The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

Abstract

Objectives: Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention.

Design: Prospective longitudinal cohort study.

Setting and participants: 417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices.

Methods: The SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/-) based on self-reported fall history and balance self-efficacy using an adapted STEADI model.

Results: Participants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB.

Conclusions and implications: The SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.

Keywords: SPPB; STEADI; fall; geriatric assessment; performance measure.

Figure 1.

One Year Fall Risk By SPPB Categories Rate ratios and 95% confidence intervals from negative binomial regression models, adjusted for age, gender, race, education level, number of comorbid conditions, BMI, psychotropic drugs, physical activity, pain, and depression *Short Physical Performance Battery (SPPB) Low Performance Group Total Score 4-6, Middle Performance Group Total Score 7-9, and Best Performance Group used as reference (REF) Total Score 10-12. ^†Gait Time Low Performance Group walked 4 meters in ≥6.21 seconds, Middle Performance Group in 4.82-6.20 seconds and Best Performance Group in <4.82 seconds. ^‡Chair Stand Low Performance Group unable to stand or completed 5 stands >16.7 seconds, Low-Middle Performance Group in 13.7-16.6 seconds, High-Middle Performance Group in 11.2-13.6 seconds, and Best Performance Group in <11.2 seconds. ^§Balance Test Low Performance Group performed Side-by-Side Stand <10 seconds, Low-Middle Performance Group Semi Tandem Stand <10 seconds, High-Middle Performance Group Full Tandem Stand 3-9 seconds, and Best Performance Group Full Tandem Stand ≥10 seconds.