Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob).

BACKGROUND: Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE: Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS: The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION: The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.

SEGURANÇA E REPRODUTIBILIDADE DO TESTE TIMED UP AND GO EM IDOSOS HOSPITALIZADOS / SAFETY AND REPRODUCIBILITY OF THE TIMED UP AND GO TEST IN HOSPITALIZED ELDERLY / SEGURIDAD Y REPRODUCIBILIDAD DE LA PRUEBA TIMED UP AND GO EN ANCIANOS HOSPITALIZADOS

RESUMO Introdução: Testes físicos seguros e confiáveis são importantes para rastrear risco de queda em idosos, entretanto, não existem estudos que tenham avaliado a segurança e a confiabilidade do teste Timed Up and Go (TUG) em idosos hospitalizados. Objetivos: Avaliar a segurança e reprodutibilidade do TUG em idosos hospitalizados. Métodos: Trata-se de um estudo transversal no qual foram coletadas três aferições do TUG para cada idoso, sendo considerado o melhor desempenho em segundos (s). Outras variáveis coletadas foram função cognitiva (MEEM), índice de comorbidades de Charlson, perfil admissional (clínico ou cirúrgico), relato de quedas no último ano e IMC. Para avaliar a confiabilidade relativa utilizou-se o coeficiente de correlação intraclasse (CCI) e para a confiabilidade absoluta, a análise de Bland-Altman. Resultados: Foram incluídos 68 idosos com média de idade de 70,4 ± 7,7 anos, índice de Charlson 5,4 ± 2,0 e predomínio do perfil clínico (64,7%). Nenhum dos 204 testes foi interrompido pelos critérios estabelecidos. Houve redução gradativa entre a primeira e a terceira aferição (1a = 11,6 ± 6,54; 2a = 10,7 ± 6,22 e 3a = 10,3 ± 5,54; p = 0,001) e elevado CCI (1a e 2a: CCI = 0,98; 1a e 3a: CCI = 0,98; 2a e 3a: CCI = 0,98; p = 0,001), sendo que a maior correlação com o melhor desempenho foi associada a 3a aferição (CCI = 0,99; p = 0,001). Identificou-se que os menores viés (0,29 s) e limites de concordância (-1,1 a 1,68 s) ocorreram também entre a terceira aferição e a de melhor desempenho. A medida de erro do método para avaliação da variabilidade foi 0,5 s e a alteração clinicamente significante 3,4 s. Conclusão: O TUG foi um instrumento seguro e com boa reprodutibilidade para mensuração do desempenho físico em idosos hospitalizados.

ABSTRACT Introduction: Safe and reliable physical tests are important to identify risk of falling in the elderly. However, there are no studies that have evaluated the safety and reliability of the test Timed Up and Go (TUG) in hospitalized elderly. Objectives: To evaluate the safety and reproducibility of the TUG in hospitalized elderly. Methods: This is a cross-sectional study where three measurements of the TUG were collected for each elderly, being considered the best performance in seconds (sec). Other variables collected were cognitive function (MMSE), Charlson comorbidity index, admission profile (clinical or surgical), history of falls in the last year and BMI. To assess the relative reliability we used the intraclass correlation coefficient (ICC), and for the absolute reliability we used the Bland-Altman analysis. Results: The study included 68 elderly with a mean age 70.4 ± 7.7 years, Charlson index 5.4 ± 2.0 and prevalence of clinical profile (64.7%). None of the 204 tests was interrupted by the established criteria. There was a gradual reduction between the first and third measurement (1st = 11.6 ± 6.54; 2nd = 10.7 ± 6.22 and 3rd = 10.3 ± 5.54; p = 0.001) and high ICC (1st and 2nd: ICC = 0.98; 1st and 3rd: ICC = 0.98; 2nd and 3rd: ICC = 0.98; p = 0.001), and the highest correlation with the best performance was associated with third measurement (ICC = 0.99; p = 0.001). We identified that the smallest bias (0.29 sec) and limits of concordance (-1.1 to 1.68 sec) also occurred between the third measurement and the best performance. The measure of the method error to evaluate the variability was 0.5 sec, and the clinically significant change was 3.4 sec. Conclusion: The TUG was a safe instrument with good reproducibility for measuring physical performance in hospitalized elderly.

RESUMEN Introducción: Pruebas físicas seguras y fiables son importantes para el rastreo del riesgo de caídas en los ancianos; sin embargo, no existen estudios que evaluaron la seguridad y la fiabilidad de la prueba Timed Up and Go (TUG) en ancianos hospitalizados. Objetivos: Evaluar la seguridad y fiabilidad del TUG en ancianos hospitalizados. Métodos: Se trata de un estudio transversal en el que se recogieron tres mediciones del TUG para cada anciano y se considera el mejor rendimiento en segundos (s). Otras variables recogidas fueron la función cognitiva (MMSE), el índice de comorbilidad de Charlson, perfil de ingreso hospitalario (clínico o quirúrgico), antecedentes de caídas en el último año y el IMC. Para evaluar la fiabilidad relativa se utilizó el coeficiente de correlación intraclase (CCI) y para la fiabilidad absoluta, el análisis de Bland-Altman. Resultados: Se incluyeron 68 ancianos con una edad media de 70,4 ± 7,7 años, índice de Charlson 5,4 ± 2,0 y prevalencia del perfil clínico (64,7%). Ninguna de las 204 pruebas fue interrumpida por los criterios establecidos. Hubo una reducción gradual entre la primera y tercera medición (1a = 11,6 ± 6,54, 2a = 10,7 ± 6,22 y 3a = 10,3 ± 5,54, p = 0,001) y CCI alto (1a y 2a: CCI = 0,98; 1a y 3a: CCI = 0,98; 2a y 3a: CCI = 0,98; p = 0,001), y la más alta correlación con el mejor rendimiento se asoció con la tercera medición (ICC = 0,99; p = 0,001). Se identificó que el sesgo más pequeño (0,29 s) y límites de concordancia (-1,1 a 1,68 s) también se produjo entre la tercera medición y el mejor rendimiento. La medición del error del método para la evaluación de la variabilidad fue de 0,5 s y el cambio clínicamente significativo fue 3,4 s. Conclusión: El TUG fue un instrumento seguro y reproducible para medir el rendimiento físico en ancianos hospitalizados.

Viability of gait speed test in hospitalized elderly patients.

OBJECTIVE: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. METHODS: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = -0.27 to 0.15). CONCLUSIONS: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance. OBJETIVO: O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis metros (TVM6) em idosos hospitalizados. MÉTODOS: Estudo com medidas repetidas envolvendo idosos hospitalizados (idade ≥ 60 anos) que realizaram o TVM6 até o quinto dia de hospitalização, sendo capazes de andar sem auxílio e não apresentando dispneia ou dor que os incapacitasse para a realização dos testes. O TVM6 foi realizado sequencialmente três vezes, com período de descanso, em um corredor plano, e a velocidade de marcha foi calculada em metros/segundo. A reprodutibilidade foi avaliada pela comparação das médias, coeficientes de correlação intraclasse (CCI) e disposições gráficas de Bland-Altman. RESULTADOS: Foram avaliados 110 idosos avaliados com um total de 330 testes. Todos os participantes completaram todos os testes. As comparações entre as velocidades obtidas nos três testes realizados indicaram CCIs elevados e viés médio baixo pela disposição gráfica de Bland-Altman. Em relação à maior velocidade aferida, a correlação e a precisão foram maiores quando comparadas à obtida no terceiro teste (1,26 ± 0,44 m/s vs. 1,22 ± 0,44 m/s; CCI = 0,99; p = 0,001; viés médio = 0,04; e limites de concordância = -0,27 a 0,15). CONCLUSÕES: O TVM6 mostrou-se seguro e teve boa reprodutibilidade nessa amostra de idosos hospitalizados. A terceira aferição parece corresponder à velocidade máxima, já que duas primeiras subestimaram o desempenho real.

Existe associação entre massa e força muscular esquelética em idosos hospitalizados? / Is there is an association between mass and skeletal muscle strength in hospitalized elderly persons?

Resumo Introdução: Massa e força muscular esquelética são variáveis que contribuem para o diagnóstico de sarcopenia. Objetivo: Avaliar a associação entre força e massa muscular esquelética em idosos hospitalizados. Método: Estudo transversal, realizado em hospital privado na cidade de Salvador-BA. Foram incluídos idosos ≥60 anos, entre o 1o e o 5o dia de internação hospitalar e que estivessem sem sedação e/ou drogas vasoativas. A massa muscular foi obtida por meio de equação antropométrica e a variável força por meio da força de preensão palmar. Fraqueza muscular foi identificada se <20 kgf para mulheres e <30 kgf para homens e a massa muscular reduzida quando o índice de massa muscular foi ≤8,9 kg/m2 para homens e ≤6,37 kg/m2 para mulheres. A correlação de Pearson foi utilizada para avaliar a relação entre massa e força e a acurácia para avaliar a capacidade da massa predizer força. Resultados: Entre os 110 idosos avaliados, houve moderada correlação entre massa e força (R=0,691; p=0,001). Entretanto, a acurácia foi fraca da massa para predizer força muscular (acurácia=0,30; IC 95% = 0,19-0,41; p=0,001). Os idosos com fraqueza eram mais velhos que os sem fraqueza, sem diferença nas outras variáveis. Conclusão: Existe uma relação linear entre massa e força muscular esquelética, porém a massa não prediz força, o que sugere que as duas medidas continuem sendo realizadas de forma independente.

Abstract Introduction: The variables mass and skeletal muscle strength contribute to the diagnosis of sarcopenia. Objective: To evaluate the association between strength and skeletal muscle mass in hospitalized elderly persons. Method: A cross-sectional study was carried out in a private hospital in the city of Salvador in Bahia. The study included individuals ≥60 years during their first and fifth day of hospitalization and who were neither sedated nor had taken vasoactive drugs. Muscle mass was calculated using an anthropometric equation and force was measured through handgrip strength. Muscle weakness was identified as <20 kgf for women and <30 kgf for men, and reduced muscle mass was when the muscle mass index was ≤8.9 kg/m2 for men and ≤6.37 kg/m2 for women. The Pearson correlation was used to evaluate the relationship between mass and strength and the accuracy of using mass to predict strength. Results: In 110 patients included, there was a moderate correlation between mass and strength (R=0.691; p=0.001). However, the accuracy of using mass to predict muscle strength was low (accuracy=0.30; CI 95% = 0.19-0.41; p=0.001). The elderly patients with muscle weakness were older than those without muscle weakness, with no differences between the other variables. Conclusion: There is a linear relation between skeletal muscle mass and strength, but mass did not predict strength, which suggests that the two measures continue to perform independently.

Viability of gait speed test in hospitalized elderly patients / Viabilidade do teste de velocidade de marcha em idosos hospitalizados

ABSTRACT Objective: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. Methods: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = −0.27 to 0.15). Conclusions: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance.

RESUMO Objetivo: O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis metros (TVM6) em idosos hospitalizados. Métodos: Estudo com medidas repetidas envolvendo idosos hospitalizados (idade ≥ 60 anos) que realizaram o TVM6 até o quinto dia de hospitalização, sendo capazes de andar sem auxílio e não apresentando dispneia ou dor que os incapacitasse para a realização dos testes. O TVM6 foi realizado sequencialmente três vezes, com período de descanso, em um corredor plano, e a velocidade de marcha foi calculada em metros/segundo. A reprodutibilidade foi avaliada pela comparação das médias, coeficientes de correlação intraclasse (CCI) e disposições gráficas de Bland-Altman. Resultados: Foram avaliados 110 idosos avaliados com um total de 330 testes. Todos os participantes completaram todos os testes. As comparações entre as velocidades obtidas nos três testes realizados indicaram CCIs elevados e viés médio baixo pela disposição gráfica de Bland-Altman. Em relação à maior velocidade aferida, a correlação e a precisão foram maiores quando comparadas à obtida no terceiro teste (1,26 ± 0,44 m/s vs. 1,22 ± 0,44 m/s; CCI = 0,99; p = 0,001; viés médio = 0,04; e limites de concordância = −0,27 a 0,15). Conclusões: O TVM6 mostrou-se seguro e teve boa reprodutibilidade nessa amostra de idosos hospitalizados. A terceira aferição parece corresponder à velocidade máxima, já que duas primeiras subestimaram o desempenho real.

Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients.

OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.

Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients

OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients. .