Incontinência urinária é associada com o declínio do desempenho físico em mulheres idosas residentes na comunidade: resultados do International Mobility in Aging Study (IMIAS)

Texto

(1)UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE FACULDADE DE CIÊNCIAS DA SAÚDE DO TRAIRI PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA. LUANA CAROLINE DE ASSUNÇÃO CORTEZ CORRÊA. INCONTINÊNCIA URINÁRIA É ASSOCIADA COM O DECLÍNIO DO DESEMPENHO FÍSICO EM MULHERES IDOSAS RESIDENTES NA COMUNIDADE – RESULTADOS DO INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS). SANTA CRUZ 2018.

(2) LUANA CAROLINE DE ASSUNÇÃO CORTEZ CORRÊA. INCONTINÊNCIA URINÁRIA É ASSOCIADA COM O DECLÍNIO DO DESEMPENHO FÍSICO EM MULHERES IDOSAS RESIDENTES NA COMUNIDADE – RESULTADOS DO INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS). Dissertação apresentada ao Programa de PósGraduação em Saúde Coletiva da Faculdade de Ciências da Saúde do Trairi da Universidade Federal do Rio Grande do Norte, como requisito para obtenção do título de Mestre em Saúde Coletiva. Área de concentração: Epidemiologia e condições de vida e saúde da população Orientador (a): Profª. Drª. Saionara Maria Aires da Câmara. SANTA CRUZ 2018.

(3) Universidade Federal do Rio Grande do Norte - UFRN Sistema de Bibliotecas - SISBI Catalogação de Publicação na Fonte. UFRN - Biblioteca Setorial da Faculdade de Ciências da Saúde do Trairi - FACISA Corrêa, Luana Caroline de Assunção Cortez. Incontinência urinária é associada com o declínio do desempenho físico em mulheres idosas residentes na comunidade: resultados do International Mobility in Aging Study (IMIAS) / Luana Caroline de Assunção Cortez Correa. - 2018. 42f.: il. Dissertação (Mestrado em Saúde Coletiva) - Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Saúde Coletiva, Santa Cruz, RN, 2017. Orientador: Saionara Maria Aires da Câmara.. 1. Incontinência Urinária - Mulheres - Dissertação. 2. Saúde da Mulher - Dissertação. 3. Força Muscular - Dissertação. 4. Envelhecimento - Dissertação. 5. Epidemiologia - Dissertação. I. Câmara, Saionara Maria Aires da. II. Título. RN/UF/FACISA CDU 616.62-055.2 Elaborado por José Gláucio Brito Tavares de Oliveira - CRB-15/321.

(4) LUANA CAROLINE DE ASSUNÇÃO CORTEZ CORRÊA. INCONTINÊNCIA URINÁRIA É ASSOCIADA COM O DECLÍNIO DO DESEMPENHO FÍSICO EM MULHERES IDOSAS RESIDENTES NA COMUNIDADE – RESULTADOS DO INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS). Dissertação apresentada ao Programa de PósGraduação em Saúde Coletiva da Faculdade de Ciências da Saúde do Trairi da Universidade Federal do Rio Grande do Norte, como requisito para obtenção do título de Mestre em Saúde Coletiva. Área de concentração: Epidemiologia e condições de vida e saúde da população Orientador (a): Profª. Drª. Saionara Maria Aires da Câmara. BANCA EXAMINADORA. _____________________________________________ Profª. Drª. Saionara Maria Aires da Câmara Presidente da banca – Instituição: Faculdade de Ciências da Saúde do Trairi/Universidade Federal do Rio Grande do Norte _____________________________________________ Profº. Drº. Diego de Sousa Dantas Examinador interno – Instituição: Faculdade de Ciências da Saúde do Trairi/Universidade Federal do Rio Grande do Norte _____________________________________________ Profª. Drª. Aline do Nascimento Falcão Freire Monte Examinador externo – Instituição: Universidade Estácio de Sá.

(5) DEDICATÓRIA. Dedico esta obra aos meus avós, Maria do Céu de Assunção e João Adelino de Assunção (in memoriam), que com esforço e dedicação, semearam na vida dos seus filhos, netos e bisnetos a importância da educação..

(6) AGRADECIMENTOS. Em primeiro lugar, rendo graças e louvores a Deus por mais uma vitória alcançada. Agradeço a Ele por ter conduzido os meus passos durante essa linda jornada. Ao meu marido e companheiro, Daniel Augusto, agradeço pelo amor incondicional, cuidado e paciência que tem me oferecido de forma tão altruísta ao longo desses anos. Obrigado por me sustentar nos momentos de dificuldade e por me mostrar novos horizontes quando tudo parece incerto. Agradeço a minha mãe, Maria Erivaneide, mulher forte, batalhadora e íntegra, que nunca mediu esforços para oferecer a minha família, o melhor. Obrigada pelos sacrifícios, pelas noites em claro, pelas horas de estudo, pelos valores e sem sombra de dúvidas, pelo exemplo. Se hoje eu estou aqui, é por sua causa. À minha irmã, Lumena Cristina, agradeço pelo amor fraternal e sincero que sempre me dedicou. Cresci seguindo os seus passos, que sempre me levaram a um lugar de superação. Agradeço a minha orientadora, Saionara Aires por sua generosidade, esta que transcende o ambiente acadêmico. Sua confiança, proatividade, inteligência e curiosidade me inspiram, e me faz querer ser uma pesquisadora/aluna cada vez melhor. Agradeço ainda a professora Catherine Pirkle pela colaboração no trabalho, e acima de tudo, pela atenção, carinho e dedicação com que me tratou durante o precioso período em que trabalhamos em equipe na Universidade do Hawaii. Agradeço ainda aos amigos de longa data, em especial a Sabrina Gabrielle e família, pelas histórias que construímos e que ainda iremos construir. Agradeço a todos os membros do projeto AMOR pelas experiências compartilhadas e por contribuírem na minha formação. À minha companheira de avaliações e viagens, Jaciara Oliveira, agradeço pelo crescimento espiritual. Por fim, quero dizer MUITO OBRIGADA a esta instituição e a todos que a compõem pelo trabalho sério e de qualidade que tem ofertado à comunidade. A UFRN/FACISA tem sido a minha segunda casa há aproximadamente oito anos, foi esse lugar que me deu uma profissão e foi esta instituição que me deu novas perspectivas de vida. Sigo crendo que grandes coisas ainda virão..

(7) RESUMO Introdução: Com o envelhecimento, mulheres apresentam pior desempenho físico quando comparadas aos homens em idades semelhantes, sugerindo que existem fatores relacionados ao sexo ou gênero, como as variáveis de história reprodutiva, que podem explicar tais diferenças. A alta paridade e a idade materna precoce estão relacionadas com a ocorrência de alterações uroginecológicas, tais como a Incontinência Urinária (IU), e também é conhecido que mulheres que tiveram muitos filhos e/ou foram mães na adolescência apresentam piores condições de saúde na velhice, incluindo pior desempenho físico. Hipotetiza-se que a mulheres que reportam IU apresentam pior desempenho físico e uma redução mais acentuada deste com o passar dos anos. No entanto, há uma lacuna na literatura para comprovar tais hipóteses. Objetivos: Avaliar se há uma relação entre a incontinência urinária e o desempenho físico em mulheres idosas de cinco localidades com diferentes condições socioeconômicas e avaliar a influência da incontinência urinária na mudança de desempenho físico ao longo de um período de dois anos. Metodologia: Trata-se de um estudo observacional longitudinal derivado do International Mobility in Aging Study (IMIAS), realizado nas cidades de Saint–Hyacinthe (Quebec, Canadá), Kingston (Ontário, Canadá), Manizales (Colômbia), Tirana (Albânia) e em Natal (Brasil). Neste estudo, aproximadamente 200 mulheres idosas (65 e 74 anos) de cada localidade, residentes na comunidade, foram avaliadas nos anos de 2012, 2014 e 2016. A presente pesquisa apresenta os dados coletados em 2014 e 2016. Para avaliação foram coletados dados socioeconômicos, medidas antropométricas e história reprodutiva. O desempenho físico foi avaliado através da Short Physical Performance Battery (SPPB) seguindo um protocolo padronizado que mede o equilíbrio, a marcha e força dos membros inferiores. O escore final da SPPB é uma soma dos pontos de cada teste, variando de 0 a 12 pontos (4 pontos para cada teste). A incontinência urinária foi avaliada por meio de autorrelato de episódios de perda involuntária de urina na última.

(8) semana, e classificada como “nenhum nos últimos 7 dias” e “algum nos últimos 7 dias”. A relação transversal entre IU e SPPB foi avaliada pela análise de regressão linear múltipla. A avaliação do efeito longitudinal da IU sobre o escore da SPPB ao longo de 2 anos foi avaliada por meio de análise de modelos lineares mistos. Em ambas as análises, foram consideradas como covariáveis: idade, local de estudo, educação, suficiência de renda e paridade. Resultados: A amostra foi composta por 915 mulheres com média de idade de 71,2 (±2,88). A prevalência da incontinência urinária variou de 11,4% (Natal) e 30,7% (Kingston). As mulheres que relataram alguma perda de urina apresentam média da SPPB significativamente inferior do que as demais, mesmo nos modelos completamente ajustados (β= -0,469; p= 0,009). Além disso, elas apresentam uma redução significativamente mais acentuada no escore da SPPB ao longo de dois anos que as mulheres que não reportaram IU (β=-0,533, p=0,001). Conclusão: A IU está associada com piores resultados na SPPB e influencia negativamente no desempenho físico ao longo de dois anos, uma vez que as mulheres com IU apresentam um declínio mais acentuado do desempenho físico neste período. Esses achados servem de base para o planejamento e aplicação de intervenções precoces para melhorar o perfil de envelhecimento das mulheres e a qualidade de vida dessa população. Palavras-chave: Saúde da Mulher. Força Muscular. Incontinência Urinária. Envelhecimento. Epidemiologia..

(9) ABSTRACT Introduction: With aging, women present worse physical performance when compared to men of similar ages, suggesting that there are factors related to sex or gender, such as variables of reproductive history that may explain these differences. High parity and early maternal age are related to the occurrence of urogynecological disorders, such as Urinary Incontinence (UI), and it is also known that women who had many children and / or were mothers in adolescence have worse health conditions in old ages, including worse physical performance. Hypothesize that women who report UI have worse physical performance and a more pronounced reduction of UI over the years. However, there is a gap in the literature to prove these hypotheses. Objectives: To evaluate if there is a relationship between urinary incontinence and physical performance in older women from five sites with different socioeconomic conditions and to evaluate the influence of urinary incontinence on the change in physical performance over a two-year period. Methodology: This is a longitudinal observational study derived from the International Mobility in Aging Study (IMIAS), conducted in Saint-Hyacinthe (Quebec, Canada), Kingston (Ontario, Canada), Manizales (Colombia), Tirana (Albania) and Natal (Brazil). In this study, approximately 200 older women (65 and 74 years old) from each locality, residents on community, were evaluated in the years of 2012, 2014 and 2016. The present study presents data collected in 2014 and 2016. For the evaluation, socioeconomic data, anthropometric measures and reproductive history were collected. Physical performance was assessed using the Short Physical Performance Battery (SPPB) following a standardized protocol that measures balance, gait and lower limbs strength. The SPPB final score is a sum of the points of each test, ranging from 0 to 12 points (4 points for each test). Urinary incontinence was assessed by self-report of episodes of involuntary loss of urine in the last week, classified as "none in the past 7 days" and "some in the last 7 days". The cross-sectional relationship between UI and SPPB was assessed by multiple linear regression.

(10) analysis. The evaluation of the longitudinal effect of UI on the SPPB score over 2 years was evaluated by analysis of mixed linear models. In both analyzes, covariables were considered: age, study site, education, income sufficiency, and parity. Results: The sample was composed by 915 women with mean age of 71.2 (± 2.88). The prevalence of urinary incontinence ranged from 11.4% (Natal) and 30.7% (Kingston). The women who reported some loss of urine presented a significantly lower SPPB mean than the others, even in the fully adjusted models (β =-0.469, p= 0.009). In addition, they show a significantly greater reduction in SPPB scores over two years than women who did not report UI (β =-0.533, p=0.001). Conclusion: UI is associated with worse results in SPPB and negatively influences physical performance over two years, since women with UI have a more pronounced decline in physical performance in this period. These findings serve as the basis for the planning and implementation of early interventions to improve the aging profile of women and the quality of life of this population. Key-words: Women's Health. Muscle Strength. Urinary Incontinence. Aging. Epidemiology..

(11) LISTA DE ILUSTRAÇÕES. Figura 1 - Trajectories of SPPB scores in two years for older women with and without urinary incontinence, adjusted by age…………………………………………………......... 25.

(12) LISTA DE TABELAS. Tabela 1 Sample characteristics in 2014 according to urinary incontinence...……...........22 Tabela 2 Adjusted multiple linear regression models for physical performance (SPPB) in 2014……………………………………………………………………………………..………..23 Tabela 3 Linear mixed models for longitudinal effects of urinary incontinence on physical performance (SPPB score) (N=775)……………………………………………............25.

(13) LISTA DE ABREVIATURAS E SÍMBOLOS. IMIAS SPPB UI. International Mobility In Aging Study Short Physical Performance Battery Urinary Incontinence.

(14) SUMÁRIO. 1. INTRODUÇÃO…………………………………………………………………. 16. 2. MÉTODO………..………………………………………………………………. 18. 2.1. Tipo do estudo...........…………………………………………………………...... 18. 2.2. Estratégia de amostragem...................…..………………………………………... 18. 2.3. Coleta de dados………............…………………………………………………... 18. 2.4. Desfecho: Desempenho físico........................……………………………………. 18. 2.5. Exposição: Incontinência urinária..….......................…………………………….. 19. 2.6. Covariáveis........………………………………………………………………….. 19. 2.6.1. Variáveis socio-demográficas…...…………………………………………….... 19. 2.6.2. Medidas antropométricas…………………………………………………......... 20. 2.6.3. História reprodutiva……………………………………………………………. 20. 2.7. Aspectos éticos…………..……………………………………………………….. 20. 2.8. Análise estatística.................……………………………………………………... 20. 3. RESULTADOS………………………………………………………………….. 22. 4. DISCUSSÃO…………………………………………………………………….. 26. 4.1. Resumo dos resultados………….……………………………………………….. 26. 4.2. Pontos fortes e limitações…………………...……………………………………. 26. 4.3. Interpretação…………………….………………………………………………... 26. 4.4. Relevância dos achados do estudo.….........................…………………………… 28. 5. CONCLUSÃO…………………………………………………………………... 29. REFERÊNCIAS………………………………………………………………………….. 30. APÊNDICE 1 –QUESTIONÁRIO IMIAS (2014)...………………………………..….. 34.

(15) 15. Urinary incontinence is associated with physical performance decline in communitydwelling older women: results from the International Mobility in Aging Study IMIAS. Authors: Luana Caroline de Assunção Cortez Corrêa, Faculty of Health Sciences of Trairi/ Federal University of Rio Grande do Norte, lu_cortez_29@hotmail.com. Catherine M. Pirkle, Office of Public Health Studies, University of Hawai’I at Manoa. cmpirkle@hawaii.edu. Nicole Rosendaal, Office of Public Health Studies, University of Hawai’I at Manoa, nicolerosendaal@gmail.com. Yan Yan Wu, Office of Public Health Studies, University of Hawai’I at Manoa, yywu@hawaii.edu. Saionara Maria Aires da Câmara, Faculty of Health Sciences of Trairi/ Federal University of Rio Grande do Norte, saionaraaires@gmail.com.. Correspondent autor: Luana Caroline de Assunção Cortez Corrêa, Faculty of Health Sciences of Trairi/ Federal University of Rio Grande do Norte, Rua Nova Europa, Parnamirim – Brazil. Email: lu_cortez_29@hotmail.com..

(16) 16. Abstract Objective To evaluate the influence of urinary incontinence (UI) on physical performance over a two-year period in older women from five sites with different socioeconomic conditions. Design Prospective cohort study using data from International Mobility in Aging Study (IMIAS). Setting Saint-Hyacinthe (Canada), Kingston (Canada), Manizales (Colombia), Tirana (Albania) and Natal (Brazil) during the period of 2014-2016. Population A total of 915 community-dwelling women aged between 65 to74 years old. Method Multiple linear regression analysis evaluated the cross-sectional relationship between UI and physical performance. The longitudinal effect of UI on physical performance over 2 years was evaluated by analysis of linear mixed models. For both analysis, the results were adjusted by covariates (age, study site, education, income sufficiency, BMI and parity). Main outcome measures Urinary incontinence was assessed by self-report of episodes of involuntary loss of urine in the last week, classified as "none in the past 7 days" and "some in the last 7 days". Physical performance was assessed using the Short Physical Performance Battery (SPPB) following a standardized protocol that measures balance, gait and lower limbs strength. The SPPB final score is a sum of the points of each test, ranging from 0 to 12 points (4 points for each test). Results The prevalence of urinary incontinence ranged from 11.4% (Natal) and 30.7% (Kingston). The women who reported some loss of urine presented a significantly lower SPPB mean than the others, even in the fully adjusted models (β = -0.469, p = 0.009). In addition, they show a significantly greater reduction in SPPB scores over two years than women who did not report UI (β = -0.533, p = 0.001). Conclusions UI is associated with worse results in SPPB and negatively influences physical performance over two years, since women with UI have a more pronounced decline in physical performance in this period. The study highlights the importance of health promotion practices to reduce the incidence of urinary incontinence on this population, then contributing to a healthier aging. Keywords Women's Health, Muscle Strength, Urinary Incontinence, Aging, Epidemiology..

(17) 17. 1. INTRODUCTION Physical performance measures evaluate a subject’s performance on standardized tasks,. according to predetermined criteria that may include counting repetitions or timing for an activity, such as walking or rising from a chair¹. Physical performance measures can inform clinical practice, since they are capable of predicting adverse outcomes such as disability, institutionalization, and mortality, particularly in the older adults2-4. Previous studies document notable differences in physical performance measures between the sexes 5,6. Women at more advanced ages tend to perform poorer at physical performance tests than men of similar ages, suggesting that there are gender-related factors that may influence physical performance over a lifetime7. A number of possible explanations for these differences have been raised, including biological factors, such as menopause7 and social aspects, such as gender inequality8, as well as physical and psychological violence9. Yet, to date, the pathways underpinning the lower average levels of physical function among older women compared to similarly aged men have been poorly delineated and require additional investigation. Reproductive history is hypothesized as one explanation for women’s poorer physical performance as they age, compared to men. The adverse effects of high parity and early age at first childbirth on physical performance have been reported in previous studies of older and middle-aged women10,11. An elevated number of pregnancies and deliveries can permanently impair the function of muscles around the pelvic floor, pelvis and hips and contribute to the development of detrimental gynecological disorders such as urinary incontinence, among a range of other clinical conditions12,13. Urinary incontinence (UI) is estimated to affect approximately 25% of older women based on epidemiological studies of large representative samples in the United States (24.7% in women aged 60-69)14, Spain (26.6% in women aged 65 - 74 years)15 and Brazil (22.2% in women aged 60-74 years)16. Studies also document that UI increases with advancing age14,15. Age-related decline in muscle strength and physical function in older women is directly associated with UI17-20. However, few studies have examined the inverse relationship, urinary incontinence contributing to negative impacts on physical performance21-23. It is possible that the.

(18) 18. social, physical and psychological impacts caused by urinary incontinence may make women increasingly less active contributing to the decline in physical performance23. It is also possible that fear of episodes of lost urine affects women’s performance in commonly used tests of physical performance, since trunk and body members movements required during testing cause an increase in intra-abdominal pressure in a cephalocaudal direction24. This creates overload on the pelvic floor muscles sufficient to allow intravesical pressure to exceed intraurethral pressure, thus predisposing urine leakage25. The objective of this study is two-fold: 1) Assess if there is an association between urinary incontinence and physical function using a multi-site sample of older women from sites in Canada, Albania, Colombia, and Brazil and 2) Evaluate the influence of urinary incontinence on physical performance changes over a two-year period in this same sample of older adults. We hypothesize that women reporting urinary incontinence will experience a greater decline in physical performance over two years, even after statistical adjustment of confounding variables and baseline physical function measures..

(19) 19. 2. 2.1. METHOD. Study design This paper presents longitudinal analysis from the International Mobility in Aging Study. (IMIAS). IMIAS is a prospective study whose main objective is to evaluate changes in mobility and disability in community-dwelling older adults living in five sites with different socioeconomic conditions: Saint-Hyacinthe (Quebec, Canada), Kingston (Ontario, Canada), Manizales (Colombia), Tirana (Albania), and Natal (Brazil). Details of the study sites and procedures can be found in the study by Zunzuneguiet al (2015)6.. 2.2. Sampling strategy A sample of 2.002 community-dwelling participants, ages 65–74 years, was recruited in. 2012, being approximately 200 women and 200 men per site. Re-evaluations were conducted every two years in 2014 and 2016. For this study, we used data from 2014 and 2016, as information on pelvic floor dysfunction was only collected in 2014. Of the total number of women, 915 were reassessed in 2014, being the sample used in the present study. At baseline the Leganes Cognitive Test (LCT) was used to screen mental status during initial recruitment and individuals who were disoriented. Four or more errors were considered as exclusion criteria, since low scores indicated inability to complete study procedures, as well as freely consent to the study26. The number of excluded people was zero in Kingston, one in SaintHyacinthe and Tirana, two in Manizales and five in Natal.. 2.3. Data collection All participants were evaluated by trained interviewers according to standard protocols, as. described below. Manuals of all procedures were available in the study languages (Albanian, Spanish, Portuguese, English and French) and are available upon request.. 2.4. Outcome: Physical performance Physical performance was assessed by the Short Physical Performance Battery (SPPB),. which consists of a set of three tests that evaluate static balance, gait speed at usual step, and chair stands2..

(20) 20. Balance Test: Participants were invited to stay for 10 seconds in three positions with increasing difficulty level: (1) side by side stand; (2) semi-tandem (heel of one foot alongside the big toe of the other foot); (3) tandem (heel of one foot directly in front of the other foot). If in any of the first two tests the participant could not sustain the position, the balance test should be stopped. In the first two positions, 1 point is assigned if performed in time ≥ 10 seconds. In the third position, the score varies from 0 to time <3 seconds, 1 point between 3 and 9.99 seconds and 2 points if the participant stays for ≥ 10 seconds. Gait Speed Test: Participants were instructed to stand with both feet touching the starting line and to start walking after a specific verbal command. Participants were asked to walk at their usual pace over a 4-m course. The faster of two walks was used to calculate the result, being assigned the values of 0 when unable to perform the test, 1 point if the time was> 8.70 seconds, 2 points if the time was between 6.21 and 8.70 seconds, 3 points between 4.82 and 6.20 seconds, and 4 points if time was <4.82 seconds. Chair Stand Test: Participants were asked to stand up and sit down five times as quickly as possible with arms folded across their chests. This was done only after participants first demonstrated the ability to rise once. The time taken to complete the five movements was recorded and assigned the value 0 when unable, 1 point if>16.7 seconds, 2 points between 13.7 and 16.69 seconds, 3 points between 11.2 and 13.69 seconds and 4 points if <11.19 seconds. The SPPB final score is the sum of the points scored in the three tests, ranging from a minimum of 0 points to a maximum of 12 points (4 points for each stage).. 2.5. Exposure: Urinary incontinence (UI). Information about UI was self-reported through the question "In the last 7 days, how many times did you accidentally lose urine?”. The possible answers were: “none”, “once” and “more than once”. Those reporting once or more than once were categorized as "some in the last 7 days" and those who answered none were categorized as "none in the last 7 days".. 2.6. Covariates:. 2.6.1. Socio-demographic variables. The socio-demographic variables collected were age, education level and income. Age was self-reported and recorded in years. The education level was collected in years of study and.

(21) 21. categorized as lowest, middle and highest, according to the 25th and 75th percentiles of each city of study. This categorization was made due to the large differences in years of schooling among sites of study27. The income sufficiency was self-reported and categorized as very well, suitably, and not/not very well.. 2.6.2. Anthropometric Measures. Weight (kg) and height (m) were collected following a standardized protocol and used to calculate body mass index (BMI).The BMI score was obtained through a mathematical operation (BMI = weight / height²) and categorized as: underweight/normal weight (<18.5-24.9), overweight (25.0–29.9), and obese (>30.0)28.. 2.6.3. Reproductive History. Participants were questioned in relation to the number of children they had throughout their lives, and the parity variable was then categorized as nulliparous, 1-3 children and 4 or more. Previous studies report that women with more than 3 children have higher chances to have worse physical performance11 and chronic diseases10.. 2.7. Ethical aspects The study was approved by local ethics boards at the respective sites and all participants. were informed about the research procedures and written informed consent.. 2.8. Statistical analysis Analyses were carried out using STATA/SE (version 14.0; Stata Corp LP, College. Station, TX, USA). First, descriptive statistics were presented according to urinary incontinence variable and compared using chi-square tests or Student t test. Linear regression models were used to evaluate the cross-sectional associations between physical performance (SPPB scores) and urinary incontinence. Two models were performed. In the first model, the association was adjusted for socioeconomic variables (age, study site, education and income sufficiency). In the second model, we added the variable BMI and parity. We performed generalized linear mixed model analyses, with SPPB as dependent variable and UI as fixed effect, adjusted for the all.

(22) 22. covariates, to evaluate whether UI is a predictor of longitudinal changes in the SPPB after two years. For all steps, we considered p<0.05 and Confidence Intervals of 95%..

(23) 23. 3. RESULTS. The characteristics of the sample according to UI in the 2014 wave are presented in the table 1. The prevalence of UI in the sample ranged from 11.4% to 30.7%, being lower in Natal and higher in Kingston. Those reporting none UI in 2016 presented on average higher SPPB than those reporting some UI (p<0.001).. Table 1: Sample characteristics in 2014 according to urinary incontinence. Urinary incontinencea Full Sample (N=915) Age (mean, SD). 71.2 (2.88). Some in the last 7 days (N=211) 71.2 (2.86). None in the last 7 days (N=703) 71.2 (2.89). Study Site (N,%). 0.994 <0.001. Kingston. 182 (19.9%). 56 (31.1%). 125 (68.9%). St. Hyacinthe. 184 (20.1%). 54 (29.4%). 130 (70.6%). Tirana. 194 (21.2%). 46 (23.7%). 148 (76.3%). Manizales. 188 (20.5%). 36 (19.2%). 152 (80.8%). Natal. 167 (18.3%). 19 (11.4%). 148 (88.6%). Education Level (N,%). 0.298. Low. 351 (38.4%). 90 (25.6%). 260 (74.4%). Medium. 361 (39.4%). 80 (22.2%). 281 (77.8%). High. 203 (22.2%). 41 (20.2%). 162 (79.8%). Lifetime parity (N,%). 0.489. Nulliparous. 102 (11.4%). 20 (19.6%). 82 (80.4%). 1-3 children. 510 (55.9%). 123 (24.3%). 386 (75.7%). 4 or more. 297 (32.7%). 233 (78.5%). 64 (21.5%). BMI (N,%). p-value. 0.009.

(24) 24. Underweight/Normal. 237 (26.1%). 43 (18.1%). 194 (81.9%). Overweight. 360 (39.5%). 78 (21.7%). 282 (78.3%). Obese. 313 (34.4%). 90 (28.9%). 222 (71.1%). Income Sufficiency (N,%). 0.136. Very well. 230 (25.1%). 64 (27.8%). 166 (72.2%). Suitably. 277 (30.3%). 59 (21.3%). 218 (78.7%). Not very well. 407 (44.6%). 88 (21.9%). 318 (78.1%). SPPB mean in 2014 (mean, SD). 0.094 9.17 (2.19). 8.92 (2.35). 9.21 (2.17). SPPB mean in 2016(mean, SD). 8.95 (2.49). 8.28 (2.87). 9.17 (2.31). <0.001. a: 1 missing value.. Table 2 shows the multiple linear regression results for SPPB mean score in 2014. Those women reporting some UI presented significant lower means of SPPB score compared to those reporting none UI, even in the fully adjusted model.. Table 2: Adjusted multiple linear regression models for physical performance (SPPB score) in 2014. Model 1 (N=913)* Model 2 (N=902)* β Constant. CI 95%. 15.988 12.706: 19.269. p-value Β. CI 95%. p-value. <0.001. 14.140 : 20.584. <0.001. -0.716:-0.103. 0.009. 17.362. Urinary Incontinence None in last week. Ref. Some in last week. -0.469. Ref -0.782:-0.157. 0.003. -0.409. Study Site Kingston. Ref. Ref.

(25) 25. St. Hyacinthe. -0.216. -0.636 : 0.203. 0.312. -0.165. -0.575:0.244. 0.428. Tirana. -1.265. -1.781:-0.748. <0.001. -1.126. -1.633:-0.618. <0.001. Manizales. -1.471. -1.992:-0.949. <0.001. -1.466. -1.996:-0.936. <0.001. Natal. -1.001. -1.530:-0.484. <0.001. -0.866. -1.400:-0.331. 0.002. Educational level High. Ref. Ref. Middle. -0.246. -0.593:0.100. 0.163. -0.180. -0.522:0.161. 0.300. Low. -0.613. -0.971 : -0.254. 0.001. -0.492. -0.848 : -0.136. 0.007. Income sufficiency Very sufficient. Ref. Ref. Suitable. -0.316. -0.723 : -0.090. 0.127. -0.211. -0.608 : 0.186. 0.298. Insufficient. -0.901. -1.384 : -0.418. <0.001. -0.888. -1.362 : -0.414. <0.001. Normal. -. -. -. Ref. Overweight. -. -. -. -0.017. -0.337:0.303. 0.917. Obese. -. -. -. -0.761. -1.097 : -0.424. <0.001. Nulliparous. -. -. -. Ref. 1 to 3. -. -. -. 0.036. -0.381 : 0.152. 0.867. 4 or more. -. -. -. -0.095. -0.562:0.372. 0.690. BMI. Lifetime parity. *Models adjusted by age in 2014.. Table 3 shows the generalized linear mixed models for longitudinal effects of UI on SPPB score. UI incontinence is a significant predictor of longitudinal changes in SPPB score after two years. Those reporting UI present SPPB mean decreased by 0.5 points more than those without UI at the follow-up (p=0.001)..

(26) 26. Table 3: Linear mixed models for longitudinal effects of urinary incontinence on physical performance (SPPB score) (N=775). Variable Coefficient Standard error p-value Time -0.214 0.082 0.009 Urinary incontinence -0.449 0.174 0.010 (yes) Time x Urinary -0.533 0.167 0.001 incontinence Model adjusted by age, study site, educational level, income sufficiency and parity.. The effect of UI on SPPB is also presented in figure 1. Those reporting UI present worse physical performance in the first evaluation and present a greater decline in SPPB score after two years.. Figure 1: Trajectories of SPPB scores in two years for older women with and without urinary incontinence, adjusted by age (p<0.001)..

(27) 27. 4. 4.1. DISCUSSION. Summary of the results This study investigated the effect of UI on physical performance over a two-year period in. older women from different settings. We hypothesized that this urogynecological disorder affects physical functioning, contributing to decline of mobility in aging. According to our results, UI is associated to physical performance in a sample of older women from different settings, and also predicts physical performance decline in two years. Those women reporting episodes of UI performed worse in the physical performance tests and presented greater decline in physical performance after two years of follow-up than those reporting none UI episodes.. 4.2. Strengths and Limitations. As far as we know, this is the first study that investigated the longitudinal effects of UI on physical functioning in a sample of older women from very distinct populations. Most of the studies performed on this subject investigated the inverse relationship (physical functioning decline leading to UI), and there is also a lack of studies about this subject with samples from middle- and low-income populations. The IMIAS data set allowed us to observe this association in distinct geographical and socioeconomic locations. However, this study has some limitations and the findings must be interpreted considering some aspects. It was not possible to perform a clinical assessment to identify UI, and it is possible that there is some under-reporting of this condition, since the evaluation of UI was carried out using self-report. However, there is no reason to believe that people with greater physical functioning decline in two years have underreported UI differently from those with smaller or no decline. So any misclassification would probably be non-differential in nature, and bias would have no effect.. 4.3. Interpretation The association between UI and physical functioning decline may be explained by the fact. that women with this condition may avoid risks and constraints during the daily-living activities because of the fear of losing urine involuntarily in public29,30. This may be true particularly for activities that demand muscle strength and increase the intraabdominal pressure, imposing overload to the pelvic floor muscles, such as raising fast from a chair and walking in a faster.

(28) 28. speed. The reduction of the intensity during these activities may lead to a greater physical decline over the long-term, and, similarly, these women may not have used their full capacity when performing the physical tests that compose SPPB. Corroborating these results, the severity of UI seems play an important role on the physical functioning; in a research with 1942 French older women31 those reporting severe UI presented even worse tests results of performance on motor and balance skills. than those reporting lower degrees. As previously described, SPPB is. composed by stand balance, gait speed and chair stand tests, and these hypotheses may explain our cross-sectional and longitudinal findings. The association between UI and physical performance decline may be also explained by previous factors that may cause both at the same time, such as reproductive aspects. Previous studies have already shown that different aspects related to women's reproductive history, such as pregnancy and childbirth, and the postpartum period can increase the overload on the pelvic floor muscles and lead to UI10,32. Hormonal factors related to pregnancy, vaginal childbirth and number of deliveries can cause lesions in the fascia, muscles, ligaments and pelvic floor nerves, and lead to reduction of the pelvic floor muscle strength exposing women to a higher risk of developing UI12,32. Moreover, there is consistence evidence associating women’s reproductive history and physical performance. 10,11,33. . A previous study with middle-aged women from Northeast Brazil. found that those women who were adolescent mothers and/or had at least three children performed worse in the chair stands tests than the ones that had no child or had their first childbirth during the adult life and/or had only 1-2 children11. The association between early maternal age and physical functioning was also showed in the IMIAS population10. There is a possibility that the reproductive history lead to both UI and decline and physical performance. However, the association between UI and physical performance was maintained even when adjusted for lifetime parity and age at first birth. So, it is likely that UI is in the causal pathway between reproductive aspects, such as early maternal age and multiparity, and the decline in physical functioning. More research is needed to elucidate these hypotheses. Studies have shown that decline in physical function, particularly impairment of mobility and lower body strength, are an important risk factor for the development and/or increase of UI frequency17-20. In women, a slower time to stand from chair 5 times was significant independent predictors of incident incontinence18 and women who had decline in walk speed and chair 5 times were more strongly correlated with having more frequent incontinence17. This association can be.

(29) 29. a direct consequence of the inability getting the toilet and remove the clothes before losing urine. Thus, it is possible that the relationship between physical performance and urinary incontinence is bidirectional, generating a cycle where the reduction of physical performance causes an increase in cases of UI and UI causes a reduction in physical performance.. 4.4. Relevance of the study findings UI is a common condition among older women and its incidence and severity tend to. increase with age. The involuntary leakage of urine interferes negatively in the quality of life, being able to generate stressful situations, social embarrassment, anxiety and depression, thus resulting in social isolation and decrease of the physical activity, contributing to the decline of the physical performance31,34. In addition, UI was previously associated with worse self-reported health status16,35,36. Previous studies have reported that low scores in the SPPB (Short Physical Performance Battery) are associated with adverse health conditions such as mortality and loss of physical abilities2,4,37,38. Even minimally change of 0.3 – 0.8 points in the SPPB average over 12 months have been considered a meaningful change in older adults39. Our findings help to understand the factors associated with declining physical performance with aging, serving as the basis for planning and applying early and appropriate interventions to improve physical performance at more advanced ages, reducing disability rates, and improving the quality of life of the population..

(30) 30. 5. CONCLUSION. This research shows that older women with urinary incontinence present worse physical performance and a greater decline in physical function over two years than those reporting no episodes of urinary incontinence. The study contributes to a better understanding of issues influencing women’s physical functioning as they age, and highlights the importance treatment, rehabilitation and health prevention practices to reduce the incidence of urinary incontinence on this population, then contributing to a healthier aging..

(31) 31. REFERENCES 1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: Association with selfreported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:85–94. 2. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM. Physical Performance Measures in the Clinical Setting. JAGS 2003;51:314–322. 3. Winter GR, Livramento GA, Fagundes PPAN, Alves RC, Krause1 MP. Comparison of the functional profile of elderly women with urinary continence and incontinence. Acta sci., Health sci 2014;36:147-152. 4. Rolland Y, Lauwers-Cances V,Cesari M,Vellas B, Pahor M,Grandjean H. Physical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol 2006;21:113-122.. 5. Hansen AM, Andersen LL, Skotte J, Christensen U, Mortensen OS, Molbo D, Lund R, Nilsson CJ, Avlund K. Social Class Differences in Physical Functions in Middle-Aged Men and Women. J Aging Health2014;26:88–105. 6. Zunzunegui MV, Alvarado BE, Guerra R, Gómez JF, Yllie A, Guralnik JM. The mobility gap between older men and women: The embodiment of gender. Arch Gerontol Geriatr 2015;61:140-148.. 7. Cooper R, Mishra G, Clennell S, Guralnik J, Kuh D. Menopausal status and physical performance in midlife: findings from a British birth cohort study. Menopause 2008;15:10431044. 8. Mechakra-Tahiri SD, Freeman EE, Haddad S, Elodie Samson E, Zunzunegui MV. The gender gap in mobility: A global cross-sectional study. BMC Public Health 2012;12:598. 9. Ahmed T, Vafaei A, Auais M, Guralnik J, Zunzunegui MV. Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS). PLoS ONE 2016;11:1-18.. 10. Pirkle CM, Sousa ACPA, Alvarado B, Zunzunegue MV. Early maternal age at first birth is associated withchronic diseases and poor physical performance in older age: cross-sectional analysis from the International Mobility in Aging Study. BMC Public Health 2014;14:293..

(32) 32. 11. Câmara SMA, Pirkle C, Moreira MA, Vieira MCA, Vafaei A, Maciel ACC. Early maternal age and multiparity are associated to poor physical performance in middle-aged women from Northeast Brazil: a cross-sectional community based study. BMC Womens Health 2015;15: 56. 12. Özdemir ÖC, Bakar Y, Nuriy O, Duran B. The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study. J. Phys Ther Sci 2015;27:2133-2137.. 13. Wall LL. Birth trauma and the pelvic floor: Lessons from the developing world. J Womens Health 1999;8:150-155. 14. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD. Prevalence and trends of symptomatic pelvic floor disorders in U.S. Women. Obstet Gynecol 2014;123: 141–148.. 15. Espuña-Pons M, Guiteras PB, Sampere DC, Bustos AM, Penina AM. Prevalencia de incontinência urinaria em Cataluña. Med Clin (Barc) 2009;133:702–705. 16. Tamanini JTN, Lebrão ML, Duarte YAO, Santos JLF, Laurenti R. Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging). Cad. Saúde Pública 2009;25:1756-1762.. 17. Huang AJ, Brown JS, Thom DH, Fink HA, Yaffe K. Urinary incontinence in older community-dwelling women: The role of cognitive and physical function decline. Obstet Gynecol 2007;109:909–1. 18. Goode PS, Burgio KL, Redden DT, Markland A, Richter HW, Sawyer P, Allman RM. Population-based study of incidence and predictors of urinary incontinence in African american and white older adults. J Urol 2008;179:1449–1454.. 19. Chiu AF, Huang MH, Hsu MH, Liu JL, Chiu JF. Association of urinary incontinence with impaired functional status among older people living in a long-term care setting. Geriatr Gerontol Int 2015;15:296–301. 20. Suskind AM, Cawthon PM, Nakagawa S, Subak LL, Reinders I, Satterfield S, Cummings S, Cauley JA, Harris T, Huang AJ. Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study. J Am Geriatr Soc 2016;65:42-50..

(33) 33. 21. Miles TP, Palmer RF, Espino DV, Mouton CP, Lichtenstein MJ, Markides KS. New-onset incontinence and markers of frailty: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. J Gerontol Med Sc Journal 2001;56:19–24. 22. Parker-Autry C, Houston DK, Julia Rushing J, Richter HE, Subak L, Kanaya AM, et al. Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence. Obstet Gynecol 2017;0:1–8.. 23. Nygaard I, Shaw J, Egger MJ. Exploring the association between lifetime physical activity and pelvic floor disorders: study and design challenges. Contemp Clin Trials 2012;33:819– 827. 24. Roza, T, Brandão S, Mascarenhas T, Jorge RN, Duarte JA.Urinary Incontinence and Levels of Regular Physical Exercise in Young Women.Int J Sports Med 2015;36:776–780.. 25. Jiang K, Novi JM, Darnell S, Arya LA. Exercise and Urinary Incontinence in Women. Obstet Gynecol Surv 2004;59:717:721. 26. de Yébenes MJG, Otero A, Zunzunegui MV, Rodríguez-Laso, A, Sánchez-Sánchez F, Del Ser T. Validation of a short cognitive tool for the screening of dementia in elderly people with low educational level. Int J Geriatr Psychiatry 2003;18:925–936.. 27. Hwang PW, Gomes, CS. Auais M, Braun KL, Guralnik JM, Pirkle CM. Economic Adversity Transitions From Childhood to Older Adulthood Are Differentially Associated With LaterLife Physical Performance Measures in Men and Women in Middle and High-Income Sites. J Aging Health 2017 [Epub ahead of print].. 28. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization. 2000. 29. Sinclair AJ, Ramsay IN. Review The psychosocial impact of urinary incontinence in women. The Obstetrician & Gynaecologist 2011,13:143–148. 30. Nicolson P, Kopp Z, Chapple CR, Kelleher C. It's just the worry about not being able to control it! A qualitative study of living with overactive bladder. Br J Health Psychol 2008;13(2):343-59. 31. Fritel X, Lachal L, Cassou B, Fauconnier A, Dargent-Molina P. Mobility impairment is associated with urge but not stress urinary incontinence in community-dwelling older women: results from the Ossebo study. BJOG 2013;120:1566–1574. 32. Memon HU, HandaVL. Vaginal childbirth and pelvic floor disorders. Womens Health 2013;9(3):1-18..

(34) 34. 33. Aiken ARA, Angel JL, Miles TP. Pregnancy as a Risk Factor for Ambulatory Limitation in Later Life. Am J Public Health 2012;102(12):2330-2335. 34. Morrisroe SN, Rodriguez LV, Wang PC, Smith AL, Trejo L, Sarkisian CA. Correlates of 1year incidence of urinary incontinence in older latino adults enrolled in a community-based physical activity trial. JAGS 2014;62:740–746. 35. Kwon BE, Kim GY, Son YJ, Roh YS, You MA. Quality of life of women with urinary incontinence: a systematic literature review. Int Neurourol J 2010;14:133-140. 36. Cardoso JDC, Azevedo RCS, Reiners AAO, Louzada CV, Espinosa MM. Auto avaliação de saúde ruim e fatores associados em idosos residentes em zona urbana. Rev Gaúcha Enferm 2014;35:35-41. 37. Pavasini R, Guralnik J, Brown JC, Bari M, Cesari M, Landi F, Vaes B, Legrand D, Verghese J, Wang C, Stenholm S, Ferrucci L, et al. Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Medicine 2016;14:215. 38. Cooper R, Kuh D. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 2010;341:c4467.. 39. Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ, Studenski SA. What is a meaningful change in physical Performance? Findings from a clinical trial in Older adults (the life-p study). Nutr Health Aging 2009;13:538–544..

(35) 35. APÊNDICE I – QUESTIONÁRIO IMIAS (2014). CONTACT INFORMATION Participant Identification No. French □. Language of the questionnaire. English □. Portuguese □ Spanish □. Contact Person Information (Not cohabiting) Relationship to participant Last name First name Full address. Telephone number Area Code. Number. Was the person alone or with somebody? Who is present? ☐ Alone ☐ Wife/Husband/Life partner ☐ Daughter ☐ Son ☐ Other family member ☐ Other non-family member Consent form signed. YES. NO. Keep this sheet with the consent form, separated from the following questionnaire.

(36) 36. EDUCATION Do you know how to read and write?. 1 No, I do not know how to read and write 2 I understand what I read, but I cannot write 3Yes, I understand what I read and I know how to write. How many years of school have you completed? INCOME Do you receive an income?. Do you receive income from. What is your individual annual income before taxes?. 1 2 3 4 0 1 2 3 4 5. Yes (go to the next question) If 2, 3 or 4 No go to household Does not know annual income. No response work Retirement or pension (includes CPP, OAS, etc.) Help from family in another country Help from family here Rental or investment income Government assistance (Ontario Works (welfare), Disability, ODSP) 6 Other__________specify 7 No answer 1 None 2 Less than $5,000 3 $5,001-$10,000 4 $10,001-$20,000 5 $20,001-$30,000 6 $30,001-$40,000 7 $40,001-$50,000 8 $50,001-$60,000 9 $60,001-$80,000 10 $80,001-$100,000 11 More than $100,000 12 No response.

(37) 37. What is your household annual income before taxes?. To what extent does your income allow you to meet your needs?. 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4. None Less than $5,000 $5,001-$10,000 $10,001-$20,000 $20,001-$30,000 $30,001-$40,000 $40,001-$50,000 $50,001-$60,000 $60,001-$80,000 $80,001-$100,000 More than $100,000 No response Very well Suitably Not very well Not at all. How many people depend partially or totally on your income (excluding yourself)? URINARY INCONTINENCE A) In the last 12 months, have you lost even a small 0 1 amount of urine?. B) During the last 7 days, how many times did you accidentally lose urine?. C) During the last 7 days, how many times did you have a strong feeling that you needed to empty your bladder, but you couldn’t get to the toilet fast enough?. 2 3 4 5 1 2 3 4 5 1 2 3 4 5. Never Once or more times per week or everyday’’ Once or more times per month Less than once per month Does not know No response None Once More than once Does not know No response None Once More than once Does not know No response.

(38) 38. D) During the past 7 days, how many times did you lose urine when coughing, sneezing, or laughing?. 1 2 3 4 5. None Once More than once Does not know No response. E) During the past 7 days, how many times did you lose urine without any physical exertion. That is, you were not exercising, coughing, laughing, etc. when you lost urine.. 1 2 3 4 5. None Once More than once Does not know No response. F) During the past 7 days, how many times did you lose urine without any warning (there was no sense of urgency before you lost urine)?. 1 2 3 4. None Once More than once Does not know No response. 5.

(39) 39. PHYSICAL PERFORMANCE (SPPB).

(40) 40. A. Side-by-side-stand Held for 10sec. 1point. Not held for10sec. 0 points. Not attempted. 0 points. If 0 points, end Balance Tests Number of seconds held if Less than 10sec:_. .. _sec. If participant did not attempt test or failed, circle why: Tried but unable. 1. Participant could not hold position unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable tounderstandinstructions. 5. B. Semi-Tandem Stand Other(specify)_. 6. Participantrefused. 7. Held for10sec. Not held for10sec Not attempted. Number of seconds held if. If participant did not attempt test or failed, circle why: Tried but unable. 1. Participant could not hold position unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable tounderstandinstructions. 5. Other(specify)_. 6. Participantrefused. 0 points 0 points (circle reason above). If 0 points, end Balance Tests. Less than 10sec:_. 1point. .. sec. 7.

(41) 41. GAIT SPEED TEST SCORING: Length of walk test course:. Four meters. Three meters. A. Time for First Gait Speed Test (sec) 1.. Time for 3 or 4 meters _. ._. sec. 2.. If participant did not attempt test or. failed, circle why: Tried but unable. 1. Participant could not walk unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable to understand instructions. 5. Other (Specify). 6. Participant refused. 7. Complete score sheet and go to chair stand test 3.. Aids for first walk. 4.. Comments:. None. Cane. Other. Time for Second Gait Speed Test (sec) 1. Time for 3 or 4 meters. sec 2. If participant did not attempt test or failed,. circle why: Tried but unable. 1. Participant could not walk unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable to understand instructions. 5. Other (Specify). 6. Participant refused. 7. B Aids for second walk. None. Cane. Other. What is the time for the faster of the two walks? Record the shorter of the two times _. .. sec. Sec [If only 1 walk done, record that time] If the participant was unable to do the walk:.

(42) 42. 0 points For 4-Meter Walk: For 3-Meter Walk: If time is more than 8.70 sec:. 1 point. If time is 6.21 to 8.70 sec:. 2 points. If time is 4.82 to 6.20 sec:. 3 points. If time is less than 4.82 sec:. If time is more than 6.52 sec:. 1 point. If time is 4.66 to 6.52 sec:. 2 points. If time is 3.62 to 4.65 sec:. 4 points. If time is less than 3.62 sec:. 3 points 4 points. Single Chair Stand Test A. Safe to stand without help. YES. NO. Results: → Go to Repeated Chair Stand Test Participant used. Participant stood without using arms arms to stand. → End test; score as 0 points. Test not completed. → End test; score as 0 points. B. If participant did not attempt test or failed, circle why: Tried but unable. 1. Participant could not stand unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable to understand instructions. 5. Other (Specify). 6. Participant refused. 7. Repeated Chair Stand Test. YES. A. Safe to stand five times. NO. If five stands done successfully, record time in seconds. Time to. complete five stands. _.. sec. B. If participant did not attempt test or failed, circle why:. Tried but unable. 1. Participant could not stand unassisted. 2. Not attempted, you felt unsafe. 3. Not attempted, participant felt unsafe. 4. Participant unable to understand instructions. 5.

(43) 43. Other (Specify). 6. Participant refused. 7. Scoring the Repeated Chair Test Participant unable to complete 5 chair stands or completes stands in >60 sec: If chair stand time is 16.70 sec or more:. 1 points. If chair stand time is 13.70 to 16.69 sec:. 2 points. If chair stand time is 11.20 to 13.69 sec:. 3 points. If chair stand time is 11.19 sec or less:. 4 points. 0 points. Scoring for Complete Short Physical Performance Battery Test Scores Total Balance Test score. ________ points. Gait Speed Test score. ________ points. Chair Stand Test score. ________ points. Total Score. ________ points (sum of points above)..

(44) 1.

(45)