Measurement of Physical Functioning in National HESs

1. Measurement of Physical Functioning in National HESs Workshop on Health Examination Surveys Luxembourg 10th April 2008 Sanna Natunen Recommendations on Measurement of Physical Functioning Natunen S., Viet L., Verscuren M.

2. Content • Why to measure • How to measure 1. Grip strength 2. Walking speed 3. Standing balance 4. Single-leg stand 5. Timed chair stand • Open questions

3. Why to measure • Demographic changes – Aging population • Used extensively in population studies/surveys • NHANES • Health Surveys for England • Mini-Finland, Health 2000-surveys etc. • Add valuable information over self report • Predict subsequent disability, need of assistance, falls, nursing home admission and mortality  e.g. targeting the interventions /prevention initiatives

4. How to measure • No international standards / recommendations • FEHES review on measurement of physical functioning • Used methods in previous HES • Feasibility with in general health surveys • Valid and reliable methods • Administrable in different settings (home/clinics) • Not expensive equipments • Not extensive training • Not time consuming

5. Grip strength

6. Grip strength

7. Grip strength • Strength of the dominant hand from 30 years and older • Selection of the measurement device • Hydraulic dynamometer • Position of the participant Recommendation of American Hand Therapist • Sitting in a straight-backed chair • Shoulders adducted in neutral, elbows flexed at 90 degrees • Procedure: • Test on the dominant hand • Repeat the test three times and record the result after each time • 3 to 5 minutes to perform

8. Walking speed

9. Walking speed

10. Walking speed • Review  Guralnik et al 1994, Curb et al 2006 • Measure normal walking speed from all 50 years and older • Equipment: Stopwatch and measurement tape • Procedure • A distance of 4 meters (Guralnik et al 2000) • Normal walking speed • The time is recorded to the nearest 0.1 second • If any walking aid (cane, walker, etc.) is used during the test, this is recorded on the collection form • 1 minutes to perform

11. Standing Balance

13. Standing balance • No previous international recommendations for standardized protocol exist • Measure standing balance from 60 years and older • Procedure • Adapted from Guralnik et al 1994 • Semi-tandem stand (10s) • Side-by-side stand (10s) / Full-tandem stand (10s) • 5 minutes to perform

14. Unassisted singel leg stand • No previous international recommendations for standardized protocol exist • Measure balance and other domains of functioning • 30 years and elderly • Protocol • One leg standing position for 30 seconds • Participant can choose the foot to raise • 3 minutes to perform

15. Timed chair stand

16. Chair stand

17. Timed chair stand • No previous international recommendations for standardized protocol exist • For all 30 years and older • Equipment • Stopwatch • Armless chair (height: 45 cm) with straight back • Procedure • Rise from the chair without the help of arms • If successful, proceed to the next step of chair rises • Rise from the chair without the help of arms (arms folded across chest), 10 times • 2 to 3 minutes to perform

18. Open questions • Grip strength • Dominant hand / both? • Walking speed • Normal walking speed / maximal walking speed? • Standing balance • Some more discriminating test also for highly functioning population? • Timed chair stand • 10 times, but is also time for 5 times rise needed?

19. Conclusions • Importance and public health relevance • Feasible: HIS/HES • Future development • EUNAAPA http://www.eunaapa.org/index.php • ALPHA http://www.thealphaproject.eu/ • PROFANE http://www.profane.eu.org/ • National networks for example in Finland: http://www.toimia.fi • Other?

20. If you would be told this you might not believe it…But if you see it you believe it!!!!