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. Why to measure Theoretical advantages and disadvantages of performance versus self-report measures of physical functioning ____________________________________________________________________________________ Advantages _______________________________________________________________________ Face validity clear for task being performed Better reproducibility Greater sensitivity to change Usual activity vs. maximal capacity Influenced less by poor cognitive functioning Influenced less by culture, language, and education _______________________________________________________________________________ Disadvantages _______________________________________________________________________ More time consuming Adequate space and special equipment needed Special training of examiners Modifications necessary for home surveys Potential injuries Simple tests may not reflect performance on complex tasks or adaptation to environment in daily life _______________________________________________________________________________ Guralnik et al. Physical Performance Measures in Ageing Research. Journal of Gereontology: Medical Science. 1989:44(5): M141-M146.

6. Grip strength

7. CountrySurveyDeviceProtocol Age group Finland Health 2000 Electric grip strength meter  Sitting position  Dominant (writing) hand  Twice (3rd measurement if needed) 30+ United Kingdom Health Survey for England 2005 Gripometer  Standing position  Both hands  Three times (alternating hands between trials, starting from non- dominant hand) 65+ Canada Canadian Health Survey 2007 Hand dynamometr  Standing position  Both hands  Twice (alternating hands between trials) 6 - 78

8. 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

9. Walking speed

10. CountrySurveyProtocol Age group Finland Health 2000  6.1 m  Maximal walking speed 55+ United Kingdom Health Survey for England 2005  2,44 m  Natural pace 65+

11. 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

12. Standing Balance

13. CountrySurveyProtocol Age group Finland Health 2000  Computer based meter  Standing 30 sec. eyes open and eyes closed, 20 sec. semi-tandem and tandem Position55+  Guralnik et al 1994  semi-tandem, tandem and foot side by side for 20 sec. Sub-sample65-74 Finrisk 2007  Standing 20 sec on tandem and one leg position; eyes open and eyes closed, eyes open and closed on the foam Sub-sample 25- 74 United Kingdom Health Survey for England 2005  Side by side stand (10sec)  Semi-tandem stand(10sec) 65+  Full tandem stand (30 sec)  One leg stand (30 sec) 65-69 United States NHANES 2003  Romberg test  In a normal support surface eyes open and closed (15 sec)  Compliant surface support with eyes open and closed (15 sec) 40-69

14. 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

15. 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

16. Timed chair stand

17. Chair stand CountrySurveyProtocol Age group Finland Health 2000  One chair stand (1)  Timed chair rise (5)  Chair 43cm high 55+ United Kingdom Health Survey for England  One chair rise (1)  Timed chair rise (5) 70+  One chair rise (1)  Timed chair rise (5/10) 65-69

18. 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

19. 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?

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

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