Background/ Purpose: A priority in healthcare for older adults is to detect declines in mobility and balance before falls occur with potential consequences of morbidity, disability, even mortality. Self-report and performance measures have varying degrees of respondent and administrative burden. We investigated the role of a single global self-rating in the detection of mobility decline. Change by repeated self-rated mobility state was compared to transition rating of self-perceived change over six months. Additionally, repeated state and transition reported change were compared with performance change. We anticipated discordance, and explored the support for potential theories to explain discordance.
Methods: Using a prospective, exploratory, observational cohort study with mixed-methods analysis, we focused on the natural history of age-related mobility change. Community-dwelling older adults provided state and transition global ratings of mobility and balance over six months, and completed questionnaires and performance tests of physical function. A subset of the older adults participated in semi-structured interviews to identify themes for domain definitions of mobility and balance, and the timeframe and frames of reference used for state ratings. Analyses included correlations for agreement between measures, and comparisons of means to investigate groups established based on discordance.
Results: Participants, n=104, had data at two consecutive time points, and 33 participated in interviews. Domain definitions and state timeframes varied. Two main frames of reference were identified. The serial state and transition based rating of change were discordant, as were self-rated and performance change. Nearly 75 percent of those with gait speed decline of at least 0.10 m/s reported worsening by transition, and about 25 percent selected a lower state rating.
Conclusions: Transition ratings appear more sensitive than serial state ratings for detection of decline in gait speed, while decline by serial state rating may be more specific to larger performance changes. Self-ratings appear to communicate valuable information about mobility and balance not available from other measures, and we recommend an expanded use of open-ended questions in research and clinical practice.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07302010-161835 |
| Date | 19 August 2010 |
| Creators | Hile, Elizabeth S. |
| Contributors | Subashan Perera, Stephanie Studenski, Susan Zickmund, Jennifer Brach, Jessie VanSwearingen |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07302010-161835/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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