36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative

Abstract

Objectives: To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women.

Design: Prospective cohort study.

Setting: Forty clinical centers in the United States.

Participants: Women aged 65 to 79 enrolled in the Women's Health Initiative Clinical Trials with gait speed and SF-36 assessed at baseline (1993-1998) and follow-up Years 1, 3, and 6 (N = 3,587).

Measurements: Women were categorized as nondecliners or decliners based on changes (from baseline to Year 1) in gait speed and SF-36 PF scores. Logistic regression models were used to estimate incident PCMD (gait speed <1.0 m/s) at Years 3 and 6. Area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of SF-36 PF with that of measured gait speed.

Results: Slower baseline gait speed and lower SF-36 PF scores were associated with higher adjusted odds of PCMD at Years 3 and 6 (all P < .001). For gait speed, decliners were 2.59 times as likely to have developed PCMD as nondecliners by Year 3 and 2.35 times as likely by Year 6. Likewise, for SF-36, decliners were 1.42 times as likely to have developed PCMD by Year 3 and 1.49 times as likely by Year 6. Baseline gait speed (AUC = 0.713) was nonsignificantly better than SF-36 (AUC = 0.705) at predicting PCMD over 6 years (P = .21); including measures at a second time point significantly improved model discrimination for predicting PCMD (all P < .001).

Conclusion: Gait speed identified PCMD risk in older women better than the SF-36 PF did, although the results may be limited given that gait speed served as a predictor and to define the PCMD outcome. Nonetheless, monitoring trajectories of change in mobility are better predictors of future mobility disability than single measures.

Keywords: disability; geriatric assessment; performance; physical function; prevention.

Figure 1

Receiver operating characteristic (ROC) curves for predicting new preclinical mobility disability at Year 3 according to physical function measured at baseline only (gray) or baseline plus 1 year (black). Gait speed, test for difference in ROC curves, P<.001. Medical Outcomes Study 36-Item Short-Form Physical Function Index, test for difference in ROC curves; P=.005.

Figure 2

Receiver operating characteristic (ROC) curves for predicting new preclinical mobility disability at Year 6 according to physical function measured at baseline only (gray) or baseline plus 1 year (black). Gait speed, test for difference in ROC curves; P<.001. Medical Outcomes Study 36-Item Short-Form Physical Function Index, test for difference in ROC curves; P=.004.