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Measuring Perceived Change in Mobility and Balance in Older Adults: A Mixed-Methods Approach

Hile, Elizabeth S. (2010) Measuring Perceived Change in Mobility and Balance in Older Adults: A Mixed-Methods Approach. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background/ Purpose: A priority in healthcare for older adults is to detect declines in mobility and balance before falls occur with potential consequences of morbidity, disability, even mortality. Self-report and performance measures have varying degrees of respondent and administrative burden. We investigated the role of a single global self-rating in the detection of mobility decline. Change by repeated self-rated mobility state was compared to transition rating of self-perceived change over six months. Additionally, repeated state and transition reported change were compared with performance change. We anticipated discordance, and explored the support for potential theories to explain discordance. Methods: Using a prospective, exploratory, observational cohort study with mixed-methods analysis, we focused on the natural history of age-related mobility change. Community-dwelling older adults provided state and transition global ratings of mobility and balance over six months, and completed questionnaires and performance tests of physical function. A subset of the older adults participated in semi-structured interviews to identify themes for domain definitions of mobility and balance, and the timeframe and frames of reference used for state ratings. Analyses included correlations for agreement between measures, and comparisons of means to investigate groups established based on discordance.Results: Participants, n=104, had data at two consecutive time points, and 33 participated in interviews. Domain definitions and state timeframes varied. Two main frames of reference were identified. The serial state and transition based rating of change were discordant, as were self-rated and performance change. Nearly 75 percent of those with gait speed decline of at least 0.10 m/s reported worsening by transition, and about 25 percent selected a lower state rating.Conclusions: Transition ratings appear more sensitive than serial state ratings for detection of decline in gait speed, while decline by serial state rating may be more specific to larger performance changes. Self-ratings appear to communicate valuable information about mobility and balance not available from other measures, and we recommend an expanded use of open-ended questions in research and clinical practice.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hile, Elizabeth S.ehile@pitt.eduEHILE
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairVanSwearingen, Jessiejessievs@pitt.eduJESSIEVS
Committee CoChairStudenski, Stephaniesas33@pitt.eduSAS33
Committee MemberBrach, Jenniferjbrach@pitt.eduJBRACH
Committee MemberPerera, Subashanksp9@pitt.eduKSP9
Committee MemberZickmund, Susanslz9@pitt.eduSLZ9
Date: 19 August 2010
Date Type: Completion
Defense Date: 13 July 2010
Approval Date: 19 August 2010
Submission Date: 30 July 2010
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: aging; mobility; self-report
Other ID:, etd-07302010-161835
Date Deposited: 10 Nov 2011 19:55
Last Modified: 15 Nov 2016 13:47


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