Functional Assessment Measures

Some common functional assessment measure protocols are listed below as an introductory resource for investigators. More information about particular areas of inquiry may be obtained in consultation with Pepper researchers.

Short Physical Performance Battery (SPPB) | Senior Fitness Test | Timed Up and Go (TUG) Test | 8-foot Up and Go Test | 30-second Sit to Stand Test | Fullerton Advanced Balance (FAB) Scale | Mini Balance Evaluation Systems Test (MiniBEST) | Berg Balance Scale | Four Square Step Test | Single Leg Stance | 4-meter Walk | 6-minute Walk | Grip Strength | Pinch Strength | Nine Hole Peg Test
Physical Function Assessment in the ICU
Functional Status Score for the ICU | Physical Function ICU Test | Chelsea Critical Care Physical Assessment Tool | ICU Mobility Scale



Short Physical Performance Battery
(Balance Test, Gait Speed Test, and Chair Stand Test)

To assess lower body function

Equipment: Folding chair without arms (seat height=17 in/43 cm), stopwatch.

Protocol:
Balance Test
NOTE: End test segments after 10 seconds, or when participant moves their feet or grasps interviewer for support.
Semi-tandem stance (heel of one foot placed to side of first toe of other foot)
–Demonstrate stance to participant.
–Knees may be bent, arms may be out for balance, feet should remain in place.
–Begin timing when participant is ready.
If the participant is unable to perform the Semi-tandem stance for 10 seconds, the Side-by-side segment is administered.
Side-by-side stance (feet together, side by side)
–Demonstrate stance to participant.
–Knees may be bent, arms may be out for balance, feet should remain in place.
–Begin timing when participant is ready.
A participant able to perform the Semi-tandem stance for 10 seconds continues to the Tandem stance segment.
Tandem stance (heel of one foot directly in front of toes of other foot)
–Demonstrate stance to participant.
–Knees may be bent, arms may be out for balance, feet should remain in place.
–Begin timing when participant is ready.

Gait Speed Test (8-foot walking course)
Participant may use cane or usual walking aid, if necessary.
Participant walks at usual pace: “As if you were walking down the street to the store”.
Begin stopwatch from the first step over the starting mark to the heel of the first foot crossing the finish mark.
Time participant for 2 walks; the quickest time is used for scoring.
Protocol variations (buffer zones): The walking course may include 2 or more feet before the starting mark for initiation of walking. Participants begin at “Go”, but the stopwatch does not begin until the participant crosses the starting mark. Also, the course may include additional space after the finish mark, to minimize potential deceleration by the participant at the conclusion.
Protocol variations (distance): 8-foot Walk; 3-meter Walk; 4-meter Walk.

Chair Stand Test
Place chair against wall for stability.
Researcher demonstrates posture and motion of chair stand to participant.
Participant sits in middle of chair, back straight, with feet shoulder-width apart.
Arms should be folded across the chest.
Participants are asked to stand up once to demonstrate ability to perform task.
If successful, participants are instructed to stand up and sit down 5 times as quickly as possible.
A correct stand means the participant rises to a full stand, body erect, and returns to a full seated position.
End test after 5 stands or 1 minute.

[Protocol and Score Sheet]

Source article
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49(2):M85-94. [PubMed] [ResearchGate]

Validity and Test-Retest Reliability
Freire AN, Guerra RO, Alvarado B, Guralnik JM, Zunzunegui MV. Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil. J Aging Health. 2012 Aug;24(5):863-78. [PubMed] [Institutional access]

Test-Retest Reliability and Sensitivity
Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM; Women’s Health and Aging Study. Reliability and sensitivity to change assessed for a summary measure of lower body function: Results from the Women’s Health and Aging Study. J Clin Epidemiol. 2002 Sep;55(9):916-21. [PubMed] [Institutional access]



Senior Fitness Test

To assess overall functional fitness

Equipment: Folding chair without arms (seat height=17 in/43 cm), hand weights (5- and 8-lbs), cone, stopwatch.

6-item Protocol:
30-sec Chair Stand (lower body strength)
Arm curl (upper body strength: 5-lbs for women, 8-lbs for men)
6-minute walk (aerobic endurance)
Protocol alternative (e.g. if space limitations): 2-minute step test
Chair sit-and-reach (lower body flexibility)
Back scratch (upper body flexibility)
8-foot up-and-go (agility/dynamic balance)

[Brief Overview of Protocol and Normative Data]

[Senior Fitness Test Manual (2nd ed) purchase link]

Source articles
Rikli RE, Jones CJ. Development and Validation of a Functional Fitness Test for Community-Residing Older Adults. J Aging Phys Act. 1999 Apr;7(2):129-161. [PubMed] [DOI link to Journal]

Rikli RE, Jones CJ. Functional fitness normative scores for community-residing adults, ages 60-94. J Aging Phys Act. 1999 Apr;7(2):162-181. [PDF download] [DOI link to Journal]

Normative Data and Test-Retest Reliability in a sample of Community-Residing Older Adults ages 60-94
Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist. 2013 Apr;53(2):255-267. [PubMed] [Journal link]

Normative Data in a sample of Community-Residing Older Adults ages 65-103
Marques EA, Baptista F, Santos R, Vale S, Santos DA, Silva AM, Mota J, Sardinha LB. Normative functional fitness standards and trends of Portuguese older adults: cross-cultural comparisons. J Aging Phys Act. 2014 Jan;22(1):126-137.[PubMed] [DOI link to Journal]



Timed Up and Go (TUG) Test

To assess mobility

Equipment: Folding chair without arms (seat height=17 in/43 cm), stopwatch.
A line is marked on the floor 10 feet (3.05m) away from the chair.

Protocol:
Participant may use cane or usual walking aid, if necessary.
Participant sits in chair with feet flat on ground, back against chair.
Instructions to participant: “When I say go, I want you to stand up from the chair, walk to the line on the floor at your usual pace, then turn, walk back to the chair at your usual pace, and sit down again.”
Begin stopwatch from the command “Go”; End when participant has returned to the original seated position.
Protocol variation : A chair with arms may be used for participants unable to rise otherwise.

[CDC Instructions and Score Sheet]

Normative Data and Test-Retest Reliability in a sample of Community-Dwelling Elderly
Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002 Feb;82(2):128-137. [PubMed] [Institutional Access]

Isles RC, Choy NL, Steer M, Nitz JC. Normal values of balance tests in women aged 20-80. J Am Geriatr Soc. 2004 Aug;52(8):1367-1372. [PubMed] [Journal Link]

Inter- and Intra-Rater Reliability and Concurrent Criterion Validity in a sample of Older Adults
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991 Feb;39(2):142-148. [PubMed] [Journal link]

Test-Retest Reliability, Discriminant Validity and Responsiveness in a sample of Community-Dwelling Elderly
Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc. 2004 Aug;52(8):1343-1348. [PubMed] [Journal link]

NOTE: TUG Test Distance = 10 feet
(See below) 8-foot Up and Go Distance = 8 feet



8-foot Up and Go Test

To assess mobility

Equipment: Folding chair without arms (seat height=17 in/43 cm), cone, stopwatch.
A cone is placed so the rear of the marker is 8 feet (2.44m) from the front of the chair.
Protocol:
Participant may use cane or usual walking aid, if necessary.
Participant sits in chair with feet flat on ground, back against chair.
Instructions to participant: “When I say go, I want you to stand up from the chair, walk around the cone at your usual pace and walk back to the chair and sit down again.”
Begin stopwatch from the command “Go”; End when participant has returned to the original seated position.
Protocol variation : A chair with arms may be used for participants unable to rise otherwise.

Concurrent Validity in a sample of Older Adults with and without mild cognitive impairment
Rolenz E, Reneker JC. Validity of the 8-Foot Up and Go, Timed Up and Go, and Activities-Specific Balance Confidence Scale in older adults with and without cognitive impairment. J Rehabil Res Dev. 2016;53(4):511-518. [PubMed]



30-second Sit to Stand Test

To assess functional leg strength

Equipment: Folding chair without arms (seat height=17 in/43 cm), stopwatch.

Protocol:
Place chair against wall for stability.
Researcher demonstrates posture and motion of chair stand to participant.
Participant sits in middle of chair, back straight, with feet shoulder-width apart.
Arms should be crossed at the wrists and held against the chest.
A correct stand means the participant rises to a full stand, body erect, and returns to a full seated position.
Participants should not swing arms to assist in rising, and use of arms to push up disqualifies a particular attempt.
The score is the number of complete stands in 30 seconds; a participant receives credit for a stand in-progress when time is called.

[CDC Instructions and Score Sheet]

Normative Data, Test-Retest Reliability and Criterion Validity in a sample of Community-Dwelling Elderly
Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999 Jun;70(2):113-119. [PubMed] [Institutional access]

See below for notes on the influence of chair height on performance
Kuo YL. The influence of chair seat height on the performance of community-dwelling older adults’ 30-second chair stand test. Aging Clin Exp Res. 2013 Jun;25(3):305-309. [PubMed] [Journal link]



Fullerton Advanced Balance (FAB) Scale

To assess balance

Equipment: Stopwatch, pencil, yardstick, 6-inch high bench, tape, foam pads for standing, metronome.

PRACTICAL NOTE: The Short Form of the Fullerton Advanced Balance Scale includes only the 4 sections with asterisks. These tests are straightforward to administer and less time-intensive than performance of the complete battery.

10 sections:
Stand with feet together and eyes closed
Reach forward to retrieve an object (pencil) held at shoulder height with outstretched arm
Turn 360 degrees in right and left directions
Step up onto and over a 6-inch bench*
Tandem walk*
Stand on one leg*
Stand on foam with eyes closed*
Two-footed jump for distance
Walk with head turns
Reactive postural control

[FAB Scale Administration Instructions]

[FAB Short Form Scoring Sheet]

[FAB Full Scale Scoring Sheet]

[FAB Scale Interpretation]

Convergent Validity, Test-Retest Reliability and Inter- and Intra-Rater Reliability in a sample of Community-Residing Older Adults
Rose DJ, Lucchese N, Wiersma LD. Development of a multidimensional balance scale for use with functionally independent older adults. Arch Phys Med Rehabil. 2006 Nov;87(11):1478-1485. [PubMed] [Institutional access]

Sensitivity and Specificity in a sample of Independently-Functioning Older Adults
Hernandez D, Rose DJ. Predicting which older adults will or will not fall using the Fullerton Advanced Balance scale. Arch Phys Med Rehabil. 2008 Dec;89(12):2309-2315. [PubMed] [Institutional access]



Mini Balance Evaluation Systems Test (MiniBEST)

To assess balance

Equipment: Stopwatch, yardstick, tape, standard chair, box (height=9in/23cm), foam pads for standing, incline ramp with 10° slope.

PRACTICAL NOTE: The MiniBest has low floor/ceiling effects and intervention can be tailored to the specific area of deficit.

14 sections:
Anticipatory
Sit to Stand
Rise to toes
Stand on one leg
Reactive postural control
Compensatory stepping correction: Forward
Compensatory stepping correction: Backward
Compensatory stepping correction: Lateral
Sensory orientation
Stance (Feet together); Eyes open, firm surface
Stance (Feet together); Eyes closed, foam surface
Incline; Eyes closed
Dynamic gait
Change in gait speed
Walk with head turns: horizontal
Walk with pivot turns
Step over obstacles
Timed Up and Go with dual task

[MiniBest Instructions and Score Sheet]

Normative Data in a sample of Adults 50 and older
O’Hoski S, Winship B, Herridge L, Agha T, Brooks D, Beauchamp MK, Sibley KM. Increasing the clinical utility of the BESTest, mini-BESTest, and brief-BESTest: normative values in Canadian adults who are healthy and aged 50 years or older. Phys Ther. 2014 Mar;94(3):334-342. [PubMed] [Institutional access]

Inter-rater Reliability in a sample of Adults 50 and older
Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther. 2009 May; 89(5): 484–498. [PubMed] [PMC free article] [Institutional access]



Berg Balance Scale

To assess balance

Equipment: Stopwatch, ruler, footstool or step, 2 standard chairs (one with arm rests, one without), 15 foot walkway.

14-item Protocol:
Sitting to standing
Standing unsupported
Sitting unsupported
Standing to sitting
Transfers
Standing with eyes closed
Standing with feet together
Reaching forward with outstretched arm
Retrieving object from floor
Turning to look behind
Turning 360 degrees
Placing alternate foot on stool
Standing with one foot in front
Standing on one foot

[Berg Balance Scale Instructions and Score Sheet]

Normative Data in a sample of Community-Dwelling Older Adults
Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002 Feb;82(2):128-137. [PubMed]

Test-Retest Reliability and Inter- and Intra-Rater Reliability in a sample of Elderly
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992 Jul-Aug;83 Suppl 2:S7-11. [PubMed]

Standard Error of Measurement and Minimum Detectable Change in a sample of Elderly
Donoghue D, Physiotherapy Research and Older People (PROP) group, Stokes EK. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009 Apr;41(5):343-346. [PubMed] [Journal link]

Berg Balance Scale Meta-analysis in Community-Dwelling Older Adults
Downs S, Marquez J, Chiarelli P. Normative scores on the Berg Balance Scale decline after age 70 years in healthy community-dwelling people: a systematic review. J Physiother. 2014 Jun;60(2):85-89. [PubMed] [Journal link]



Four Square Step Test

To assess balance

Equipment: Stopwatch, 4 canes or dowel rods 1 inch in height.

Protocol:
Place and secure 4 canes or dowel rods 1-inch high at 90-degree angles on the floor. Note set-up illustration to right.
Instructions: “Try to complete the sequence as fast as possible without touching the sticks. Both feet must make contact with the floor in each square. If possible, face forward during the entire sequence.”
Sequence: Participant begins in Square 1, facing Square 2, then steps in Squares 1, 2, 3, 4, and returns to Square 1. Then the participant turns to face Square 4, and steps in Squares 4, 3, 2, and returns to Square 1.
Demonstrate the sequence to participant and allow practice trial.
Timing begins when the leading foot contacts Square 2; timing ends when the last foot has returned to Square 1.
If participant fails to complete sequence successfully, loses balance, or makes contact with the cane, the trial should be repeated.
Perform 2 tests, use best time as score.
Participant may use cane or usual walking aid, if necessary.

[Protocol and Score Sheet]

Normative Data, Test-Retest Reliability and Inter- and Inter-Rater Reliability in a sample of Community-Dwelling Older Adults
Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002 Nov;83(11):1566-1571. [PubMed]

Validity and Reliability: A review of studies
Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev. 2017 Sep 11;6(1):187. [PubMed] [PMC free article] [Institutional access]

Illustration (Moore & Barker. 2017) used under CCA 4.0 Int’l License



Single Leg Stance

To assess balance

Equipment: Stopwatch.

Protocol:
Participant stands unassisted with one leg flexed.
Eyes should remain open, and hands are either placed on hips or arms are crossed and held against the chest.
Test terminates when the foot of the flexed leg touches either the ground or the standing leg, or an arm leaves the hips.
Maximum time is 60 seconds.
Protocol variations : Record time for both legs; Record time only for a preferred leg.

Normative Data by Age Cohorts
Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15. [PubMed] [ResearchGate]

Reference Values
Yoshimura N, Oka H, Muraki S, Akune T, Hirabayashi N, Matsuda S, Nojiri T, Hatanaka K, Ishimoto Y, Nagata K, Yoshida M, Tokimura F, Kawaguchi H, Nakamura K. Reference values for hand grip strength, muscle mass, walking time, and one-leg standing time as indices for locomotive syndrome and associated disability: the second survey of the ROAD study. J Orthop Sci. 2011 Nov;16(6):768-77. [PubMed] [Institutional Access]

Hall KS, Cohen HJ, Pieper CF, Fillenbaum GG, Kraus WE, Huffman KM, Cornish M, Shiloh A, Flynn C, Sloane R, Newby LK, Morey MC. Physical performance across the adult lifespan: correlates with age and physical activity. J Gerontol A Biol Sci Med Sci 2017 Apr;72(4):572-578. [Institutional access] [PubMed]



4-meter Walk

To assess gait speed

Equipment: Stopwatch.

Protocol:
Participant may use cane or usual walking aid, if necessary.
Align participant at starting mark.
Begin stopwatch at Instruction: “Go”.
Gait speed equals the calculation of the distance traveled divided by time.
Protocol variations (buffer zones): The walking course may include 2 or more feet before the starting mark for initiation of walking. In this case, participants begin at “Go”, but the stopwatch does not begin until the participant crosses the starting mark. Also, the course may include additional space after the finish mark, to minimize potential deceleration by the participant at the conclusion.
Protocol variations (distance): 4-meter Walk; 3-meter Walk; 8-foot Walk.

Normative Data and Test-Retest Reliability in Healthy Adults
Bohannon RW. Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997 Jan;26(1):15-19. [PubMed] [Institutional Access]

Standard Error of Measurement, Minimal Detectable Change and Minimal Clinically Important Difference in Older Adults
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006 May;54(5):743-749. [PubMed] [Journal link]

Gait Speed Meta-analysis in Research on Older Adults
Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):39-46. [PubMed] [Journal link]



6-minute Walk

A field test to assess functional aerobic capacity

Equipment: Stopwatch, measuring wheel (recommended).

Protocol:
Demonstrate walking a lap to participant.
Instruct participant to cover as much distance as safely possible.
Announce remaining time as each minute passes.
Assistive devices (e.g. cane, walker) may be used.
Maximum time is 6 minutes.
2 assessments are required to account for a learning effect.
A 30-meter or 100-foot unimpeded hallway is recommended. Some studies have shown longer distances on oval track.
Protocol variation : When the Six-minute Walk is used to assess mobility, rather than aerobic capacity, participants are instructed to walk at a self-selected speed.
The American Thoracic Society details specific protocol guidelines for participants with respiratory diagnoses (See reference below).

Normative Data and Test-Retest Reliability in a sample of Community-Dwelling Elderly
Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002 Feb;82(2):128-137. [PubMed] [Institutional Access]

Test-Retest Reliability, Criterion Validity and Construct Validity in a sample of Older Adults
Harada ND, Chiu V, Stewart AL. Mobility-related function in older adults: assessment with a 6-minute walk test. Arch Phys Med Rehabil. 1999 Jul;80(7):837-841. [PubMed] [PDF link]

Standard Error of Measurement, Minimal Detectable Change and Minimal Clinically Important Difference in Older Adults
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006 May;54(5):743-749. [PubMed] [Journal link]

American Thoracic Society Guidelines
Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1428-1446. [PubMed] [Institutional Access]



Grip Strength

To assess muscular strength of the hand and forearm

Equipment: Dynamometer.

Protocol variations : Standing, arm down at side; Standing, arm out;
Seated, arm down at side; Seated, elbow flexed to 90 degrees by side, neutral wrist position.
Grip strength for each hand is calculated as the mean of 3 trials, regardless of protocol.

Seated Protocol:

Participant sits with back and knees at 90 degrees.
Shoulder is adducted and neutrally rotates, elbow flexed at right angle, wrist is held between 0-15 degrees of ulnar deviation.

Standing Protocol:

Participant stands with feet hip-width apart and even, toes pointing forward
–Knees comfortable but not bent
–Shoulders back and chest up
–Head is level, eyes straight ahead
–Arm at side, with palm facing leg
Participant grasps the dynamometer between the fingers and the palm at the base of the thumb.
Participant holds the dynamometer in line with the forearm at the thigh level so it does not touch the body.

Participants unable to stand may still perform the test in a seated position.
–Both feet should be placed on the ground.
–Participant sits straight up, and does not hold on to anything.
–Arm should be at the side.
–If participant is in a wheelchair, arm may touch the armrest, however, the participant should not use the armrest for leverage.


Normative Data in samples of the elderly
Desrosiers J, Bravo G, Hébert R, Dutil E. Normative data for grip strength of elderly men and women. Am J Occup Ther. 1995 Jul-Aug;49(7):637-644. [PubMed] [PDF download]

Lam NW, Goh HT, Kamaruzzaman SB, Chin AV, Poi PJ, Tan MP. Normative data for hand grip strength and key pinch strength, stratified by age and gender for a multiethnic Asian population. Singapore Med J. 2016 Oct;57(10):578-584. [PubMed] [Journal link]

Test-Retest Reliability in a sample of Community-Dwelling Elders
Bohannon RW, Schaubert KL. Test-retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005 Oct-Dec;18(4):426-7. [PubMed] [Institutional access]



Pinch Strength

To assess muscular strength of the hand and fingers

Equipment: Dynamometer or pinch gauge.

3 Pinch tests:
Lateral pinch (other names: Key)
Place the pinch gauge between the pad of the thumb and the lateral surface of the index finger.
Three-point pinch (other names: Palmer, three jaw chuck)
Place the pinch gauge between the pad of the thumb and pad of the index and middle fingers.
Two-point pinch (other names: Tip-to-tip, O-pinch)
Place the pinch gauge between the tip of the thumb and the tip of the index finger.
This is a more precise pinch, and strength readings are usually less than the prior 2 tests.

Each test is administered 3 times, and scores are averaged for each pinch test.

Normative Data in a sample of adults (age 20s-90s)
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985 Feb;66(2):69-74. [PubMed] [View article]

Lam NW, Goh HT, Kamaruzzaman SB, Chin AV, Poi PJ, Tan MP. Normative data for hand grip strength and key pinch strength, stratified by age and gender for a multiethnic Asian population. Singapore Med J. 2016 Oct;57(10):578-584. [PubMed] [Journal link]



Nine Hole Peg Test

To assess finger dexterity

Equipment: Stopwatch, 9-Hole peg board with pegs, container for pegs.

Protocol:
The test should begin with the dominant hand.
A practice test is performed for each hand.
Instructions : Pick up the pegs one at a time, using your right (or left) hand only and put them into the holes in any order until all the holes are filled. Then remove the pegs one at a time and return them to the container. Stabilize the peg board with your left (or right) hand. See how fast you can put all the pegs in and take them out again.
Begin stopwatch when person touches first peg.
End timing when the last peg has been removed from the board and touches the peg container.
The test is then repeated for the non-dominant hand.

[Nine Hole Peg Test Instructions]

Normative Data, Inter-rater Reliability and Test-Retest Reliability in a sample of adults
Mathiowetz V, Weber K, Kashman N, Volland G. Adult Norms for the Nine Hole Peg Test of Finger Dexterity. Occup Ther J Res. 1985 Jan;5(1):24-38. [View article]

Oxford Grice K, Vogel KA, Le V, Mitchell A, Muniz S, Vollmer MA. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003 Sep-Oct;57(5):570-573. [PubMed] [Journal link]


Physical Function Assessment in the ICU

Recent reviews of functional assessment tools in the critically ill:
Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU – what should we be using? – an observational study. Crit Care. 2015 Mar 29;19:127. [PubMed] [PMC free article] [Institutional access]

Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, Koopman R, Denehy L. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med. 2015 May;41(5):744-762. [PubMed] [Institutional access]


Functional Status Score for the ICU (FSS-ICU)

To assess functional status of patients in an Intensive Care Unit

5-item Protocol:
Rolling
Supine to sit
Unsupported sitting at the edge of the bed
Sit to stand
Ambulation
An ordinal scale is used for scoring (1:total assist to 7:complete independence)
–A score of 0 is assigned if a patient was unable to perform a task, due to either physical limitation or medical status.

Convergent and Discriminant Validity in a clinimetric analysis of 5 international datasets
Huang M, Chan KS, Zanni JM, Parry SM, Neto SG, Neto JA, da Silva VZ, Kho ME, Needham DM. Functional Status Score for the ICU: An International Clinimetric Analysis of Validity, Responsiveness, and Minimal Important Difference. Crit Care Med. 2016 Dec;44(12):e1155-e1164. [PubMed] [PMC free article] [Journal link]

Predictive Utility in a sample of ICU patients
Thrush A, Rozek M, Dekerlegand JL. The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: a prospective cohort study. Phys Ther. 2012 Dec;92(12):1536-1545. [PubMed] [Journal link]



Physical Function ICU Test (PFIT)

To assess functional status of patients in an Intensive Care Unit

Equipment: Assistants for sit-to-stand component.

4- or 5-item Protocol (PFIT=5 items; PFIT-s=4 items):
Sit-to-stand
Measured by number of assistants required to help patient achieve standing position
Marching in place
Duration of marching, # of steps, cadence rate (steps/min)
Knee extension strength
Oxford scale (graded 0-5)
Shoulder flexion strength
Oxford scale (graded 0-5)
Bilateral shoulder lifts (lifts/min)*
Duration, # of repetitions, cadence (reps/min)
–Patients begin with hands on their thighs, and measurement ceases when shoulder flexion is less than 90°,
or more than 2 seconds have elapsed between flexion movements.

*This component is not measured in the PFIT-s

[PFIT Overview]

Inter-rater Reliability in a sample of tracheostomy patients
Skinner EH, Berney S, Warrillow S, Denehy L. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc. 2009 Jun;11(2):110-115. [PubMed] [View article]

Predictive Utility in a sample of ICU patients
Denehy L, de Morton NA, Skinner EH, Edbrooke L, Haines K, Warrillow S, Berney S. A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther. 2013 Dec;93(12):1636-1645. [PubMed] [Journal link]



Chelsea Critical Care Physical Assessment Tool (CPAx)

To assess functional status of patients in an Intensive Care Unit

Equipment: Spirometer, dynamometer.

10-item Protocol:
Respiratory function
Cough
Bed mobility
Supine to sit
Dynamic sitting
Sit to stand
Standing balance
Bed to chair transfer
Stepping
Grip strength
An ordinal scale is used for scoring (0:dependent or unable to 5:independence)

[CPAx Overview]

Inter-rater Reliability in a sample of London ICU patients
Corner EJ, Wood H, Englebretsen C, Thomas A, Grant RL, Nikoletou D, Soni N. The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy. 2013 Mar;99(1):33-41. [PubMed] [Journal link]

Construct Validity in a sample of ICU patients
Corner EJ, Soni N, Handy JM, Brett SJ. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Crit Care. 2014 Mar 27;18(2):R55. [PubMed] [PMC free article] [Journal link]



ICU Mobility Scale

A quick bedside observational assessment of patient mobility in an Intensive Care Unit

Equipment: None.

11-item Ordinal Scale:
0: Inactive
1: Bed activity
2: Passive movement to chair
3: Sitting over edge of bed
4: Standing
5: Transfer from bed to chair
6: Marching with or without assistance
7: Walk 5 yds with assistance of 2 or more persons
8: Walk 5 yds with assistance of 1 person
9: Walk 5 yds with gait aid
10: Walk 5 yds without gait aid or other assistance

[ICU Mobility Score PDF]

Inter-rater Reliability in adult ICU patients
Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J, Buhr H, Higgins A, Presneill J, Berney S. Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung. 2014 Jan-Feb;43(1):19-24. [PubMed] [Institutional access]

Construct and Predictive Validity in a sample of ICU patients
Tipping CJ, Bailey MJ, Bellomo R, Berney S, Buhr H, Denehy L, Harrold M, Holland A, Higgins AM, Iwashyna TJ, Needham D, Presneill J, Saxena M, Skinner EH, Webb S, Young P, Zanni J, Hodgson CL. The ICU Mobility Scale Has Construct and Predictive Validity and Is Responsive. A Multicenter Observational Study. Ann Am Thorac Soc. 2016 Jun;13(6):887-893. [PubMed] [Institutional access]


Further information about many of these measures and additional references are available at the Rehabilitation Measures Database webpage of the Shirley Ryan AbilityLab (formerly the Rehabilitation Institute of Chicago).


Gait Speed Point Assignment Ranges: An Historical Perspective (1994-present)
Point assignment 3-Meter walk (SPPB Score Sheet) Guralnick et al, 1994
1 <=1.51 ft/sc <=1.40 ft/sc
2 1.51-2.11 ft/sc 1.43-1.95 ft/sc
3 2.14-2.72 ft/sc 2.0-2.5 ft/sc
4 >2.72 ft/sc >2.58 ft/sc
    1. Point assignments spanned a slightly slower gait speed for the Guralnick et al cohort. Note that 8-Foot Walk timing reported in their journal article was rounded to 1 decimal point for categories of performance.
    2. Gaps in timing between point assignments are due to degree of decimal point precision.