 1.391 (0.88) 1.469 (2.33) 1.134 (4.29) 3.944 (10.70) 2.067 (5.18) 2.506 (8.30) ICC 0.970 0.992 0.964 0.854 0.919 0.815 12 11 11 11 14.67 (±6.72) 5.82 (±2.07) 26.54 (±15.64) 4.55 (±2.16) 15.83 (±6.69) 5.65 (±2.23) 25.32 (±15.59) 5.00 (±2.19) 4.971 (32.60) 1.312 (22.88) 3.309 (12.76) 0.858 (17.97) 0.490 0.676 0.966 0.875 12 12 11 11 12 6.17 (±4.24) 5.75 (±4.43) 33.07 (±15.97) 16.55 (±5.24) 67.56 (±33.84) 6.08 (±4.78) 5.92 (±4.4) 28.29 (±12.14) 20.63 (±9.25) 71.08 (±30.94) 2.654 (43.33) 2.192 (37.57) 5.959 (19.42) 6.080 (32.71) 24.462 (35.29) 0.696 0.790 0.857 0.384 0.469 12 7 14.67 (±5.12) 11.86 (±4.88) 14.50 (±5.63) 12.43 (±4.47) 1.701 (11.66) 1.215 (10.00) 0.919 0.963 ev rR w CAPTION ie Variable Height (cm) Weight (kg) BMI (kg/m2) Body Fat (%) Lean Mass (kg) Total Body Water (L) Performance Measures SPPB Standing Balance (s) 2.4-m walk (s) 5 Repeated Chair Stands (s) SPPB Summary Score BOOMER Step Test (R) Step Test (L) Timed up and go (s) Functional Reach (cm) Static Timed Standing (s) Grip Strength (kg) Right Hand Left Hand Fo On Table 1. Test-retest results and reliability for common functional performance measures. Note. % value in brackets are presented as the percentage of average test-retest measurements. ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Page 18 of 22 http://mc.manuscriptcentral.com/ipg Page 19 of 22 TABLE 2 Number 12 12 11 11 11 10 MD (±SD) -0.42 (±1.97) -0.35 (±2.08) -0.02 (±1.60) -0.71 (±5.58) -0.56 (±2.92) -1.42 (±3.40) LoA (±1.96SD) -4.27 – 3.44 -4.42 – 3.72 -3.16 – 3.12 -11.64 – 10.22 -6.29 – 5.17 -8.07 – 5.24 p 0.479 0.571 0.971 0.682 0.537 0.196 12 11 11 11 -1.17 (±7.03) 0.16(±1.86) 1.22 (±4.68) -0.45(±1.21) -14.95 – 12.61 - 3.47 – 3.80 -7.95 – 10.39 -2.83 – 1.92 0.577 0.775 0.407 0.242 12 12 11 11 12 0.08 (±3.75) -0.17 (±3.10) 4.77(±8.43) -4.08(±8.60) -3.50(±34.60) -7.27-7.44 -6.24 – 5.91 -11.74 – 21.29 -20.93 – 12.77 -71.31 – 64.31 0.940 0.856 0.090 0.146 0.733 12 7 0.17(±2.41) -0.57(±1.72) -4.55 – 4.88 -3.93 – 2.80 0.815 0.413 ev rR w ie Variable Height (cm) Weight (kg) BMI (kg/m2) Body Fat (%) Lean Mass (kg) Total Body Water (L) Performance Measures SPPB Standing Balance (s) 2.4-m walk (s) 5 Repeated Chair Stands (s) SPPB Summary Score BOOMER Step Test (R) Step Test (L) Timed up and go (s) Functional Reach (cm) Static Timed Standing (s) Grip Strength (kg) Right Hand Left Hand Fo On CAPTION Table 2. Bland-Altman Analysis of levels of agreement between test-retest measures. Note. ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics P values presented are results of one sample t-test to determine if mean significantly differs from 0. http://mc.manuscriptcentral.com/ipg International Psychogeriatrics FIGURE 1 1 % 100 Fo CAPTION Figure 1. Typical Error of Measurement (TEM) equation. w ie ev rR ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 http://mc.manuscriptcentral.com/ipg Page 20 of 22 Page 21 of 22 FIGURE 2 w ie ev rR Fo On CAPTION Figure 2. Bland-Altman plot for Grip Strength Right hand ly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 International Psychogeriatrics http://mc.manuscriptcentral.com/ipg International Psychogeriatrics FIGURE 3 w ie ev rR Fo ly On 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 CAPTION Figure 3. Bland-Altman plot for the Timed Up and Go http://mc.manuscriptcentral.com/ipg Page 22 of 22