PhenX Measures: Physical Activity Frailty and Falling Barbara - - PowerPoint PPT Presentation

PhenX Measures: Physical Activity Frailty and Falling

Barbara Konkle

4.18

Physical Activity

• Existing Measures

– Many require physical activity that could be impacted by joint disease – Disability index proprietary for leg/back – Impairment - psychological functioning – Sitting-sedentary – very detailed – Total physical activity – too detailed

Physical Activity – Existing Measures to Consider

• Physical Activity (IPAQ)
• Total Physical Activity Screener
• Physical Functioning – Subjective (NHANES)
• Physical Activity Self-Efficacy – Adolescent Protocol
• (Physical Activity Self-Efficacy – Adult Protocol)
• Body Mass Index

Hemophilia Activities List

• The HAL measures the impact of hemophilia on self-

perceived functional abilities in adults.

• It contains 42 multiple choice questions in seven

domains:

– Lying/sitting/kneeling/standing (8 items) – Functions of the legs (9 items) – Functions of the arms (4 items) – Use of transportation (3 items) – Self-care (5 items) – Household tasks (6 items) – Leisure activities and sports (7 items)

Van Generen FR et al, Haemophilia 2006;12:36-46. Timmer et al, Haemophilia 2018;24:e33-e49.

PedHAL

• The PedHAL should be selected to measure the impact of

hemophilia on self-perceived functional abilities in children.

• The current version (0.11) consists of 53 items in seven

domains:

– Sitting/kneeling/standing (10 items) – Functions of the legs (11 items) – Functions of the arms (6 items) – Use of transportation (3 items) – Self care (9 items) – Household tasks (3 items) – Leisure activities and sports (11 items) – A parent/proxy (age 4-8) and child version (8-18) was constructed with some minor linguistic differences (see questionnaires, above).

Groen WG, et al. Haemophilia 2010; 16(2):281-9. Timmer et al, Haemophilia 2018;24:e33-e49

Functional Independence Score for Patients with Hemophilia (FISH)

• Measures difficulty in performing

– Eating – Grooming – Bathing – Dressing – Chair Transfer – Squatting – Walking Pattern – Stair Climbing – Running

Poonoose et al, Haemophilia 2006;11:598-602. Timmer et al, Haemophilia 2018;24:e33-e49.

Frailty/Fall: Existing Measures

• Fracture history – too detailed and too much
• n hip fracture
• Balance/one leg – too variable in hemophilia1

– Impact of joint disease

• Arthritis/Osteoarthritis – too X-ray based and

focus on osteoarthritis common targets

• Spine and Femur DEXA – too female oriented
• Muscle strength – hand grip probably not

relevant

1Stephensen D et al, Haemophilia 2016;22:e512-e518.

Frailty/Fall to Consider

• If we want-
• Timed Up & Go (TUG)1,2

– Time to rise from a chair, walk 3 meters, turn around, walk back to the chair, turn around and sit back down. – Takes little time to administer and high inter-rater reliability – 87% sensitivity and specificity – In small hemophilia study (n=75 > 40 yrs) differentiated between multiple fallers and non-fallers3

1Shumway-Cook A et al, Predicting the probability for falls in community-dwelling older

adults using the Timed UP & Go Test. Phys. Ther. 200;80:896-903.

2Perell KL et al. Fall risk assessment measures: an analytic review. J Gerontol

2001;56A:M761-M766.

3Sammels M. Falling and fall risk factors in adults with haemophilia: an exploratory study.

Haemophilia 2014;20:836-45.

Male Osteoporosis/ Bone Density

• Male Osteoporosis Risk Estimation Score (MORES)1

– Used risk factor data from the NHANES Survey III to develop a best fitting multivariable logistic regression model in men >50 years

• Development cohort (1,497)
• Validation cohort (1,498)

– But used traditional risk factors which would not take into account effect of FVIII

• DXA scan (male emphasis or expand for both males

and females)

– Has been used to assess bone density in hemophila

1Shepherd AJ et al, Ann Fam Med 2007;5:540-6.