Short Physical Performance Battery
Original Editor - Ahmet Begde
Top Contributors - Ahmet Begde, Laura Ritchie, KRYSTAL TAN, Vidya Acharya, Kim Jackson, Lucinda hampton and Alexandra Stead
Introduction
The Short Physical Performance Battery (SPPB) is a standardised, performance-based assessment of lower-extremity physical function.[1] It consists of three components: standing balance, gait speed, and repeated chair stands. It is widely used to assess physical performance in older adults and to monitor functional change in clinical and rehabilitation settings.[1] The SPPB was developed by the National Institute on Aging (NIA) and can be used free of charge without permission.[2]
Objective
The SPPB is an objective measurement instrument of balance, lower extremity strength, and functional capacity in older adults (>65 years of age).[1] It combines three domains: walking (gait speed), sit-to-stand (repeated chair stands), and standing balance, to assess functional mobility.[3] In addition to the paper version, a mobile phone application is available.[4] Training videos have been produced by the NIA to support standardised administration of the test.[2]
Intended Population
The SPPB is used to assess functional mobility in the following populations:
- Community-dwelling older adults[5]
- People with Multiple Sclerosis (MS)[6]
- People with chronic pulmonary disease (e.g. COPD)[7]
- People with cognitive impairment or dementia (preliminary evidence, based on conference-abstract data)[8]
Equipment
Equipment needed for the SPPB assessment includes:
- Pencil
- Stopwatch
- Instruction tool (paper or mobile app)
- Ruler
- Chair
Method of Use
The test is easy to administer and takes approximately 10 mins. The SPPB includes three subtests.[1]
Chair Stand Test
Single Chair Stand
The participant is asked to perform a single sit-to-stand movement as quickly as possible. The time is recorded.
Scoring:
- Participant stood without using arms: go to Repeated Chair Stand Test
- Participant used arms to stand: end test; score as 0 points
- Test not completed: end test; score as 0 points
Repeated Chair Stand
The participant is asked to perform 5 sit-to-stand movements as quickly as possible. The time is recorded.[1]
Scoring:
- Participant unable to complete 5 chair stands or completes stands in >60 sec: 0 points
- If chair stand time is 16.70 sec or more: 1 point
- 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
Balance Tests
The participant is asked to stand unsupported for 10 seconds with their feet in a certain position (feet together, semi-tandem, full tandem).[1]
Scoring:
Side-by-side stand
- Held for 10 sec: 1 point
- Not held for 10 sec: 0 points
- Not attempted: 0 points
- If 0 points, end Balance Tests
Semi-Tandem Stand
- Held for 10 sec: 1 point
- Not held for 10 sec: 0 points
- Not attempted: 0 points
- If 0 points, end Balance Tests
Tandem Stand
- Held for 10 sec: 2 points
- Held for 3 to 9.99 sec: 1 point
- Held for less than 3 sec: 0 points
- Not attempted: 0 points
Gait Speed Test
The test measures gait speed. The participant walks to a line on the floor (3 or 4 meters) at a normal pace. The time is recorded.[1]
Scoring:
For 4-Metre 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: 4 points
For 3-Metre Walk:
- 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: 3 points
- If time is less than 3.62 sec: 4 points
Scoring and Interpretation
The scores from the three subtests (Chair Stand, Balance, Gait Speed) are summed to produce a total SPPB score ranging from 0 to 12, with higher scores indicating better lower-extremity physical performance.[1][9]
Commonly used interpretive bands are:[1]
| Total score | Interpretation |
|---|---|
| 0–3 | Severe limitation in physical performance |
| 4–6 | Moderate limitation in physical performance |
| 7–9 | Mild-to-moderate limitation in physical performance |
| 10–12 | Little to no limitation in physical performance |
Lower total SPPB scores (commonly ≤8) have been associated with increased risk of disability, falls, hospitalisation, and mortality in older adults, and the tool is widely used both as a screening measure for frailty and mobility disability and to monitor functional change over time in clinical and rehabilitation settings.[10][11]
Administration of the Assessment
The video below briefly demonstrates how to administer the assessments. The second video is the first video of the playlist providing background information on objective physical performance measures, how to administer the assessments, scoring of the SPPB and safety tips. This video reviews the theoretical basis for the use of this test. The other videos in the playlist show how to administer the assessments in detail.
Psychometric Properties
Reliability
Studies including older adults reported excellent interrater reliability of the SPPB (ICC = 0.81 to 0.91).[14][15] Test-retest reliability in people with dementia has also been reported as excellent (ICC = 0.84).[15] A further study in people with chronic pulmonary disease reported excellent interrater reliability (ICC = 0.92).[14] A 2024 systematic review of the SPPB's psychometric properties similarly reported good-to-excellent reliability across the included studies (ICC 0.82–0.92).[9]
Validity
A 2024 systematic review found that validity evidence for the SPPB, assessed across studies in adults aged 60 years and over, ranged from weak to strong depending on the comparator measure and population studied, with floor and ceiling effects reported in some studies of very high- or very low-functioning adults.[9] In a study of 48 people with MS, SPPB scores were strongly associated with measures of lower extremity function (|rs| = 0.66–0.79) and weakly associated with measures of upper extremity function (|rs| = 0.03–0.33).[16] The SPPB's predictive validity for all-cause mortality has also been established in a systematic review and meta-analysis, supporting its use as a surrogate outcome measure in trials evaluating rehabilitation and treatment interventions.[10][11]
Resources
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr P, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49(2):M85-94.
- ↑ 2.0 2.1 SPPB Guide [Internet]. 2018 [cited 14th September 2020]. Available from: https://sppbguide.com/
- ↑ Cassidy B, Arena S. The Short Physical Performance Battery as a Predictor of Functional Decline. Home Healthcare Now. 2022 May 1;40(3):168-9.
- ↑ Short physical performance battery (SPPB) guide [Internet]. sppbguide.com. [cited 2022 Nov 27]. Available from: https://sppbguide.com/smart-phone-app
- ↑ Westman AW, Combs-Miller S, Moore J, Ehrlich-Jones L. Measurement characteristics and clinical utility of the short physical performance battery among community-dwelling older adults. Arch Phys Med Rehabil. 2019 Jan 1;100(1):185-7.
- ↑ Motl RW, Chaparro G, Hernandez ME, Balto JM, Sandroff BM. Physical function in older adults with multiple sclerosis: an application of the short physical performance battery. J Geriatr Phys Ther. 2018 Jul 1;41(3):155-60.
- ↑ Fermont JM, Mohan D, Fisk M, Bolton CE, Macnee W, Cockcroft JR, McEniery C, Fuld J, Cheriyan J, Tal-Singer R, Müllerova H. Short physical performance battery as a practical tool to assess mortality risk in chronic obstructive pulmonary disease. Age Ageing. 2021 May;50(3):795-801.
- ↑ Wu D, Smail E, Schrack J, Wanigatunga A, Kasper J, Spira A. Links of Short Physical Performance Battery Score with Incident Dementia: Results from the NHATS. Innov Aging. 2021;5(Suppl 1):434.
- ↑ 9.0 9.1 9.2 Kameniar K, Mackintosh S, Van Kessel G, Kumar S. The psychometric properties of the Short Physical Performance Battery to assess physical performance in older adults: a systematic review. J Geriatr Phys Ther. 2024;47(1):43-54.
- ↑ 10.0 10.1 Pavasini R, Guralnik J, Brown JC, di Bari M, Cesari M, Landi F, Marzetti E, Calvani R, Bernabei R, Stenholm S, Volpato S. Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Med. 2016;14:215.
- ↑ 11.0 11.1 Ribeiro Silva C de F, Ohara DG, Matos AP, Pinto ACN, Pegorari MS. Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. Int J Environ Res Public Health. 2021;18(20):10612.
- ↑ UCSF Division of Geriatrics. Short Physical Performance Battery (SPPB). Available from: http://www.youtube.com/watch?v=N_rJOGhQqZ4 [last accessed 14/09/20]
- ↑ DrJackGuralnik. SPPB tips by Dr. Jack Guralnik. Available from: https://www.youtube.com/playlist?list=PLIYnOnBLJyCrlV3jW7CJSWBN0ZRLL0HqY [last accessed 14/09/20]
- ↑ 14.0 14.1 Medina-Mirapeix F, Bernabeu-Mora R, Llamazares-Herrán E, Sánchez-Martínez MP, García-Vidal JA, Escolar-Reina P. Interobserver reliability of peripheral muscle strength tests and short physical performance battery in patients with chronic obstructive pulmonary disease: a prospective observational study. Arch Phys Med Rehabil. 2016 Nov 1;97(11):2002-5.
- ↑ 15.0 15.1 Olsen CF, Bergland A. Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia. BMC Geriatr. 2017 Dec;17(1):1-0.
- ↑ Motl RW, Learmonth YC, Wójcicki TR, Fanning J, Hubbard EA, Kinnett-Hopkins D, Roberts SA, McAuley E. Preliminary validation of the short physical performance battery in older adults with multiple sclerosis: secondary data analysis. BMC Geriatr. 2015 Dec;15(1):1-7.