Development of a test of physical performance for the nursing home setting

Purpose. This study was undertaken to develop a performance-based instrumen t to measure a range of function present among nursing home (NH) residents and to establish the reliability and validity of the measures. Design and M ethods: Fourteen items integral to daily life in a NH setting were administ ered to 95 NH residents with sufficient cognitive ability to follow a one-s tep command at baseline, 1 week later, and 6 months later. Intraclass corre lation coefficients and Cronbach's coefficient alpha were calculated for re liability estimates. The Minimum Data Set (MDS), Katz, and Multidimensional Observational Scale for Elderly Subjects (MOSES) were used to establish co ncurrent validity. Factor analysis, correlation matrices, and other objecti ve criteria were used for item reduction. Results: Test-retest reliability for items ranged between .73 and .93. Factor analysis and correlations betw een Nursing Home Physical Performance Test (NHPPT) items and scales with me asures of activities of daily living (ADL) suggest that the NHPPT taps aspe cts of gross motor function (Factor 1) and fine motor coordination and task sequencing (Factor 2) required for ADL function and mobility. The NHPPT ma y 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 si zes 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 r esidents. Further studies are necessary to assess the value of this instrum ent for prediction and monitoring of functional status in the NH.