Overview
M. Elaine Cress, PhD, Associate Professor at the University of Georgia in Athens, and her colleagues have developed a new measure of physical function called the Continuous Scale Physical Functional Performance (CS-PFP) test. This test is a valid, reliable, and sensitive measure of physical function. It is applicable to a wide range of function levels and has minimal floor and ceiling effects. Furthermore, it was found that exercise training can significantly improve physical function in the practical tasks of independent living.
Functional independence is a primary contributor to quality of life. Technical advances and medical expertise have prolonged life for persons experiencing traumatic injury, stroke, heart failure and chronic conditions. As a result, more people are living longer with the possibility of becoming disabled. Accurate assessment of physical function is important for predicting risk factors for functional dependence, institutional discharge planning, documenting intervention strategies, and medical reimbursement. Optimal physical performance results in the coordinated integration of the cardiovascular and neuromuscular systems into efficient movements which are mediated by psychosocial factors (e.g. motivation, depression, and confidence).
The CS-PFP test is a unique instrument designed to provide a comprehensive, in-depth measure of physical function that reflects abilities in several separate physical domains (1). The CS-PFP is based on ordinary activities of daily life, performed at maximal effort within the bounds of safety and comfort. It requires standard conditions and utilizes a scripted dialogue. All tasks are quantified by time, distance, or weight. Each task is scored 0-to-100 based on an empirically derived range established from data gathered on older adults with a broad range of individual functional abilities. The test yields a total score (0-100) that is the average of five separate physical domain scores: upper body strength, lower body strength, flexibility, balance and coordination, and endurance.
The validation of the CS-PFP is published in Archives of Physical Medicine and Rehabilitation, December,1996 (1). To validate the CS-PFP, the protocol was administered to 148 older adults from three different living status situations: community dwellers, continuous care retirement residents who were independent, and continuous care retirement residents reporting mild limitation. As expected, the community dwellers had the highest fitness and physical function scores, the continuous care retirement residents who were independent had the next best scores, and the continuous care retirement residents with limitations had the lowest scores. Measures of physical function such as Instrumental Activities of Daily Living (IADL) did not discriminate among any of the groups (2). The SF36 Health Survey (3) did discriminate the lowest group, but did not discriminate physical function between the two higher groups.
Age related loss in physiologic capacities contributes to the decline in physical function in the elderly. Despite the beneficial effects of exercise interventions on capacity measures, the functional benefits have not been shown in independently living older adults. The objective of this study was to evaluate exercise in independent older adults for significant and meaningful functional improvements, not detected by commonly used measures of physical function. In a randomized controlled study, 49 independently living men and women were assigned to either a non-exercise control group (CONTROL; n=29) or an exercise training (EXERCISE; n=23) group. Participants (age=76 ±4), in good general health, were recruited from retirement communities or apartments. The combined endurance and strength training was performed at 75% to 80% intensity, met 3 days/week for 6-months of supervised sessions. Outcome measures included physical capacity, health status and physical function using a newly developed performance test-the Continuous Scale Physical Functional Performance test (CS-PFP). Compared to the CONTROL group, the EXERCISE group showed significant increases in maximal oxygen consumption (11%) and muscle strength (33%). No significant differences were found between groups for changes in the Sickness Impact Profile, SF-36 scales, nor the 6-minute walk. However, the CS-PFP score improved significantly in the EXERCISE group (14%, effect size .80). Independent older adults gained meaningful functional benefits from several months of exercise training. The public health importance of physical activity may relate not just to the role of exercise in preventing decline, but also to its role in enhancing physical function.
In conclusion, the CS-PFP is a valid, reliable, and sensitive measure of physical function that is applicable to a wide range of functional levels. The test may be used to evaluate, discriminate, and predict physical functional performance for both research and clinical purposes.
References
- Cress ME, Buchner DM, Questad KA, Esselman PC, deLateur BJ, Schwartz RS. Continuous-scale physical functional performance in a broad range of older adults: a validation study. Arch Phys Med Rehabil. 77(12):1243-1250. 1996.
- Pfeiffer M. Multidimensional functional assessment: the OARS methodology. Durham, NC: Duke University Center for the Study of Aging and Human Development, 1975.
- Ware JE, Sherbourne CD. The MOS 36-item Short Form Health Survey (SF-36). Med Care. 30(6): 473-83. 1992.
Revised
08/13/2005
