title: Coimpairments: strength and balance as predictors of severe walking disability.
abstract: BACKGROUND
  Little information is available on the joint effects of multiple impairments (coimpairments) on the risk of disability. Our aim was to study the joint effects of strength and balance impairments on severe walking disability.
  
  
  METHODS
  The data are from the baseline of the Women's Health and Aging Study (WHAS), a study of moderately to severely disabled women. A total of 1,002 women aged 65 and older participated in the tests, which took place in their homes. Severe walking disability was defined as self-reported inability to walk one-quarter mile and customary walking speed in a 4-meter test of < or =0.4 m/s. Balance was measured as an ability to hold progressively more difficult stands (feet side-by-side, semitandem and tandem stands). Maximal knee extension strength was measured using a hand-held dynamometer.
  
  
  RESULTS
  There were 129 women who were severely walking disabled but able to walk at least minimally. In logistic regression analysis, balance and knee extension strength were independent predictors of severe walking disability. To study the combined effects, nine groups were formed on the basis of strength tertiles by balance categories in the entire population. In the best balance category, the crude prevalences of severe walking disability were 1.2%, 4.9%, and 14.3% in the highest to lowest strength tertiles. In the middle balance category, the rates were 2.9%, 10.0%, and 45.4.1%, and in the poorest balance category 4.9%, 22.1%, and 42.6%, correspondingly. The age, body weight, and height-adjusted odds ratios (OR) showed that the risk of severe walking disability in the subgroup with best balance and strength was less than 5% of the risk in the subgroup with poorest balance and strength (OR .034, 95% confidence interval [CI] .007-.166). Correspondingly, in the subgroups with poorest strength and best balance (OR .097, 95% CI .025-.38) or poorest balance and best strength (OR .102, 95% CI .012-.866) the risk was about 10%. The age-specific estimates of prevalence of severe walking disability in women were: 2.0% for ages 65-74 years, 3.4% for ages 75-84 years, and 9.1% for ages 85 years and older.
  
  
  CONCLUSIONS
  The burden of coimpairments seems to be greater than the sum of single impairments involved. An effective way to reduce severe disabilities could be prevention of coimpairments.
authors.affiliation: Epidemiology, Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA. taina@maila.jyu.fi
authors.forename: T
authors.initials: T
authors.lastname: Rantanen
authors.forename: J M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: L
authors.initials: L
authors.lastname: Ferrucci
authors.forename: S
authors.initials: S
authors.lastname: Leveille
authors.forename: L P
authors.initials: LP
authors.lastname: Fried
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001827:Body Height; D001835:Body Weight; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D005544:Forecasting; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D016015:Logistic Models; D009069:Movement Disorders / Q000503:physiopathology*; D009119:Muscle Contraction / Q000502:physiology*; D016017:Odds Ratio; D011159:Population Surveillance; D004856:Postural Balance / Q000502:physiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016138:Walking / Q000502:physiology*