title: Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis.
abstract: BACKGROUND
  The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality.
  
  
  METHODS
  Articles were searched in MEDLINE, the Cochrane Library, Google Scholar, and BioMed Central between July and September 2015 and updated in January 2016. Inclusion criteria were observational studies; >50 participants; stratification of population according to SPPB value; data on all-cause mortality; English language publications. Twenty-four articles were selected from available evidence. Data of interest (i.e., clinical characteristics, information after stratification of the sample into four SPPB groups [0-3, 4-6, 7-9, 10-12]) were retrieved from the articles and/or obtained by the study authors. The odds ratio (OR) and/or hazard ratio (HR) was obtained for all-cause mortality according to SPPB category (with SPPB scores 10-12 considered as reference) with adjustment for age, sex, and body mass index.
  
  
  RESULTS
  Standardized data were obtained for 17 studies (n = 16,534, mean age 76 ± 3 years). As compared to SPPB scores 10-12, values of 0-3 (OR 3.25, 95%CI 2.86-3.79), 4-6 (OR 2.14, 95%CI 1.92-2.39), and 7-9 (OR 1.50, 95%CI 1.32-1.71) were each associated with an increased risk of all-cause mortality. The association between poor performance on SPPB and all-cause mortality remained highly consistent independent of follow-up length, subsets of participants, geographic area, and age of the population. Random effects meta-regression showed that OR for all-cause mortality with SPPB values 7-9 was higher in the younger population, diabetics, and men.
  
  
  CONCLUSIONS
  An SPPB score lower than 10 is predictive of all-cause mortality. The systematic implementation of the SPPB in clinical practice settings may provide useful prognostic information about the risk of all-cause mortality. Moreover, the SPPB could be used as a surrogate endpoint of all-cause mortality in trials needing to quantify benefit and health improvements of specific treatments or rehabilitation programs. The study protocol was published on PROSPERO (CRD42015024916).
authors.affiliation: Cardiology Unit, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro, 8, 44124, Ferrara, Italy. pvsrti@unife.it.
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authors.affiliation: Cardiology Unit, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro, 8, 44124, Ferrara, Italy.|Maria Cecilia Hospital, GVM Care & Research, E.S.: Health Science Foundation, Cotignola, Italy.
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authors.affiliation: Cardiology Unit, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro, 8, 44124, Ferrara, Italy.
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mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D035002:Lower Extremity / Q000502:physiology*; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment
keywords: All-cause mortality; Meta-analysis; Physical function; Short Physical Performance Battery