Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel – a qualitative approach

Abstract

Background Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials. Methods Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations. Results The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively. Conclusions These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.

Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols

“…more verbal and physical cueing in the walk tests (Table 4). A recent consensus reached by a panel of experts working in the care of people with dementia has stated that physical performance assessments should be tailored for the specific characteristics of dementia, and external cues are necessary during assessments (Trautwein et al, 2019). Our findings have provided further support to the consensus that systematic cueing should be an integral part of the testing protocols of the walk tests for older adults with dementia in order to obtain accurate assessment results from this group.…”

“…Poor short-term memory and executive function, difficulties to follow instructions, and psychological and behavioral symptoms are the common clinical features found in people with dementia that can reduce their capacities to complete physical performance tests (Rockwood et al, 2000). Providing systematic verbal and physical cues has been shown effective in facilitating the performance of people with dementia in physical performance tests (Nordin et al, 2006;Ries et al, 2009;Tappen et al, 1997;Trautwein et al, 2019). Our previous study has demonstrated that providing systematic cues could maximize the consistency of the performances of older adults with dementia in the walk tests (Chan and Pin, 2018).…”

Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

“…Feasibility of the motor assessments were discussed with an international expert panel before the conduct of this study. Furthermore, a standardized testing procedure was developed by the expert panel (Trautwein et al, 2019). Subsequently, the applied test battery has been checked for feasibility in IWD.…”

Effects of a 16-week multimodal exercise program on gait performance in individuals with dementia: a multicenter randomized controlled trial

“…The strengths of the study include the emphasis on high-quality methods and a detailed reporting of our methods and findings [ 53 ]. Of note, we had a large sample size of over 300 individuals with mild to moderate dementia, our assessments were deemed adequate for IWD by an expert panel [ 87 ], and our MEP was specifically tailored to fit the needs and characteristics of IWD (please refer to [ 53 ]).…”

“…Third, the assessments to determine motor performance used in this study are widely used in research but have not been specifically developed for IWD. Even though we intensively discussed the adequateness of these assessments during an expert panel [ 87 ] and carefully selected the most appropriate ones, we cannot rule out the possibility that the use of existing assessments not specifically designed for IWD may have led to biased results. For example, these assessments often do not sufficiently take into account fluctuating daily forms and motivational aspects that may play a role when examining IWD.…”