Functional Performance Testing in Physical Therapy

Functional Performance Testing

An assessment method used to evaluate an individual's ability to perform daily activities and tasks, often revealing the relationship between strength and functional ability.

Why test functional performance

Allows us to test pt abilities for functional activities

Muscle weakness related to decreased function and falls

Functional performance testing shows the relationship between strength and function

Strength decreases at a rate of 10% per decade starting at age 30, accelerating to 15% per decade after age 60

Power decreases very rapidly with aging - at a rate of 20-30% per decade

Traditional MMT may not be sensitive enough to detect frailty in older individuals, nor does it accurately represent functional ability

To assist PT's in setting goals that will have long range health benefits and reduce or prevent mobility disability - PT's must be aware of how to test, and interpret these tests of functional mobility/performance

Third party payers require us to use functional tests to receive payment and approval for PT services

Power decreases very rapidly with aging - at a rate of

20-30% per decade

Strength decreases at a rate of

10% per decade starting at age 30, accelerating to 15% per decade after age 60

Functional Threshold

The minimum amount of strength required to perform a specific activity effectively.

Functional performance and ICF Model

mainly is in the activity section of the ICF model

ADLs

Activities of daily living that include essential tasks such as dressing, eating, bathing, transferring, and walking.

Tasks of mobility

Sit to stand

Climbing stairs

Lifting

Writing

Rising from the floor

Bed mobility key muscles

Abdominals, erector spinae, gluteus medius

Transfers and squats muscles

Gluteus maximus, medius, and obturator externus, piriformis, quadriceps

Ambulation and stair climbing muscles

Abdominals, erector spinae, gluteus maximus and medius, obturator externus, piriformis, quadriceps

Floor transfer muscles

Abdominals, erector spinae, gluteus maximus and medius, obturator externus, piriformis, quadricep and gastrocnemius

Fast gait muscles

Gastrocsoleus, gluteus maximus and medius, quadriceps

Reliability

The degree to which a measurement consistently produces the same results under the same conditions.

Validity

The extent to which a test accurately measures what it is intended to measure and provides meaningful information.

Intrarater Reliability

The consistency of scores assigned by the same rater across multiple assessments.

Interrater Reliability

The degree of agreement among different raters assessing the same subject.

Test-Retest Reliability

The consistency of a subject's performance on the same test over time.

Intrasubject reliability

How consistently a subject performs over time

Sensitivity

The ability of a test to correctly identify individuals with a condition, reflecting true positive results.

Specificity

The ability of a test to correctly identify individuals without a condition, reflecting true negative results.

Construct Validity

The degree to which a test accurately measures the theoretical construct it is intended to assess.

Content Validity

The extent to which a test covers the complete range of the construct being measured.

Criterion Validity

The degree to which a test correlates with a specific outcome, including concurrent and predictive validity.

concurrent validity

The extent to which a new test or measure is related to an established or standard test or measure

predictive validity

The extent to which a test or measure is able to predict future function or performance

Responsiveness

how well a test detects a change

Responsiveness

The ability of a test to detect meaningful changes in a subject's performance over time.

Minimal Detectable Change (MDC)

The smallest amount of change in a measurement that exceeds the measurement error of the instrument, indicating a true change in performance.

Minimal Clinical Important Difference (MCID)

The smallest difference in a measured variable that indicates a significant change in a patient's condition, surpassing trivial differences.

Power

The ability to exert force quickly, which decreases significantly with aging, at a rate of 20-30% per decade.

Key Muscles for Functional Movement

Muscle groups essential for performing daily activities, including hip, trunk, calf, and back muscles.

Measurement Error

The degree of inaccuracy in a measurement, which must be exceeded by the MCID to ensure the difference is meaningful.

Functional performance tests

Chair stand

5x sit to stand

30 sec sit to stand

Gait speed

Timed up and Go

Stair climb

Floor Rise

Grip Strength

Chair Stand Test

An assessment of a patient's ability to stand up from a seated position without using their arms, indicating lower body strength and balance.

5x Sit to Stand Test (5T-STS)

A test where a patient stands up and sits down five times as quickly as possible, measuring mobility and functional strength.

30 Second Sit to Stand Test (30s STS)

A test where a patient stands up from a seated position as many times as possible in 30 seconds, assessing lower extremity strength and endurance.

Gait Speed

The speed at which a person walks, often used as an indicator of functional mobility and overall health.

Timed Up and Go (TUG) Test

A test that measures the time taken for a patient to stand up from a chair, walk a short distance, turn around, walk back, and sit down, assessing mobility and fall risk.

Stair Climb Test

An assessment of a patient's ability to ascend and descend stairs, indicating lower body strength and balance.

Floor Rise Test

A test that evaluates a person's ability to get up from the floor, reflecting functional strength and mobility.

Grip Strength

A measure of hand and forearm strength, often assessed using a dynamometer, indicating overall muscle strength and function.

Chair stand purpose

Look at pt's ability to stand without use of the arms

Chair stand reliability

0.89

5t STS norms

8 s

5t- sts score >10 secs

Predictive of a future mobility disability

5T- STS Score > 15 secs

Fall risk community dwelling older adult

30s STS correlates with

LE strength, walking speed, stair-climbing ability and balance as well as 1 rep max for leg press

5t sts cutoff

15s

equipment for chair stand test

standard chair (17''), stopwatch

5t STS pt position

sit with arms folded across their chest and with their back against the chair.

5T STS Time

Time starts when the tester says "Go."

Time stops when the patient's body touches the chair following the fifth repetition.

30 sts starts when

Pt begins to move

30 s sts norm

9-17

If patient cannot complete one repetition without the use of the arms, the score for the 30 sec STS =

0

5 times sit to stand MCID

23 seconds

5 times sit to stand Cutoff

balance dysfunction or if greater than 60 years old: >13 seconds, If less than 60 years old <10 seconds

6th vital sign

gait speed

Self selected walking speed correlates with

functional ability and balance confidence

Almost perfect measure

Gait speed

Gait speed reliability

0.78 to 0.9

Gait speed validity is related to

Normal walking speed

1.2-1.4 m/sec

Meaningful improvement in walking speed

Increase by minimum of 0.05 m/s

meaningful improvement and useful predictor of well-being of gait speed

Increase by 0.1 m/sec in patients with gait impairments

Gait speed cut off score for healthy older adults

<0.7 increased risk for adverse events

Gait speed MDC

0.05 m/s

Parkinsons Gait MDC

.18 COMFY

.25 FAST

MS Gait speed MDC

.26

Acute stroke mdc comfy

.11

chronic stroke gait speed mdc comfy

0.18

MDC chronic stroke fast

0.13

MCID subacute stroke gait speed

0.16

SCI MDC gait speed

0.13

Gait speed mcid

0.1 m/s

10 Meter Walk Test

A test that measures walking speed over a distance of 10 meters, often used to assess mobility and functional ability. Test both comfortable speed and fast walking speed.

20 Meter Walk Test

An assessment that measures walking speed over a distance of 20 meters, including acceleration and deceleration phases.

Sensitivity and Specificity

Measures of a test's accuracy; sensitivity refers to the test's ability to correctly identify those with a condition, while specificity refers to correctly identifying those without the condition.

gait speed cut offs stroke

>0.7=community ambulator

0.4-0.8=limited community ambulator

<04.=household ambulator

Dynamic Balance

The ability to maintain stability while in motion, crucial for activities such as walking and turning.

Community Ambulator

An individual who can walk independently in community settings, typically at a speed of 1.8-2.7 mph.

Household Ambulator

A person who can only walk within their home environment, usually at a speed of less than 0.4 m/s.

Limited Community Ambulator

An individual who can walk in the community but at a slower pace, typically between 0.4-0.8 m/s.

Cross street and normal WS

1.2-1.4 m/s (2.7mph+)

More likely to be hospitalized

0-0.6 m/s

Less likely to be hospitalized

1 m/s+

Dependent in ADL and IADLs

0-0.6 m/s

Independent in ADLs

1 m/s+

Need interventions to reduce fall risk

0-1 m/s

Less likely to have and adverse event

1m/s+

10 M walk time

Mark at 0, 2,8 and 10

Time starts a 2 and ands at 8, (test 6 meters)

20 m walk time

5 m acceleration→10 m walk→5m deceleration

Walking speed = 10m/sec

TUG purpose

assess mobility, balance, walking ability, and fall risk in older adults

quick measure of dynamic balance and mobility (< 5 min)

TUG procedure

Standing up from a chair→walking→turning around→sitting back down

TUG Reliability

ICC = 0.99; re-test reliability = 0.99

Average TUG Time

8s

Tug cutoff

13.5 seconds(14)

TUG >20 sec

impaired mobility

TUG >30 seconds

dependency in most adls

60-69 Tug mean

8.1