Physical functioning: Definitions, measurement, and expectations

The nephrology community has begun to recognize the importance of physical functioning in the overall treatment of their patients. Physical functionin g is highly associated with such outcomes as hospitalization, nursing home admission, falling, level of dependency, and death in older individuals. Be cause there are many terms used to refer to physical functioning, this repo rt classifies physical functioning into basic actions and complex activitie s; activities considered essential for maintaining independence, and those considered discretionary that are not required for independent living, but may have an impact on quality of life. We also present a model of the deter minants of physical functioning, which goes beyond the presence or absence of disease and considers physical, sensory, environmental, and behavioral f actors. Measurement of physical functioning can be complicated and ranges f rom self-report questionnaires to performance measures of specific tasks to vigorous laboratory measures. There are limitations to each of the measure ment methods; however, some level of assessment provides information about the patient that is not otherwise available. Valid and reliable tests of ph ysical performance are available that are easily administered and provide v aluable information about the patient. Just as the patient's nutrition, med ications, and adequacy of dialysis are monitored, baseline and subsequent p hysical functioning assessments allow us to monitor the patient's clinical course as it relates to their physical ability. Such measurement also allow s for the identification of patients with lower functioning who would benef it from physical therapy or other exercise intervention. (C) 1999 by the Na tional Kidney Foundation, Inc.