The Relationship Between Performance of Sit-To-Stand From a Chair and Getting Down and Up From the Floor in Community-Dwelling Older Adults.

BACKGROUND AND PURPOSE: The ability to perform sit-to-stand from a chair and getting down and up from the floor, or the ability to safely perform a floor transfer are important transitional activities for independent living. The sit-to-stand maneuver is frequently performed by community-dwelling older adults and is routinely evaluated as a part of geriatric physical therapy assessment. Conversely, a floor transfer is rarely performed by older adults or addressed by clinicians, even when working with frail patients who live alone and are at high risk for falls. Accordingly, the specific aim of this cross-sectional study was to determine the concurrent, predictive, and discriminant validity of the five times sit-to-stand (5xSTS) test against 3-point floor transfer performance. METHODS: A total of 46 community-dwelling adults, ages 65-96 years, were recruited using a stratified sampling technique based on self-reported levels of floor transfer ability: independent (n = 16); assisted (n = 15); and dependent (n = 15). Forty-five of the 46 participated in the data collection process. Participants were first assessed for the 5xSTS test and were categorized based on performance as unable to perform (n = 14), poor performance (>13.6 seconds), or good performance (≤13.6 seconds). Participants then performed the 3-point floor transfer test and were classified based on results as independent (n = 18), assisted (n = 10), or dependent (n = 17). Spearman correlations were calculated to assess the concurrent validity for the 5xSTS testing procedure against 3-point floor transfer performance. The Kruskal-Wallis test was used to: 1) determine the discriminant validity of 5xSTS test outcome performance among groups that differ in 3-point floor transfer test performance; and 2) examine the significance level of the socio-demographic data. RESULTS: Moderate to strong positive correlations were found between the 3-point floor transfer test and the categorical performance outcomes of the 5xSTS test (rho ranged from 0.67 to 0.88, p < .001). A strong negative correlation was found between 5xSTS scores and the 3-point floor transfer test (rho = 0.86, p < .001). There was moderate sensitivity (71%) and strong specificity (93%) for the 5xSTS test to predict floor transfer performance. The outcomes of 5xSTS performance differed significantly among 3-point floor transfer performance outcome groups. Older adults who were unable to perform 5xSTS test were also dependent in floor transfer performance. In contrast, older adults who demonstrated good performance in the 5xSTS test were independent in floor transfer performance (p ≤ 0.012). CONCLUSION: Floor transfer is a highly important safety maneuver for older adults, although it is rarely performed and assessed. This study documents that the 5xSTS test displays concurrent, predictive, and discriminative validity properties, making it a potentially useful initial screening tool to predict floor transfer ability. Failure to complete the 5xSTS test may also be a reliable indicator of floor transfer performance dependency among community-dwelling older adults.

Characteristics of Older Adults Who Are Unable to Perform a Floor Transfer: Considerations for Clinical Decision-Making.

BACKGROUND AND PURPOSE: The ability to get down to and up from the floor or to perform a floor transfer (FT) is a vital and useful skill for older adults at risk of falling. Little is known about the health-related factors that separate older adults who can perform FT independently from those who cannot. Therefore, the specific aims of this cross-sectional study are to (1) describe and compare health-related factors among older adults who were independent, assisted, or dependent in FT performance; and (2) establish the parallel reliability between self-reported and actual performance of FT. METHODS: A total of 46 community-dwelling adults ages 65 to 96 years were recruited using a stratified sampling technique based on self-reported levels of FT ability: independent (n = 15), assisted (n = 15), or dependent (n = 15). Participants were asked to perform the actual FT test and were categorized according to test result as independent (n = 18), assisted (n = 10), or dependent (n = 17). Sociodemographic and health-related factors of participants were separated into the 3 FT test outcome groups. The Kruskal-Wallis test was used to compare these factors across the 3 FT test outcome groups. The quadratic-weighted κ coefficient was calculated to determine the agreement between self-reported FT ability and FT test performance. RESULTS: Significant differences were observed among the FT test outcome groups based on all sociodemographic and health-related factors (P < .05). Older adults who were dependent in FT were older and dependent in instrumental activities of daily living (IADL, 100%). Also, this group required some type of help during basic activities of daily living (ADL, 35.3%), which reflected a homebound status and the need for caregiver support, including the use of 2-handed assistive devices during ambulation. More than half the participants in this category had fallen at least once in the past 6 months. Conversely, older adults who were independent in FT were younger and living independently in the community (83.3%). The parallel reliability between the self-reported FT ability and actual FT test performance was 0.92 (95% confidence interval, 0.88-0.97). CONCLUSION: Sociodemographic and health-related factors were significantly different among older adults who demonstrated varying abilities on the FT test. This study has shown that the self-reported FT ability and actual FT test performance represented reliable alternative forms to assess the ability to transfer from a standing to a supine position on the floor and then back to an erect position. Evaluation of FT ability and/or performance is recommended as a standard component of geriatric functional assessment to make more informed clinical decision in providing effective physical therapy interventions.

Reliability and Validity of the Floor Transfer Test as a Measure of Readiness for Independent Living Among Older Adults.

BACKGROUND AND PURPOSE: The ability to get up from the floor after a fall is a basic skill required for functional independence. Consequently, the inability to safely get down to and up from the floor or to perform a floor transfer (FT) may indicate decreased mobility and/or increased frailty. A reliable and valid test of FT ability is a critical part of the clinical decision-making process. The FT test is a simple, performance-based test that can be administered quickly and easily to determine a patient's ability to safely and successfully get down and up from the floor using any movement strategy and without time restriction. The primary purpose of this cross-sectional study was to determine the intrarater reliability and validity of the FT test as a practical alternative to several widely used yet time-consuming measures of physical disability, frailty, and functional mobility. METHODS: A total of 61 community-dwelling older adults (65-96 years of age) participated in the study, divided into 2 separate subsamples: intrarater reliability was studied with 15 participants, while concurrent validity was studied with the remaining 46 participants. In both subsamples, the participants were stratified on the basis of the self-reported levels of FT ability as independent, assisted, and dependent. Intrarater reliability was assessed on 2 separate occasions and scores were analyzed by intraclass correlation coefficient and κ statistics. Concurrent validity of the FT test was assessed against the self-reported FT ability questionnaire, Physical Functioning Scale, Phenotype of Physical Frailty, and the Short Physical Performance Battery. Known-groups validity was tested by determining whether the FT test distinguished between (1) community-dwelling older adults with physical disabilities versus those without physical disabilities; and (2) community-dwelling older adults who were functionally dependent versus those who were independent. Participants were also categorized on the basis of FT test outcome as independent, assisted, or dependent. The Spearman correlation coefficients were calculated to examine the strength of the relationships between the FT test and physical status measures. The Kruskal-Wallis test was used to determine whether the FT test significantly discriminated between groups as categorized by the Physical Functioning Scale and Short Physical Performance Battery, and to examine the significance level of the sociodemographic data across the 3 FT test outcome groups. RESULTS: The intrarater reliabilities of the measures were good (0.73-1.00). There were statistically positive and strong correlations between the FT test and all physical status measures (ρ ranged from 0.86 to 0.93, P < .001). Older adults who passed the FT test were collectively categorized as those without physical disabilities and functionally independent, whereas older adults who failed the FT test were categorized as those with physical disabilities and functionally dependent (P < .001). CONCLUSION: The FT test is a reliable and valid measure for screening for physical disability, frailty, and functional mobility. It can determine which older adults have physical disabilities and/or functional dependence and hence may be useful in assessing readiness for independent living. Inclusion of the FT test at initial evaluation may reveal the presence of these conditions and address the safety of older adults in the community.

A daily adjustable progressive resistance exercise protocol and functional training to increase quadriceps muscle strength and functional performance in an elderly homebound patient following a total knee arthroplasty.

BACKGROUND AND PURPOSE: There is no routinely prescribed protocol to address quadriceps weakness and functional impairments following a total knee arthroplasty (TKA). The purpose of this case report is to introduce and describe the early use of a daily adjustable progressive resistance exercise (DAPRE) protocol as an adjunct to standard rehabilitation to maximize quadriceps muscle strength and functional performance in an elderly homebound patient following a TKA. CASE DESCRIPTION: A 61-year-old female was referred to home care physical therapy for 6 weeks following left TKA due to functional deficits and inability to activate the weak left quadriceps muscle. In phase I, the patient received three visits with emphasis on edema management, improving left knee range of motion, and reducing pain. Phase II consisted of two main components: (1) a DAPRE protocol aimed at maximizing the quadriceps strength and (2) functional training aimed at improving normal gait patterns, transfers, and dynamic balance. OUTCOMES: The patient made substantial improvements in both quadriceps muscle strength and functional performance in the first seven weeks following the TKA. The patient had a pain free return to daily living activities. DISCUSSION: The results suggest that early initiation of a DAPRE protocol was free of adverse events and improved quadriceps strength and functional performance for this patient.