Getting Familiar with Contemporary Objective Tests and Measure
Short Physical Performance Battery (SPPB)

By Gary Burgess
Therapy Manager
Arlington Court Skilled Nursing & Rehab

As most of you know objective tests and measures are the vital criteria for justification of skilled services in a SNF setting. Many different tests with many different formats provide a clinician the information necessary to document therapeutic progress within a rehab setting. One specific useful examination that many may not be aware of is the Short Physical Performance Battery or SPPB. Years of research and many different case studies including multiple diagnosis have went into preparing this useful predictive tool to inform patients and families of patients the risks that come with aging and the direct correlation of fall risks and increasing mortality rate. At Arlington Court we have the capability of providing this exam and educating patients and loved ones the sometimes unfortunate reality that comes with age.  The meticulous nature of this test gives clinicians as well as the patient marked numeric progress when other basic tests may not. As we all know even minimal marked progress is extremely important when attempting to maintain morale in a SNF setting.

The SPPB is a test made up of 5 concise components and requires only a stopwatch and tape measure for the clinician and a chair for the client. The test is scored in a range from zero (worst) to 12 (best). The SPPB has been proven to show valid prediction of a patient at risk for mortality, inpatient admission, and disability.

Component 1-Chair Rise Task

The clinician will instruct the patient to fold arms across chest and stand up then sit back down in the chair 5 times as quickly as safely possible without stopping. Always demonstrate movement before testing. Have patient start in seated position and start timer as soon as patient begins to move. Count aloud the number of repetitions as the patient completes and stop the timer as patient has sat down after 5th stand. Record the amount of time required and note any presence of imbalance. The recorded time will be utilized in scoring according to the outcome measures.

Patient unable to complete 5 stands or completes in greater than 60 sec-0 points

If completed time is 16.70 sec or more-1 point
If completed time is 13.70 to 16.69 sec-2 points
If completed time is 11.20 to 13.69 sec-3 points
If completed time is less than 11.20 sec-4 points

Components 2, 3, 4-Balance Testing

This is a quick task to measure standing balance with the client’s feet in three different positions. First, the clinician will instruct the patient to stand with feet together for 10 seconds without upper extremity support. Allow client to utilize arms to get into position and start timer when they let go and stand unsupported. If patient is able to complete then progress to semi tandem stance. Repeat previous steps with the exception of patient placing heel of one foot beside the big toe of the other. If client is able to complete 10 seconds and semi tandem then progress to full tandem stance. Have patient place one foot directly in front of the other and start timer once patient is no longer utilizing arms for support. The test is stopped when the client moves their feet, grabs for clinician, or after 10 seconds have elapsed. The therapist will record the time for scoring.

Side by Side stance
Held for 10 sec-1 point
Unable to hold for 10 sec-0 points

Semi-Tandem stance
Held for 10 sec-1 point
Unable to hold for 10 sec-0 points

Tandem Stance
Held for 10 sec-2 points
Held for 3 to 9.99 sec-1 point
Held for less than 3 sec-0 points

Component 5-Gait Speed Test

The clinician measures out 4 meters or roughly 13 feet in a straight line. They then instruct the patient to walk the distance as quickly as one can safely perform. Assistive devices are allowed in this exam. Start the timer when the patient begins to walk and stop when the patient completely crosses the finish line. Repeat the gait speed test once more and record the fastest time on the score sheet.

If patient walked 4 meters in 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-4 points

The sum of the points scored within the chair stand test, three balance tests, and the gait speed test will total between zero and 12. Total scoring of 0 to 4 represents a high risk of inpatient readmission, 5 to 8 a moderate risk, and 9 to 12 a low risk. At Arlington Court, we have begun utilizing the SPPB because the meticulous nature of scoring provides the ability to quantify minimal improvement over time, further promoting justification of skilled services when it may not be warranted otherwise.