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Development of a Test of Physical Performance for the Nursing Home Setting

^a Division of Geriatrics and Gerontology, Department of Internal Medicine
^b Division of Biostatistics, Washington University School of Medicine, St. Louis, MO

Correspondence: Ellen F. Binder, MD, Division of Geriatrics and Gerontology, Washington University School of Medicine, 4488 Forest Park Boulevard, Suite 201, St. Louis, MO 63108. E-mail: ebinder{at}imgate.wustl.edu.

Decision Editor: Eleanor S. McConnell, RN, PhD

Purpose: This study was undertaken to develop a performance-based instrument to measure a range of function present among nursing home (NH) residents and to establish the reliability and validity of the measures. Design and Methods: Fourteen items integral to daily life in a NH setting were administered to 95 NH residents with sufficient cognitive ability to follow a one-step command at baseline, 1 week later, and 6 months later. Intraclass correlation coefficients and Cronbach's coefficient alpha were calculated for reliability estimates. The Minimum Data Set (MDS), Katz, and Multidimensional Observational Scale for Elderly Subjects (MOSES) were used to establish concurrent validity. Factor analysis, correlation matrices, and other objective criteria were used for item reduction. Results: Test–retest reliability for items ranged between .73 and .93. Factor analysis and correlations between Nursing Home Physical Performance Test (NHPPT) items and scales with measures of activities of daily living (ADL) suggest that the NHPPT taps aspects of gross motor function (Factor 1) and fine motor coordination and task sequencing (Factor 2) required for ADL function and mobility. The NHPPT may also tap aspects of ADL function and mobility not measured by the MDS (r = –.72–.75), MOSES (r = –.82–.84), or Katz (r = –.75–.77) scales. Effect sizes based on mean change scores were larger for the NHPPT scales (.38–.53) than for the other functional scales (.27–.33). Implications: The NHPPT is a reliable performance-based instrument that discriminates among frail NH residents. Further studies are necessary to assess the value of this instrument for prediction and monitoring of functional status in the NH.

Key Words: Aging • Physical performance • Activities of daily living

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