What's needed is EXACT PROTOCOLS that deliver walking independence! NOT THIS USELESS CRAPOLA! You're fired!
Utility of the Short Physical Performance Battery for Determining Walking Independence in Patients With Stroke
Abstract
Introduction
The Short Physical Performance Battery (SPPB) is a functional assessment tool comprising three components: balance, gait, and muscle strength. It is easier to administer than the Berg Balance Scale (BBS), which has been used to determine walking independence. However, the cutoff value of the SPPB for determining walking independence in patients with stroke remains unknown. Therefore, this study aimed to compare the utility and cutoff values of the SPPB and BBS for determining walking independence in patients with stroke.
Methods
A total of 301 patients with stroke (mean age: 71.8±12.3 years) who were admitted to the convalescent rehabilitation ward of our center between July 2021 and June 2024 were included in this study. The SPPB, BBS, Stroke Impairment Assessment Set (SIAS), Mini-Mental State Examination (MMSE), and Functional Ambulation Categories (FAC) were administered at discharge. Walking independence was defined as FAC ≥4, and non-independence was defined as FAC ≤3. Logistic regression analysis was performed to examine the relationship between walking independence and the SPPB and BBS, with adjustments for age, sex, body mass index, days since onset, history of stroke, SIAS, and MMSE as covariates. The cutoff values of the SPPB and BBS for determining walking independence were calculated by receiver operating characteristic curve analysis, and the areas under the curve (AUC) for both measures were compared. The significance level was set at 0.05.
Results
Of the 301 patients, 184 were classified as walking independent, and 117 were classified as non-independent. The SPPB (odds ratio (OR)=2.15; 95% confidence interval (CI): 1.69-2.73) and BBS (OR=1.14; 95% CI: 1.25-1.56) were significantly associated with walking independence at discharge (p<0.001). The cutoff values for walking independence were ≥10 points for the SPPB (AUC: 0.948, sensitivity: 0.940, and specificity: 0.855) and ≥49 points for the BBS (AUC: 0.945, sensitivity: 0.967, and specificity: 0.821), without significant difference in AUC.
Conclusions
The SPPB demonstrated high discriminative accuracy comparable to the BBS, indicating its usefulness as a simple and practical evaluation tool.
Introduction
Given that previous studies have reported that approximately 75-90% of patients with stroke regain independent ambulation [1], achieving walking independence represents a key goal of stroke rehabilitation. Determining walking independence is primarily based on physical assessments of balance, gait, and muscle strength. The Berg Balance Scale (BBS) has been widely used to assess fall risk and determine walking independence [2-6]. The BBS focuses on balance function and is a reliable assessment tool [7,8]. However, it is time-consuming and cannot capture multiple aspects of physical function, such as walking speed and muscle strength.
The Short Physical Performance Battery (SPPB) is a comprehensive measure of physical function consisting of three components: balance, gait, and standing up. It is characterized by its simplicity and short time to perform [9,10]. The SPPB has been used as a screening tool for assessing physical function in older adults, such as predicting the risks of falls and diagnosing sarcopenia and frailty [11-16]. However, no reliable cutoff value of the SPPB for walking independence, particularly in patients with stroke, has been identified, and no international guidelines have been established in this regard. Patients with stroke exhibit highly individualized functional impairments, such as motor paralysis, sensory deficits, and balance impairments [17-19]. Therefore, more appropriate indicators are needed to accurately evaluate walking independence. The SPPB includes gait and muscle strength assessments in addition to balance assessments, thereby having the potential to provide a comprehensive perspective on gait independence. Additionally, the SPPB requires less time and fewer resources than the BBS, making it potentially more feasible for clinical application.
This study aimed to compare the usefulness of the SPPB and the BBS for determining walking independence in patients with stroke and investigate the cutoff value of the SPPB. The findings of this study can help determine whether the SPPB is an alternative or complementary assessment tool to the BBS. Additionally, the findings may contribute to determining walking independence and improving rehabilitation planning for patients with stroke.
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