Pilot Project on Assessing Physical Performance in Hospitalized Older Patients

SPPB是一套客观的下肢身体表现指标（平衡、从椅子上站起来和步态速度测试），旨在评估老年人的功能限制。 对社区居住的老年人进行的流行病学研究表明，在这一成套测试中的表现高度预测死亡率、机构化、医疗保健支出和随后的残疾。 最近的工作表明，SPPB可以在门诊安全地在短时间内进行，护士和患者都可以接受，并且它预测的不良结局与流行病学研究队列中发现的结果相似。 这支持的前提是，标准化的性能措施的身体功能可能是有价值的，在常规的临床实践中，作为即将发生的问题的早期预警信号。 尚未评估的是，一组简单的性能测试是否适用于住院患者，以及它是否可以指示住院期间的改善和住院后即刻的功能变化。 据推测，出院后功能恶化表明临床表现恶化，这可能无法通过正常疾病导向的随访来评估，并预测再次入院的风险较高。 如果患者因以下疾病之一入院，则认为其有资格参加本研究：充血性心力衰竭、慢性阻塞性肺疾病、肺炎、中风、控制不佳的糖尿病。之所以选择这些疾病，是因为它们是老年患者住院的常见原因，也是因为这些疾病会强烈影响老年体弱受试者的身体功能。 患者在住院后48小时、出院前以及出院后1周和4周在家中接受SPPB给药。 在3、6、9和12个月时进行电话随访，以评估新的入院情况、住院情况和生命状态。 这项研究的数据收集工作现已完成，正在进行分析。 描述这项研究的方法和SPPB的基线相关性的论文已经发表。 一篇题为“老年患者住院后短期身体表现电池的预测价值”的权威性论文正在《老年医学科学杂志》上出版。

The SPPB is a set of objective measures of lower extremity physical performance (tests of balance, rising from a chair, and gait velocity) that was designed to assess functional limitations in older persons. It has been demonstrated in epidemiologic studies of community-dwelling older persons that performance on this test battery is highly predictive of mortality, institutionalization, health care expenditures, and subsequent disability. Recent work has demonstrated that the SPPB could be performed safely and in a short time in outpatient clinics, that it was acceptable to nurses and patients and that it predicted adverse outcomes similarly to what was found in epidemiological research cohorts. This supports the premise that standardized performance measures of physical functioning may be valuable when employed in routine clinical practice as early warning signs of impending problems. What has not been evaluated is whether a simple battery of performance tests is practical to administer to hospitalized patients and whether it can indicate improvement during the hospitalization and change in function in the immediate period post-hospitalization. It is hypothesized that deterioration of function after hospital discharge indicates a worsening in the clinical picture that may not be appreciated through the normal disease oriented follow-up and predicts a high risk of readmission to the hospital. Patients were considered eligible for the study if admitted for one of the following conditions: congestive heart failure, chronic obstructive pulmonary disease, pneumonia, stroke, diabetes in poor control. These conditions have been selected because they are common causes of hospitalizations in older patients and because are conditions that strongly affect physical function in older frail subjects. Patients were administered the SPPB at 48 hours after hospitalization, just prior to discharge and at home 1 week and 4 weeks after discharge. Telephone followup to assess new hospital admissions, institutionalization and vital status were done at 3, 6, 9 and 12 months. The data collection for the study has now been completed and analyses are under way. A paper describing the methodology of this study and the baseline corrlations of the SPPB has already been published. A definitive paper entitled "Predictive value of the Short Physical Performance Battery following hospitalization in older patients" is in press at the Journal of Gerontology Medical Sciences.