title: Feasibility and inter-rater reliability of physical performance measures in acutely admitted older medical patients.
abstract: OBJECTIVE
  Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliability of four simple measures of physical performance in acutely admitted older medical patients.
  
  
  METHODS
  During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4-meter gait speed, 30-s chair stand and Cumulated Ambulation Score. Relative reliability was expressed as weighted kappa for the Cumulated Ambulation Score or as intra-class correlation coefficient (ICC1,1) and lower limit of the 95%-confidence interval (LL95%) for grip strength, gait speed, and 30-s chair stand. Absolute reliability was expressed as the standard error of measurement and the smallest real difference as a percentage of their respective means (SEM% and SRD%).
  
  
  RESULTS
  The primary reasons for admission of the 52 included patients were infectious disease and cardiovascular illness. The mean± SD age was 78±8.3 years, and 73.1% were women. All patients performed grip strength and Cumulated Ambulation Score testing, 81% performed the gait speed test, and 54% completed the 30-s chair stand test (46% were unable to rise without using the armrests). No systematic bias was found between first and second tests or between raters. The weighted kappa for the Cumulated Ambulation Score was 0.76 (0.60-0.92). The ICC1,1 values were as follows: grip strength, 0.95 (LL95% 0.92); gait speed, 0.92 (LL95% 0.73), and 30-s chair stand, 0.82 (LL95% 0.67). The SEM% values for grip strength, gait speed, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%.
  
  
  CONCLUSIONS
  In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different raters. The feasibility and inter-rater reliability of the 30-s chair stand were moderate, complicating the use of the 30-s chair stand in acutely admitted older medical patients. However, the predefined modified version of the chair stand test was both feasible and with high inter-rater reliability in this population.
authors.affiliation: Optimized Senior Patient Program, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research-Copenhagen; Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Ann Christine
authors.initials: AC
authors.lastname: Bodilsen
authors.affiliation: Optimized Senior Patient Program, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Helle Gybel
authors.initials: HG
authors.lastname: Juul-Larsen
authors.affiliation: Optimized Senior Patient Program, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Janne
authors.initials: J
authors.lastname: Petersen
authors.affiliation: Musculoskeletal Rehabilitation Research Unit, Department of Physical Therapy & Institute of Sports Medicine, Bispebjerg & Frederiksberg Hospitals, University of Copenhagen, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: Beyer
authors.affiliation: Optimized Senior Patient Program, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Ove
authors.initials: O
authors.lastname: Andersen
authors.affiliation: Optimized Senior Patient Program, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research-Copenhagen; Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bandholm
mesh_terms: D000368:Aged; D005260:Female; D005684:Gait / Q000502:physiology; D018737:Hand Strength / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D016138:Walking / Q000502:physiology