Predictive Value of the Short Physical Performance Battery Following Hospitalization in Older Patients

Volpato, Stefano; Cavalieri, Margherita; Sioulis, Fotini; Guerra, Gianluca; Maraldi, Cinzia; Zuliani, Giovanni; Fellin, Renato; Guralnik, Jack M.

doi:10.1093/gerona/glq167

Cited by 370 publications

(291 citation statements)

References 38 publications

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“…We evaluated this association using established binary and categorical cutoffs for both the SPPB and FFP (7,14). As a sensitivity analysis, we evaluated the association between SPPB and time to delisting or death across a range of binary cutoffs (45)(46)(47). To adjust for potential confounders, we used stratified Cox proportional hazards models, employing a similar approach to sequential modeling as used in examining the association between frailty and LT-VLA disability.…”

Section: Original Article Analytical Approachmentioning

confidence: 99%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

187

216

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Rationale: Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation.Objectives: To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates.Methods: In a multicenter prospective cohort, we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons with conceptually related factors. In a nested case-control study of frail and nonfrail subjects, we measured serum IL-6, tumor necrosis factor receptor 1, insulin-like growth factor I, and leptin. We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale. We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models, respectively.Measurements and Main Results: Of 395 subjects, 354 completed FFP assessments and 262 completed SPPB assessments; 28% were frail by FFP (95% confidence interval [CI], 24-33%) and 10% based on the SPPB (95% CI, 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, sex, diagnosis, and transplant center, both FFP and SPPB were associated with increased risk of delisting or death before lung transplant. For every 1-point worsening in score, hazard ratios were 1.30 (95% CI, 1.01-1.67) for FFP and 1.53 (95% CI, 1.19-1.59) for SPPB.Conclusions: Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.Keywords: biomarker; body composition; disability; frailty; lung transplantation Author Contributions: J.P.S., J.M.D., C.J.G., P.D.B., P.P.K., J.D.C., and D.J.L. made substantial contributions to the conception and design of the work; J.P.S. wrote the first draft of the manuscript; and J.P.S., J

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Section: Original Article Analytical Approachmentioning

confidence: 99%

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Singer¹,

Diamond²,

Gries

et al. 2015

Am J Respir Crit Care Med

187

216

View full text Add to dashboard Cite

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“…31 Strong associations have been found between SPPB performance in older persons and measures of self reported disability, 31 functional measures such as the 6-MWT 27 and 400-m walk time, 40,41 and is a strong and consistent predictor of progressive disability, hospitalization, poor clinical outcomes after hospitalization, nursing home admission and mortality. 31,[42][43][44][45][46][47][48] Criteria for small and substantial meaningful change scores have been established. 49,50 Baseline SPPB scores in men with PCa suggest normally functioning individuals (scores greater than 9 out of 12 possible), but with a tendency for men with longer ADT exposure to have slightly lower scores compared with control groups.…”

Section: Sppbmentioning

confidence: 99%

Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy

Storer¹,

Miciek²,

Travison³

2012

Asian J Androl

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Prostate cancer (PCa) is the most common visceral malignancy in men with androgen deprivation therapy (ADT) the preferred therapy to suppress testosterone production and hence tumor growth. Despite its effectiveness in lowering testosterone, ADT is associated with side effects including loss of muscle mass, diminished muscle strength, decrements in physical performance, earlier fatigue and declining quality of life. This review reports a survey of the literature with a focus on changes in muscle strength, physical function and body composition, due to short-term and long-term ADT. Studies in these areas are sparse, especially well-controlled, prospective randomized trials. Cross-sectional and longitudinal data (up to 2 years) for men with PCa treated with ADT as well as patients with PCa not receiving ADT and age-matched healthy men are presented when available. Based on limited longitudinal data, the adverse effects of ADT on muscle function, physical performance and body composition occur shortly after the onset of ADT and tend to persist and worsen over time. Exercise training is a safe and effective intervention for mitigating these changes and initial guidelines for exercise program design for men with PCa have been published by the American College of Sports Medicine. Disparities in study duration, types of studies and other patient-specific variables such as time since diagnosis, cancer stage and comorbidities may all affect an understanding of the influence of ADT on health, physical performance and mortality. Keywords: androgen deprivation therapy; androgen suppression; exercise prescription; exercise training; functional assessment; lean body mass; older men; prostate cancer INTRODUCTION Prostate cancer (PCa) is the most common visceral malignancy in men.1 Since the tumor is initially testosterone dependent, androgen deprivation therapy (ADT) is the preferred modality to suppress testosterone production in men with this disease. ADT has been extensively studied with surgical and chemical castration achieved via bilateral orchiectomy, use of a gonadotropin hormone-releasing hormone (GnRH) agonist or anti-androgens. Annually, about 500 000 men in the United States are treated with GnRH agonists.2 Though their effectiveness in lowering serum testosterone to castrate levels is well established, side effects are common.Testosterone and its metabolites are essential for the maintenance of muscle mass and bone mineral content. Body composition changes in men undergoing ADT place them at increased risk not only for diminished physical capacity, but also for coronary artery disease, type II diabetes and the metabolic syndrome, 3 though a recent meta-analysis suggests no increase in cardiovascular mortality. 4 In addition, ADTassociated decreases in muscle and bone mass are thought to be associated with increased fracture risk, diminished muscle strength, decrements in physical performance, earlier fatigue and declining quality of life (Figure 1).This narrative review focuses on changes in muscle strength, physi...

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“…The only study investigating this issue was a singlecenter study performed on a small sample (n = 85) of patients with well-selected main diseases (chronic obstructive pulmonary disease [COPD], pneumonia, congestive heart failure (CHF), or minor stroke). 16 . In this proof-of-concept study, SPPB could predict the combined end point of death or rehospitalization, as well as functional decline, within 1 year.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of the Short Physical Performance Battery in Older Patients Discharged from Acute Care Hospitals

Corsonello

Lattanzio

Pedone

et al. 2012

Rejuvenation Research

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We investigated the prognostic role of the Short Physical Performance Battery (SPPB) in elderly patients discharged from the acute care hospital. Our series consisted of 506 patients aged 70 years or more enrolled in a multicenter collaborative observational study. We considered three main outcomes: 1-year survival after discharge, functional decline, and hospitalization during follow-up. Independent predictors/correlates of the outcomes were investigated by Cox regression or logistic regression analysis when appropriate. The diagnostic accuracy of SPPB in relation to study outcomes was investigated by receiver operating characteristic (ROC) curve. SPPB score was associated with reduced mortality (hazard ratio [HR] = 0.86, 95% confidence interval [CI] 0.78-0.95). When the analysis was adjusted for functional status at discharge, such an association was still near significant only for SPPB values > 8 (HR = 0.51; 95% CI 0.30-1.05). An SPPB score < 5 could identify patients who died during follow-up with fair sensitivity (0.66), specificity (0.62), and area under the ROC curve (0.66). SPPB also qualified as independent correlate of functional decline (odds ratio [OR] = 0.82; 95% CI 0.70-0.96), but not of rehospitalization or combined end-point death or rehospitalization. An SPPB score < 5 could identify patients experiencing functional decline during follow-up with lower sensitivity (0.60), but higher specificity (0.69), and area under the ROC curve (0.69) with respect to mortality. In conclusion, SPPB can be considered a valid instrument to identify patients at major risk of functional decline and death after discharge from acute care hospital. However, it could more efficiently target patients at risk of functional decline than those at risk of death.

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Predictive Value of the Short Physical Performance Battery Following Hospitalization in Older Patients

Abstract: In older acutely ill patients who have been hospitalized, the SPPB provides important prognostic information. Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge.

Cited by 370 publications

References 38 publications

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation

Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy

Prognostic Significance of the Short Physical Performance Battery in Older Patients Discharged from Acute Care Hospitals

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