Physical function in older adults with MS: An application of the Short Physical Perform ance Battery Robert W. Motl, Gioella Chaparro, Manuel E. Hernandez, Julia M. Balto, Brian M. Sandroff Greying of MS • Prevalence: 32% between 55-64 years; 14% over 65 years; peak prevalence is 55- 59 years. • Interaction: Intersection of aging and chronic, progressive disease. • Consequences: Self-reported loss of physical functioning and lim itations with ADLs.
Short Physical Perform ance Battery (SPPB) • Objective m easure of lower extrem ity physical functioning in older adults. • Three com ponents: Balance, gait speed, and lower extrem ity strength. • Predictive of nursing hom e adm ission, m obility im pairm ent, disability, and m ortality. • Best m easure perform ance-based m easure of physical function in older adults. SPPB in MS: Recent Validation • Purpose: Construct validity of SPPB scores in older adults with MS. • Sam ple: 44 older adults with MS. • Method: SPPB plus walking speed and endurance (lower extrem ity) and grip and bicep strength (upper extrem ity). • Results: Strong correlations between SPPB and lower extrem ity function ( r p >.8 0 ), and weak correlations with upper extrem ity function ( r p <.30 ). • Meaning: SPPB scores represent a m easure of lower extrem ity function in older adult with MS. M otl et al., BM C Geriatrics, 2015, 15, 157
Present Study • Purpose: We exam ined physical function using the SPPB in a com m unity-dwelling sam ple of older adults with MS com pared with controls who were m atched on age and sex. • Hypotheses: (1) older adults with MS would have worse overall physical function on the SPPB than older adults without MS and (2) older adults with MS would have worse perform ance on the balance, gait speed, and lower extrem ity strength com ponents on the SPPB Sam ple • MS inclusion criteria: (a) definite diagnosis of MS confirm ed in writing by neurologist; (b) relapse free in the last 30 days; (c) am bulatory with or without assistance (i.e., walk independently or walk with a cane/ rollator) based on EDSS scores of 6.5 or less; and (h) m TICS score above 21 (i.e., no m ajor cognitive im pairm ent). • Non-MS inclusion criteria: (a) m atched a subject with MS on age and sex and (b) m TICS score above 21. • Screening: Screened 34 persons with MS and 23 persons without MS • Enrollm ent: 20 older adults with MS and 20 older adults without MS.
SPPB • Standing balance: Maintain upright posture while standing with feet in side-by-side, sem i-tandem , and tandem positions for up to 10 sec per position. • Gait speed: Tim e taken by a participant to walk a 4- m eter course at a norm al pace. • Lower extrem ity strength: Chair stand test in which participants were instructed to sit in and fully rise from a chair 5 tim es as quickly as possible, without using arm s for support. • Scoring: (a) Categorical score ranging from 0 (inability to com plete a test) through 4 (highest level of perform ance) using standardized scoring, and (b) sum m ary ranging between 0 and 12 by sum m ing the com ponent categorical scores. Procedure • IRB approval and written ICD • Single session in a laboratory setting • Neurological exam for EDSS • Height and weight • SPPB • Dem ographic survey for age, sex, and education
Analysis • SPSS Statistics, Version 22 • Descriptive statistics as m ean (SD). • Independent sam ples t -tests for com paring SPPB overall and com ponent scores between groups. – Cohen’s d as an effect size estim ate. • Distribution of scores using frequency analyses, and com pared the frequency of cases with an SPPB score of 10 or below using chi-square statistic. • Pearson ( r p ) and Spearm an rho rank-order ( r s ) correlations (a) between SPPB scores and com ponent scores for the overall and separate sam ples, and (b) between EDSS and SPPB scores for the older MS sam ple. Results: Sam ple Characteristics
Results: SPPB Com parison b/ w Sam ples Results: SPPB Com ponent Frequencies
Results: Overall SPPB Scores per Sam ple Disability Risk • Only 2 older adults without MS had SPPB scores below 10 (i.e., 10 %), whereas 8 older adults with MS had SPPB scores below 10 (i.e., 40 %) • Significant, 4-fold difference in future risk for disability ( χ 2 =4.8 0 , df =1, N =40 , p =.0 28 )
Results: Com ponents Correlate with Overall Score Results: EDSS and SPPB • EDDS scores strongly correlate with overall SPPB scores ( r p =– .721, r s =– .717) • Strong correlations between EDSS scores and the com ponent scores: – Balance ( r p =– .734, r s =– .78 1) – Gait speed ( r p =– .58 6, r s =– .628 ) – Lower extrem ity strength ( r p =– .60 3, r s =– .623)
Discussion 1 st direct com parison of objectively m easured physical • function between older adults with MS and m atched controls. Prim ary results : • – Older adults with MS had worse physical function overall and on the SPPB com ponents of balance and gait speed, with a m oderate, nearly significant difference in lower extrem ity strength. – 40 % of older adults with MS had an overall SPPB score of less than 10 , and this portended a 4-fold increase in future disability com pared with older adults without MS. – Older adults with worse MS disability based on EDSS scores further had worse physical function overall and based on the com ponents of balance, gait speed, and lower extrem ity strength. Discussion
Prim ary Lim itations • Sam ple size was relatively sm all • Sam ple did not present with cognitive dysfunction, based on m TICS scores as a general screener • We collected cross-sectional data without broad consideration of outcom es other that neurological disability based on EDSS Conclusions: We Should Intervene! • Our results present a picture of deteriorated physical function in older adults with MS that portends considerable risk for future disability. • This lower level of physical functioning is associated with lower extrem ity weakness as well as reduced balance and gait speed. • We should consider developing interventions that target the consequences of aging with MS
Acknowledgem ents • Participants! • Undergraduate students, graduate students, post-doctoral fellows, & colleagues. Thank you and questions
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