Measures of attributes of locomotor capacity in older people: a systematic literature review following the COSMIN methodology

Abstract

Background Locomotor capacity (LC) is an important domain of intrinsic capacity and key determinant of functional ability and well-being in older age. The United Nations Decade of Healthy Ageing (2021–2030) calls for strengthening data and research on healthy ageing, including the measurement of older persons' LC. To advance the measurement and monitoring of LC, there is pressing need to identify valid and reliable measures. Objective To identify all the available tools that were validated for measurement of LC or of its specific attributes in older people and to assess the methodological quality of the studies and measurement properties of the tools. Design Systematic review. Setting Anywhere (Community-dwelling; long-term care facility; etc.) Subjects Older people. Methods We used highly sensitive search strategies to search the following databases: Medline, Embase, Scopus, CINAHL and PsycINFO. The study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of outcome measurement instruments. Results A total of 125 studies were included, which assessed tools for balance (n = 84), muscle power (n = 12), muscle strength (n = 32, including four studies about tools for balance and muscle power) and endurance (n = 1). No studies on tools for muscle function, joint function, or locomotor capacity overall, were retrieved. We identified 69 clinician-report or objective assessment tools for balance, 30 for muscle strength, 12 for muscle power and 1 endurance assessment tool. The GRADE assessment of quality of evidence showed that only a few tools have high quality evidence for both sufficient validity and reliability: The Balance Evaluation Systems Test (BESTest), the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. Conclusions A few tools with high quality evidence for sufficient validity and reliability are currently available for balance assessment in older people that may be recommended for use in clinical and research settings. Further validation studies are required for muscle strength, muscle power and endurance assessment tools.

“TiC-TUG”: technology in clinical practice using the instrumented timed up and go test—a scoping review

“…The need for further validation studies adhering to the COSMIN terminology of measurement properties is once again emphasized by the WHO Locomotor Capacity Working Group [ 10 ].…”

“…A recent systematic review [ 59 ] of MIDs for different balance measures used with older people in research and clinical settings shows that MIDs are still pending for many health conditions. Future studies should aim to determine iTUG responsiveness and MID thereby highlighting the ability of the iTUG to detect clinically important change [ 10 , 60 ].…”

“…From a global perspective, feasible and widely applicable assessments are required, especially for use in low- and middle-income countries [ 10 ]. The iTUG holds great potential in this regard, as the measurement can be carried out almost at any time and in any location where a chair, a 3 m space and, e.g., a smartphone is available.…”

“…Since more than 30 years the TUG has been established as a clinical standard test to study mobility during the aging process, also in the context of many age-associated diseases and geriatric syndromes [ 5 ]. Due to its profoundly established validity and reliability the World Health Organization recommends the TUG for balance assessment in older people in clinical and research settings [ 10 ].…”

A unified framework for the measurement of mobility in older persons

“…Most patient-reported mobility measures fall in this category. The second systematic review focuses on actual mobility [ 13 ] measurement through life-space mobility assessments that consider the frequency and extent of one’s mobility both in the home and in the community. Furthermore, there is a third systematic review on locomotor capacity that includes relevant performance-based measures of mobility such as gait speed and Timed Up and Go, consistent with our framework’s delineation of locomotor capacity for mobility [ 14 ].…”