Pilot Project on Assessing Physical Performance in Hospitalized Older Patients

SPPB是一套客观的下肢物理性能测量（平衡测试、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。在社区居住的老年人的流行病学研究中已经证明，该测试组的表现可以高度预测死亡率、制度化、医疗保健支出和随后的残疾。最近的研究表明，SPPB可以在门诊诊所安全、短时间内进行，护士和患者都可以接受，而且它预测的不良后果与流行病学研究队列中的发现相似。这支持了一个前提，即在常规临床实践中，身体功能的标准化表现测量可能是有价值的，可以作为即将发生问题的早期预警信号。尚未评估的是，一套简单的性能测试是否适用于住院患者，以及它是否能表明住院期间的改善和住院后立即的功能变化。假设出院后功能恶化表明临床情况恶化，可能无法通过正常的以疾病为导向的随访发现，并预示着再入院的高风险。

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.