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Comparison of the Tinetti and Short Physical Performance Battery test specificities for detecting neuromotor pathologies. Abstract: Introduction: Increasing elderly populations require specific and accurate health assessment tools. Purpose: To compare the specificities of the short physical performance battery SPPB and the Tinetti Index validated in Brazil in patients with and without neuromotor dysfunctions.

Materials and methods: Thirty-nine individuals 19 healthy and 20 with neuromotor changes of both sexes aged 60—75 years, living in Coari Amazonas state in Brazil , underwent SPPB and Tinetti scale assessments on alternate dates. Results and discussion: We observed significant differences between the scales, where the distribution was very concentrated after the Tinetti assessment and more dispersed after the SPPB in healthy individuals.

This demonstrated that SPPB can detect minimal differences in gait and balance between healthy individuals, while the Tinetti scale is better at discriminating between healthy and those affected by mobility disorders. Keywords: Gait, Postural Balance, Aged. Descritores: Marcha. Human aging generates progressive morphological, physiological, biochemical and psychological changes that are part of the normal life cycle and are associated with the emergence of chronic degenerative diseases that may accelerate the functional decline of elderly individuals.

Combinations of these factors compromise the performance in the elderly, causing loss of balance, impairment of visual, vestibular, proprioceptive, and somatosensory systems and postural control difficulties 1. Body balance is considered the most affected function during the aging process 1.

Therefore, identifying balance and gait deficits as soon as they are apparent allows for preventive measures to be taken to avoid falls 2. Considering these factors, the interest in objective measures of functional balance has increased since the s, and scales have been devised to measure balance, gait performance, risk of falling, and related variables during rehabilitation sessions.

However, few studies have focused on these criteria, and their results are insufficient to support clinical decisions or to use as diagnostic tools when the functional balance is decreased 3.

Balance is assessed by a variety of tests that involve different protocols and methodologies 4 and can be classified into static, timed, functional, subjective, and observational. Most of these tests have been chosen for their ease and low cost, but little is known about their correlations to each other 4 , 5. Given the importance of body balance evaluation, several instruments for evaluation of postural control have been developed during the search for clinical predictors of the risk of falls in the elderly.

Other evaluation scales and indexes for physical characteristics of the population with balance and gait deficits include the Berg scales, and the Tinetti, Katz and SPPB tests 6.

The scale of Tinetti evaluates specific aspects of gait and balance, assigning a physical capacity score to the individual 6 , it is an established evaluation scale validated in Brazil in , and is thought to be able to detect changes in balance and gait 7. The short physical performance balance — SPPB test has been used on studies about aging, as a practical and effective tool to assess physical performance and to identify risks of future disability in elderly individuals.

The test assesses three aspects of the performance of the lower limbs: muscle strength, gait, and balance fundamental components for quality of life, accepted as universal health status indicators in the elderly 8. The test has been validated in Brazil 6. The SPPB scale proposed by Guralnik 9 has demonstrated validity and reliability for functional capacity ratings and is useful for predicting early deterioration, institutionalization, and death; it shows sensitivity to changes and is applicability in diverse communities.

But whether the SPPB test provides an advantage over the classical scales used in the evaluation of balance and falls that show high reliability indexes and sensitivities such as the Tinetti scale remains to be seen. The purpose of this study was to compare the specificities of the evaluations of healthy elderly individuals with neuromotor pathologies made by the SPPB and Tinetti scales.

We suspected the SPPB scale would be more specific than the Tinetti scale due to greater detail in its application. This was a transversal study in which we selected individuals according to inclusion and exclusion criteria. According to the census, the city has a geographical area of 57, The total population recorded in the census was 75, inhabitants and of this total, 4. The city presented an HDI of 0.

The inclusion factors required individuals to be between 60 and 75 years of age, to be residents of the city of Coari, to be free from uncontrolled chronic diseases e.

We excluded individuals unable to respond to the commands of the tests, those who had suffered fractures in the past two years, and had those who did not attended the data collection event. We conducted a Physiotherapy Clinic at ISB-UFAM as a pre-assessment evaluation to detect neuromotor injury cases across the sample universe with elderly individuals 57 without cerebral injury and 46 with cerebral injury.

After these evaluations, we classified individuals into two distinct groups according to the presence or absence of cerebral injury. A researcher, blinded to the pre-assessment, selected twenty individuals of the group without injury for the S group and 19 individuals with cerebral lesions for the P group.

After assembly of the groups, we applied two functional performance tests validated for the Portuguese language SPPB protocol 6 and Balance Index and Tinetti Gait 7 to each individual.

The SPPB evaluates three balancing positions: with feet together, semi-tandem, and tandem. Participants able to maintain the position with feet together and semi-tandem for 10 seconds are assigned 1 point, those who do not keep the position during this time or refuse to try, are not awarded points; participants able to hold the tandem position for 10 seconds are assigned 2 points; those remaining in position between 3 and 9. The total value of the balancing test is given by the sum of the three positions, with a maximum score 4 points.

Gait velocity is assessed as follows: individuals are asked to walk with their usual step for a distance of 4 meters. Two walks are timed and the score is the time of the shorter walk. The maximum score is 04 points, the lower the speed, the lower the score. The lower limb strength test is performed with individuals sitting and standing up from their chair five times in a row, without using their upper limbs for support.

The maximum score of the lower limbs strength test is 4 points. The scale evaluates all items from a score of 0 worst performance to 12 points best performance. The test result may be graduated: zero to 3 points in cases of very poor performance; points in cases of low performance; points in cases of moderate performance; and points in cases with good performance 6. The Tinetti test evaluates balance and gait abnormalities, it consists of 16 items, where nine are for body balance and seven for the gait.

During the gait evaluation the height and stride length, distance from the step, symmetry and continuity of steps, the ankle distance, and other variables are considered. The score for each exercise varies from , where a lower score indicates a poorer physical ability.

The total score 28 points is the sum of body balance 16 points and gait scores 12 points , the higher scores reflect better individual performances 7. We applied the protocols for each test on alternate days, to avoid test outcome interference due to possible fatigue or muscle pain. We also respected the same place and application times, to eliminate biases from changing climate and environments.

On the first day we started with the Tinetti Index and after 48 hours we applied the validated version for the Portuguese language SPPB. We used descriptive statistics for data processing and analysis. We presented results as averages and standard deviations, or as absolute and percentage values as appropriate.

We used the R Graphis program to further evaluate the data statistically: ANOVA multivariate test for comparison between two variables in the same group and for comparison of the same variable between different groups ; finally, we identified correlations between the gait and balance variables in Tinetti and SPPB tests. The purpose of our research was to compare the specificities of SPPB and Tinetti scales for the evaluation of healthy elderly individuals with neuromotor pathologies.

Table 2 shows the sociodemographic and clinical data of the individuals in the study population. We found no correlation between the items evaluated and the results of the tests. The SPPB test proved more sensitive than the Tinetti test, because it uncovered minimal gait and balance disturbances that were not identified by the Tinetti test Figure 1. We found a correlation between balance, gait, and strength of the lower limbs in the SPPB test and the balance and gait in the Tinetti test, but when the balance results in the SPPB test were compared to those in the Tinetti test, the correlation disappeared, the same applied to the gait evaluation.

The Tinetti test showed more clear differences between individuals with gait disturbances and those without them than the SPPB test, but this last one was able to uncover smaller motor behavior differences Figure 2. Figure 2 Interaction between the strands Authors data. Figure 3 Interaction between the strands Authors data.

Different methods can be used to evaluate the postural balance and identify the nervous system adaptations for maintaining stable postures, which probably do not produce the same effect of sensory disturbance. Other studies have compared the results of balance tests reflecting different proprioceptive disturbances.

However, whether different methods identify similar proprioceptive disorders, allowing for comparisons between groups or experimental conditions is unclear The evidence in the literature suggests the existence of a positive correlation between equilibrium and gait tests, and these are considered complementary to each other, requiring their joint application to evaluate balance in the elderly population 1 , 4 , 11 , 12 , Although the SPPB application time is the highest of all the tests, the reliability of its results was found to be higher than those of all the other tests analyzed Our results showing the higher diagnostic specificity of SPPB than that of the Tinetti test, suggest a clinical advantage with the adoption of the SPPB as a standard clinical evaluation instrument.

The SPPB scale presented more dispersed scores for the two groups than the Tinetti scale, reflecting better resolution of the differences in the physical quality of gait and balance of the groups.

By contrast, the Tinetti scale showed a higher concentration in high scores for the healthy group. Thus, some individuals screened as requiring intervention by the SPPB test, were regarded as normal according to their Tinetti results. After comparing gait and balance questions within the same tests, Nakano found a strong correlation between the scores of the balance and gait domains.

In our study, we found a positive correlation between balance, gait, and lower limb strength according to SPPB results, and between balance and gait according to Tinetti results. When comparing the same variables between different tests, Karuka et al presented a positive correlation between the Berg balance scale BSE scores and those of the Tinetti test.

The reliability of the SPPB scale has been confirmed by studies that showed correlations between pathological situations and the test scores. In this study, the Tinetti scale was able to differentiate well the individuals in the S and P groups higher S score , while the SPPB test presented scattered scores for both groups, and it was impossible to differentiate individuals between the groups based on the test scores alone. However, as the individuals in the P group did not present the same degree of impairment, the SPPB was more specific for detecting performance decreases as evidenced by the gait and balance quality score dispersion.

The SPPB was able to detect small differences in the quality of gait and balance that remained unidentified by the Tinetti test, indicating the greater reliability of the SPPB test for clinical evaluations in similar populations. However, we are aware of its limitations, specially the fact that we carried out the study with a specific population, in a restricted location; and, thus, our results cannot be extrapolated to any population. We found the SPPB to be more specific than the Tinetti test in our population, due to the significant difference in scores obtained between the groups of individuals we found major differences between the results of gait and balance in both groups , with a difference in the physical quality of the individual in gait and balance.

The SPPB test was able to detect smaller differences in gait and balance quality than the Tinetti test. Fhon JRS et al.

Rev Bras Geriatr Geront, ; 18 1 Ansai JH et al. Rev Bras Geriatr Geront, ; 17 1 Rev Bras Geriatr Gerontol, ; 19 6 Nakano MM. Gomes C. Funtional capacity of elderly people living in a long-term care facility: a prospective study.

Rev Bras Geriatr Gerontol, ; 13 2 Guralnik JM, et al. N Engl J Med, ; 9 : Banco de dados: cidades : Amazonas: Coari [documento da internet]. Analysis of agreement of assessment tools of body balance in the elderly.

Rev Bras Fisioter, ; nov. Sousa LMM et al. Enferm Global, ;


Finding a clinical assessment scale - Physical Medicine and Rehabilitation

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Performance Oriented Mobility Assessment

Las alteraciones de la marcha y el equilibrio son los principales factores que las generan, con un rango de valores ajustados de riesgo relativo entre 1. La fiabilidad inter e intraobservador obtuvo un Kappa ponderado de 0. Falls are the fourth most prevalent geriatric syndrome which diminishes body functionality and increases morbidity, mortality, and early admission to nursing homes. Gait and postural balance alterations are the main generating factors with Risk Relative from 1.


Tinetti test

The test is in two short sections that contain one examining static balance abilities in a chair and then standing, and the other gait. It has numerous other names, including Tinetti Gait and Balance Examination , Tinetti's Mobility Test , Tinetti Balance Test , the wide variation in naming, test sections and cut off values sometimes cause confusion. From Wikipedia, the free encyclopedia. Tinetti test Synonyms Performance Oriented Mobility Assessment Purpose assessing a person's static and dynamic balance abilities.

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