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OUTCOME MEASURES
“Researchers telling us that we must measure outcome is a bit like dentists telling us to floss our teeth. We
know it’s good for us, but the immediate rewards for the investment of time and energy are difficult to see,
and no one ever died for lack of flossing!”
(Binkley, 1996)
An outcome is a characteristic or construct that is expected to change owing to an intervention, disease, injury, etc. An
outcome measure is an indicator of an outcome. Outcome measures can be used to:

Describe a state at one point in time 

Predict a future state   ?

Evaluate change in state over time  
Treatment

PHYSICAL PERFORMANCE MEASURES
Physical performance measures are standardized outcome measures designed to provide specific information regarding
a client’s physical parameters associated with functional tasks and activity goals important to everyday living (Jones &
Rikli, 2002).
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Physical Parameters
Muscle strength/endurance
Aerobic capacity
Flexibility
Motor ability
Power
Speed/agility
Balance
Dynamic
Static
Body composition
Body Structures & Functions (Impairment)

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
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Functions
Walking
Stair climbing
Standing up from chair
Lifting/reaching
Bending/kneeling
Jogging/Running
Activity (Limitation)
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Activity Goals
Personal care
Shopping errands
Housework
Gardening
Sports
Traveling
Participation (Restriction)
This information is necessary to design individualized, targeted exercise and activity programs. Baseline measures
repeated at multiple intervals during the program provide critical data to track client progress to make program
modifications, to provide feedback and to evaluate program effectiveness (Jones & Rikli, 2002).
The following physical performance measures have been found to be reliable and valid for use with the older
population. Validity refers to whether a test measures what it is intended to measure; reliability refers to the
dependability of test scores. These measures are feasible to use in clinical practice - in determining feasibility,
equipment, cost, time, space, difficulty to administer and score and safety have all been taken into consideration.
Before administering any of these physical performance measures, it is important to check for contraindications,
measure pulse and blood pressure, and to make sure that clothing and shoes are appropriate. Pulse oximetry and
ratings of perceived exertion (RPE) can also be taken. The rationale for measuring these variables is that in addition to
confirming a client may be tested safely, during serial evaluations, improvements may manifest either by change in the
primary outcome of interest or by reduced symptoms with the same outcome achieved.
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References
1. Jones CJ, Rikli RE. Measuring functional fitness of older adults. The Journal on Active Aging, March.April 2002;
24-30.
2. Rikli RE, Jones CJ. A functional ability framework indicating physiologic parameters associated with functions
required for basic and advanced everyday activities. Senior Fitness Test Manual, 2001. Champaign, IL: Human
Kinetics.
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TIMED UP AND GO TEST (TUG)
Purpose
 To evaluate basic mobility skills in older adults; requires static and dynamic balance.
Content
 Measurement of the time in seconds for a person to rise from sitting from a standard arm chair, walk three meters,
turn, walk back to the chair, and sit down. The person wears regular footwear and customary walking aid.
Equipment
 Arm chair with a seat height of approximately 46 centimeters and arm height of 65 centimeters; three meter
walkway; cone or tape; stopwatch or wrist watch with a second hand.
Protocol
 Measure three meters from chair and place a cone marker on the floor.
 Client sits with back against chair with arms on armrests. Instruct client to “walk at your normal pace to the cone on
the floor, turn around and walk back then sit down with your back against the chair”.
 One practice test and two trials are recommended
Performance Standards
Normative
 No formal normal values are available. Less than 10 seconds has been cited as normal mobility with 11 – 20 seconds
being within normal limits for the frail elderly who can go out alone.
 A recommended practical cut-off value for the TUG to indicate normal versus below normal performance is 10-12
seconds.
 In a meta-analysis of 21 studies reporting TUG times in healthy older adults, the mean times progressively increased
with age with 8.1 seconds (95% confidence interval = 7.1-9.0) among 60 to 69 year olds, 9.2 seconds (95% CI = 8.210.2) among 70-79 year olds, and 11.3 seconds (95% CI = 10.0-12.7) among 80-99 year olds.
Criterion
 Standardized cut-off scores to predict risk of falling have not yet been established; however, a score of 14 seconds or
more suggests that the person may be prone to falls.
 A score of <20 seconds is associated with independence with transfers and gait
 A score of >30 seconds associated with requiring assistance with balance and functional activities
 Minimum clinically important differences (MCID) or clinically meaningful change of the TUG has been reported to be
0.8-1.4 seconds.
References
1. Arnold C, Faulkner RA. (2007).The history of falls and the association of the timed up and go test to falls and nearfalls in older adults with hip osteoarthritis. BMC Geriatr; 7.
2. Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, Akos R, Conzelmann M, et al. (2003).
Identifying a cut-off point for normal mobility: A comparison of the timed 'up and go' test in community-dwelling
and institutionalised elderly women. Age and Ageing 32 (3): 315–20.
3. Bohannon RW. (2006). Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys
Ther; 29:64-8.
4. French HP, Fitzpatrick M, FitzGerald O. (2011). Responsiveness of physical function outcomes following
physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study. Physiotherapy; 97:30208.
5. Jette AM, Jette DU, Ng J, Plotkink DJ, Back MA. (1999).The Musculoskeletal Impairment Study Group. Are
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performance-based measures sufficiently reliable for use in multicenter-trials? J Gerontol A Biol Med Sci; 54:M3-6.
6. Morris S, Morris ME, Iansek R. (2001). Reliability of measurements obtained with the Timed 'Up & Go' test in
people with Parkinson Disease. Physical Therapy 81 (2): 810–8.
7. Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. (2008). Prognostic validity of the Timed Up-and-Go
test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential
care facilities. Age and Ageing 37 (4): 442–8.
8. Podsiadlo D, Richardson S (1991). The timed 'Up & Go': A test of basic functional mobility for frail elderly persons.
Journal of the American Geriatrics Society 39 (2): 142–8.
9. Rockwood K, Awalt E, Carver D, MacKnight C. (2000). Feasibility and measurement properties of the functional
reach and the timed up and go tests in the Canadian study of health and aging. J Gerontol A Biol Med Sci;
55A:M70-3.
10. Shumway-Cook A, Brauer S, Woollacott M. (2000). Predicting the probability for falls in community-dwelling older
adults using the Timed Up & Go Test. Physical therapy 80 (9): 896–903.
11. Steffen TM, Hacker TA, Mollinger L. (2002). Age- and gender-related test performance in community dwelling
elderly people: six-minute walk test, Berg balance scale, timed up & go test, and gait speeds. Phys Ther 2002;
82:128-37.
12. Thompson, M, Medley, A. (1998). Performance of Individuals with Parkinson's Disease on the Timed Up & Go.
Journal of Neurologic Physical Therapy 22 (1): 16–21.
13. Wall JC, Bell C, Campbell S, Davis J. (2000). The timed getup-and-go test revisited: measurement of the
component tasks. J Rehabil Res Dev; 37:109-13.
14. Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH. (2011). A comparison of 3 methodological approaches to
defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J
Orthop Sports Phys Ther; 41:319-27.
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GAIT SPEED (SELF-SELECTED)
Purpose
 To evaluate basic functional mobility.
Protocol
 Measure and mark a standard distance (e.g. four meters) and then measure and mark two meters. before the start
(for acceleration) and two meters at the end (for deceleration) of this middle section.
 Instruct client to “walk at a comfortable pace”.
 Have client perform two to three repetitions and calculate the average time.
Performance Standards
Normative
Criterion
 Gain of 0.1 m /s is predictor for well-being in those without normal gait speed (i.e. could be used a client goal).

Best initial estimate reported to be ~ 0.05 m/s for small meaningful change and ~ 0.10 m/s for substantial
change
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References
1. Fritz S. Lusardi M. White Paper: Walking Speed – The sixth vital sign. (2010). Journal of Geriatric Physical Therapy;
32(2): 2-5.
2. Hardy SE, Perera S, et al. (2007). Improvement in gait speed predicts better survival in older adults. Journal of the
American Geriatric Society; 55(11): 1727-34.
3. Lusardi MM. (2003). Functional Performance in Community Living Older Adults. Journal of Geriatric Physical Therapy
2; 26(3), 14-22.
4. Perera S, Mody SH, Woodman RC, Studenski SA. (2006). Meaningful change and responsiveness in common physical
performance measures in older adults. J Am Geriatr Soc; 54(5):743-9.
5. Purser JL, Weinberger M, et al. (2005). Walking speed predicts health status and hospital costs for frail elderly male
veterans. Journal of Rehabilitation Research and Development; 42(4): 535-46.
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SIX MINUTE WALK TEST (6MWT)
Purpose
 The six-minute walk test (6MWT) was first used in the clinical setting to test exercise tolerance in individuals with
chronic respiratory disease and respiratory failure. Current literature reports its use as a submaximal exercise test to
measure functional exercise capacity (i.e., the ability to engage in physically demanding activities of daily living) in
individuals with a wide variety of characteristics including healthy older adults and those with chronic heart and lung
disease, heart failure, fibromyalgia, peripheral arterial disease and neurological conditions as well as with older
adults.
Content
 The 6MWT measures the distance an individual is able to walk over a total of six minutes on a hard, flat surface. The
goal is for the individual to walk as far as possible in six minutes. The individual is allowed to self-pace and rest as
needed as they traverse back and forth along a marked walkway.
Equipment
 30 meter, pre-measured flat walking area with interval markings every three meters.
 Cones or brightly colored tape to mark boundaries of the course.
 Watch or timer to time six minutes.
 Chair available if patients need to rest during testing.
Protocol
 This is ideally conducted in an enclosed, quiet hallway by a single administrator. However, it is important to note
that there are variations among studies in how the test is conducted which affects performance. These variations
include the instructions provided to the participant, the number of turns in the course, the frequency and type of
encouragement given, and the number of trials performed. Each of these variations is outlined briefly.
Test instructions - Due to the differing functional statuses of participants, the 6MWT test may cause some
people to perform at higher exertion levels than others. While many studies do not report the exact instructions,
most describe the instruction as having participants walk at their usual pace or a comfortable pace and to walk
as far as possible. Participants are instructed prior to the test to wear comfortable clothing and shoes and to use
their typical walking aid during the test.
Walkway length and number of turns in the course - The American Thoracic Society recommends an indoor, 30
meter corridor or walkway with cones placed at the beginning and end of the 30 meter boundary to indicate
turns. In the literature, the corridor distance across studies varies which is likely due to the need to use what is
readily available.
Use of encouragement - Encouragement is often given and is typically standardized, although it varies in
frequency across studies from providing encouragement every 30 seconds to every two minutes.
Encouragement increases the distance walked and if used, the exact protocol should be reported.
Number of trials performed - One to two practice trials may be useful. In most populations, at least two practice
walks should be administered (with adequate time for rest and recovery) prior to recording measurements.

The primary outcome is the distance covered in meters or converted measure (such as feet) over six minutes.
Safety Issues and Contraindications
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 Contraindications for this test include unstable angina in the previous month, myocardial infarction in the previous
month, and high blood pressure (resting heart rate of > 120, systolic blood pressure of 180 mm Hg, or diastolic blood
pressure > 100 mm Hg). The test should be stopped if a person reports chest pain, intolerable shortness of breath,
leg cramps, staggering, diaphoresis, or pale/ashen appearance.
Performance Standards
Normative
 6MWT distance in healthy adults has been reported to range from 400m to 700m. Age and sex-specific reference
standards (see predictive 6MWT distance equations below) are available and may be helpful for interpreting 6MWT
scores for both healthy adults and those with chronic diseases. However, it is difficult to use normative values
because of the differing methods used in studies.
- Women 6MWT Distance = (7.57x height in cm)- (5.02x age)- (1.76x weight in kg)- 309m
- Men 6MWT Distance = (2.11x height in cm)- (5.78x age)- (2.29x weight in kg)- 667m
Criterion
 Minimally Clinical Important Difference (MCID) reports range from 43 – 54 meters
 Best initial estimate reported to be ~ 20 meters for small meaningful change and ~ 50 meters for substantial
change
 <350 meters indicative of poor prognosis
References
1. American Thoracic Society. ATS Statement: Guidelines for the Six-Minute Walk Test. (2002). Am J Respir Crit Care
Med; 166: 111–117.
2. Guyatt GH, Thompson PJ, Berman LB, Sullivan MJ, Townsend M, Jones NL, Pugsley SO. (1985). How should we
measure function in patients with chronic heart and lung disease? J Chronic Dis.; 38:517-24.
3. Perera S, Mody SH, Woodman RC, Studenski SA. (2006). Meaningful change and responsiveness in common
physical performance measures in older adults. J Am Geriatr Soc; 54(5):743-9.
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FIVE TIMES CHAIR SIT TO STAND TEST (FTSST OR 5XSST)
Purpose
 A measure of functional lower limb muscle strength; may be useful in quantifying functional change of
transitional movements
Equipment
 Armless chair or standard chair with arms. Chair heights recorded in literature vary, generally 43-45 cm,
stopwatch.
Protocol
 Client sits with arms folded across chest and with their back against the chair. Ensure that the chair is not
secured against the wall.
 Instructions to client are: "I want you to stand up and sit down five times as quickly as you can when I say 'Go'."
The client is instructed to stand fully between repetitions of the test and not to touch the back of the chair
during each repetition (It is ok if the patient does touch the back of the chair, but it is not recommended)
 Timing begins at "Go" and stops when the client’s buttocks touch the chair on the fifth repetition.
 Provide one practice trial before measurements are recorded. If there is concern the client may fatigue with a
practice trial, it is OK to demonstrate to the client and have the client do two repetitions to ensure they
understand the instructions.
 Inability to complete five repetitions without assistance or use of upper extremity support indicates failure of
test.
 Try NOT to talk to client during the test (may decrease patient’s speed).
Performance Standards
Normative – variable values reported
50-59 years
60-69 years
70-79 years
80-89 years
Report 1
Mean (SD) seconds
7.1 (1.5)
8.1 (3.1)
10.0 (3.1)
10.6 (3.4)
Report 2
Mean seconds
N/A
11.4
12.6
14.8
75-79 years
80-84 years
85-89 years
90 + years
Report 3
Women Mean (SD ) Men Mean (SD)
seconds
seconds
12.2 (4.1)
12.1(5.4)
13.4 (5.6)
12.9 (5.5)
14.1 (6.5)
13.7 (7.2)
15.1 (6.5)
17.2 (8.0)
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Criterion
 Minimal Detectable Change (MDC) = 2.5 - 4.2 in healthy elderly
 MCID = 2.3 seconds in those with vestibular disorders
 Initial screening tool-cut off score of > 12 seconds to identify need of further assessment for fall risk; > 15
indicates risk of recurrent falls
References
1. Bohannon RW. (2006). Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of
data from elders. Perceptual and Motor Skills; 103(1): 215-222.
2. Buatois S, Miljkovic D., et al. (2008). Five times sit to stand test is a predictor of recurrent falls in healthy
community-living subjects aged 65 and older. Journal of the American Geriatrics Society; 56(8): 1575-1577.
3. Buatois S., Perret-Guillaume C, et al. (2010). A simple clinical scale to stratify risk of recurrent falls in communitydwelling adults aged 65 years and older. Physical Therapy; 90(4): 550-560.
4. Goldberg A, Chavis M, Watkins J, Wilson T. (2012). The five-times-sit-to-stand test: validity, reliability and
detectable change in older females. Aging in Clinical and Experimental Research; 24(4): 339-344.
5. Lord SR, et. (2002). Sit to stand performance depends on sensation, speed, balance and psychological status in
addition to strength in older people. J Gerontol A Biol Sci Med Sci; 57(8): M539-43.
6. Meretta BM, Whitney SL, et al. (2006). The five times sit to stand test: responsiveness to change and concurrent
validity in adults undergoing vestibular rehabilitation. Journal of Vestibular Research; 16(4-5): 233-243.
7. Mong Y, Teo, TW, et al. (2010). 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and
validity. Archives of Physical Medicine and Rehabilitation; 91(3): 407-413.
8. Schaubert KL, Bohannon RW (2005). Reliability and validity of three strength measures obtained from
community-dwelling elderly persons. J Strength Cond Res; 19(3): 717-720.
9. Tiedemann A, Shimada H, et al. (2008). The comparative ability of eight functional mobility tests for predicting
falls in community-dwelling older people. Age and Ageing; 37(4): 430-435.
10. Whitney SL, Wrisley DM, et al. (2005). Clinical measurement of sit-to-stand performance in people with balance
disorders: validity of data for the Five-Times-Sit-to-Stand Test. Physical Therapy; 85(10): 1034-1045.
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2-MINUTE STEP IN PLACE TEST
Purpose
 The 2 Minute Step in Place test is designed to test the aerobic endurance and functional fitness of seniors. This test
is performed as an alternative to the six-minute walk test for people who have difficulty balancing or who may not
be able to do traditional fitness tests.
Content
 Test of aerobic endurance, associated with the ability to perform lifestyle tasks (i.e. walking and stair climbing)
Equipment
 Stopwatch, tape measure, marking tape
Protocol
 With the client standing up straight next to the wall, determine the midpoint between the iliac crest and the patella
and mark that as a line on the wall.
 The client faces the wall and marches in place for two minutes, lifting the knees to the height of the marking. Resting
is allowed, and holding onto the wall or a stable chair is allowed. Stop after two minutes.
 Record the total number of times the right knee reaches the marked level in two minutes.
Performance Standards
Women
Age
60-64
65-69
70-74
75-79
80-84
85-89
90-94
Below Average
< 75
< 73
< 68
< 68
< 60
< 55
< 44
Average
75 to 107
73 to 107
68 to 101
68 to 100
60 to 91
55 to 85
44 to 72
Above Average
> 107
> 107
> 101
> 100
> 91
> 85
> 72
Men
Age
Below Average Average
Above Average
60-64
< 87
87 to 115
> 115
65-69
< 87
86 to 116
> 116
70-74
< 80
80 to 110
> 110
75-79
< 73
73 to 109
> 109
80-84
< 71
71 to 103
> 103
85-89
< 59
59 to 91
> 91
90-94
< 52
52 to 86
> 86
References
1. Jones CJ, Rikli RE. (2002). Measuring functional fitness of older adults, The Journal on Active Aging; March April, pp.
24–30.
2. Różańska-Kirschke A, Kocur P, Wilk M, Dylewicz P. (2006). The Fullerton Fitness Test as an index of fitness in the
elderly. Medical Rehabilitation; 10(2): 9-16.
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GRIP STRENGTH
Purpose
 Marker of physical performance among community-dwelling older people.
Content
 Test of overall body strength.
Equipment
 Hand dynamometer
Protocol
 Standard posture suggested by the American Society of Hand Therapists is sitting with elbow flexed 90°.
Performance Standards
Age
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
Normative Values for Grip Strength (Mean + SD kg)
Female
Right
Left
Right
31.9+6.1
28.3+6.3
53+9.4
28.2+6.8
25.4+5.8
49.8+10.4
29.8+5.3
26+4.9
51.5+8.2
26+5.7
21.5+5.4
45.9+12.1
25+4.6
20.7+4.6
40.7+ 9.3
22.5+4.4
18.6+3.7
41.3+9.3
22.5+5.3
18.8+4.6
34.2+9.8
19.3+5.0
17.1+4.0
29.8+9.5
Male
Left
51.2+8.5
45.7+10.3
46.2+7.7
37.7+10.6
34.8+9.2
34.8+ 9.0
29.3+8.2
24.9+7.7
References
1. Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. (2008). Journal of Geriatric
Physical Therapy; 31(1): 3-10.
2. Liao WC, Wang CH, Yu SY, Chen LY, Wang. CY. (2013). Grip strength measurement in older adults: A comparison of
three testing positions. Australia Journal of Aging. Article first published online: 23 SEP 2013.
3. Mijnarends DM, Meijers JMM, Halfens RJG, ter Borg S, Luiking YC, Verlaan S, Schoberer D, Jentoft, AJC, van Loon,
LJC, Schols, JMGA. (2013). Validity and Reliability of Tools to Measure Muscle Mass, Strength, and Physical
Performance in Community-Dwelling Older People: A Systematic Review. Journal of the American Medical Directors
Association In press.
4. Stevens PJ, Syddall HE, Patel HP, Martin HJ, Cooper C, Sayer AA. (2012). Is grip strength a good marker of physical
performance among community-dwelling older people? The Journal of Nutrition, Health & Aging; 16(9): 769-774.
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SINGLE LIMB STANCE TEST (SLST) - ALSO REFERRED TO AS UNIPEDAL STANCE TEST (UPST) AND ONE-LEG STANDING
BALANCE.
Purpose
 To screen for balance impairments in the older adult population
Content
 Measure of static balance
Equipment
 Stop watch
Protocol
 To perform the test, client is instructed to stand on one leg without support of arms or bracing of the unweighted
leg against the stance leg. The client begins by practicing once or twice on each side with gaze fixed straight ahead.
 The number of seconds that the client is able to maintain this position is recorded. Termination or a fail test is
recorded if 1) foot touches the support leg; 2) hopping occurs; 3) the foot touches the floor, or 4) the arms touch
something for support.
 When using this test, having clients choose what leg they would like to stand on would be appropriate as you want
to record their "best" performance.
 Client should be barefoot or in low/no-heel and firm bottom shoes
Performance Standards
Normative
Report 1
Age
40-49
50-59
60-69
70-79
80-89
Eyes Open Mean (SE) Seconds
40.3(10.8)
37.0(12.6)
26.9(16.6)
15.0(13.9)
6.2(9.3)
Report 2
Age
Eyes Open Mean (SD) Seconds
60-64
20.4(14.2)
64-69
17.6(14.9)
70-74
8.3(5.0)
75-80
4.8(3.9)
Eyes Closed Mean (SE) Seconds
7.3(7.0)
4.8(4.8)
2.8(2.2)
2.0(1.6)
1.3(0.6)
Eyes Closed Mean (SD) Seconds
7.2(7.0)
4.8(3.4)
3.7(2.3)
1.1(1.2)
Criterion
 Reported in the literature that individuals increase their chances of sustaining an injury due to a fall by two
times if they are unable to perform a One-Legged Stance Test for five seconds.
References
1. Anemaet, W, Moffa-Trotter M. (1999). Functional tools for assessing balance and gait impairments. Topics in
Geriatric Rehab, 15(1), 66-83.
2. Bohannon RW. (2006). Single limb stance times. A descriptive meta-analysis of fata from individuals at least 60
14
years of age. Topics in Geriatric Rehabilitation; 22(1): 70-77.
3. Bohannon R, Larkin, P, Cook A, Singer J. (1984). Decrease in timed balance test scores with aging. Physical
Therapy, 64, 1067-1070.
4. Briggs, R, Gossman, M, Birch, R, Drews, J, Shaddeau S. (1989). Balance performance among noninstitutionalized
elderly women. Physical Therapy, 69(9), 748-756.
5. El-Sobkey SB. (2011). Normative values for one-leg stance balance test in population-based sample of
community-dwelling older people. Middle-East Journal of Scientific Research; 7(4): 497-503.
6. Franchignoni F, Tesio L, Martino M, Ricupero, C. (1998). Reliability of four simple, quantitative tests of balance
and mobility in healthy elderly females. Aging (Milan), 10(1), 26-31.
7. Schlicht J, Camaione, D & Owen, S. (2001). Effect of intense strength training on standing balance, walking
speed, and sit-to-stand performance in older adults. Journal of Gerontological Medicine and Science, 56A(5),
M281-M286.
8. Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. (2007). Journal of Geriatric Physical Therapy; 30(1): 8-15.
9. Vellas B, Wayne S, Romero L, Baumgartner R., et al. (1997). One-leg balance is an important predictor of
injurious falls in older persons. Journal of the American Geriatric Society, 45, 735-738.
15
BICEP CURL TEST
Purpose
 Test of upper body and arm strength and endurance; associated with ability to perform lifestyle tasks (i.e.
carrying objects)
Content
 The aim of this test is to do as many arm curls as possible in 30 seconds.
Equipment
 Five pound weight for women; eight pound weight for men, chair without armrests, stopwatch
Protocol
 This test is conducted on the dominant arm side (or stronger side).
 The subject sits on an armless chair, with feet flat on floor, holding the weight in the hand using a suitcase grip
(palm facing towards the body) with the arm in a vertically down position beside the chair. Brace the upper arm
against the body so that only the lower arm is moving (tester may assist to hold the upper arm steady). Curl the
arm up through a full range of motion, gradually turning the palm up (flexion with supination). As the arm is
lowered through the full range of motion, gradually return to the starting position. The arm must be fully bent
and then fully straightened at the elbow.
 Repeat this action as many times as possible within 30 seconds.
 The score is the total number of controlled arm curls performed in 30 seconds.
Performance Standards
Women
Age
60-64
65-69
70-74
75-79
80-84
85-89
90-94
Below Average
< 13
< 12
< 12
< 11
< 10
< 10
<8
Average
13 to 19
12 to 18
12 to 17
11 to 17
10 to 16
10 to 15
8 to 13
Above Average
> 19
> 18
> 17
> 17
> 16
> 15
> 13
Men
Age
60-64
65-69
70-74
75-79
80-84
85-89
90-94
Below Average
< 16
< 15
< 14
< 13
< 13
< 11
< 10
Average
16 to 22
15 to 21
14 to 21
13 to 19
13 to 19
11 to 17
10 to 14
Above Average
> 22
> 21
> 21
> 19
> 19
> 17
> 14
References
16
1. Anna Różańska-Kirschke, Piotr Kocur, Małgorzata Wilk, Piotr Dylewicz, The Fullerton Fitness Test as an index of
fitness in the elderly, Medical Rehabilitation 2006; 10(2): 9-16.
2. Jones C.J., Rikli R.E., Measuring functional fitness of older adults, The Journal on Active Aging, March April 2002,
pp. 24–30.
FOUR STEP SQUARE TEST (FSST)
Purpose
 To clinically assess the ability to change directions while stepping; measure of dynamic standing balance
Content
 Clients are required to step over four canes/sticks set-up like a cross on the floor with the tips of the canes facing
together (to create four squares).
Equipment
 Stopwatch, four canes/sticks
Protocol
 At the start of the test, the client stands on the upper left square (square 1) and faces the direction of square 2. The
stepping sequence is (clockwise): square 1, square 2, square 4, square 3. Then (counter-clockwise) back to square 3,
square 4, square 2, and then end at square 1.
 Verbal instructions to client are “Try to complete the sequence as fast as possible without touching the sticks. Both
feet must make contact with the floor in each square. If possible, face forward during the entire sequence”.
 Timing begins when the client’s right foot contacts the floor in the square.
 The test procedure may be demonstrated and one practice trial allowed prior to administration of the test. Two
trials should be performed with the better time (in seconds) taken as the score.
Performance Standards
Normative
 Not available
Criterion
 A score of > 15 seconds associated with increased risk for multiple falls in older adults.
 Minimal detectable change estimate 4.6 seconds
References
17
1. Dite W, Temple VA. (2002). A clinical test of stepping and change of direction to identify multiple falling older
adults. Archives of Physical Medicine and Rehabilitation 83(11): 1566-1571.
2. Wagner JM, et al. (2013). Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability,
and responsiveness. Int J Rehabil Res ;36(3):253-9.
18
TIME LOADED STANDING (TLS)
Purpose
 Measure of combined trunk and shoulder endurance suitable for individuals with osteoporosis.
Content
 The TLS assessment measures the time a person can stand while holding a weight in each hand with the arms at
90 degrees of shoulder flexion and the elbows extended.
Equipment
 Two 1 kg hand weights, 0.5 kg hand weights, stop watch
Protocol
 First demonstrate to client and check they can achieve the test position without using the weights.
 Instructions to client are “I want you to stand up straight with your feet hip-width apart. I want you to first bend
your elbows, bringing your hands to your shoulders, then to stretch your arms out in front of you keeping your
elbows straight and to hold this position.”
 Next assess which weight the client can manage. Ideally use 1.0 kg weights. If a client is unable to hold or lift the
1.0 kg weight to the start position, use the 0.5 kg weights. Demonstrate and explain the task to the client using
the weights.
 Instructions to client are “Now I want you to stand up straight with your feet hip-width apart. I will hand you two
weights. I want you to first bend your elbows bringing the weights to your shoulders, then to stretch your arms
out in front of you keeping your elbows straight.”
 Once you have checked which weight to use, complete the TLS assessment. Instructions to client are “I want you
to stand up straight as before. I will hand you two weights, I want you to first bend your elbows bringing the
weights to your shoulders, then to stretch your arms in front of you keeping your elbow straight and to hold this
position for as long as comfortable. You must pass me the weights when you first become uncomfortable or wish
to stop. I will stop you in I think your arms are tiring”.
 Ensure client is stands erect with feet hip-width apart and not leaning on anything for support.
 Stand in front and hand client two weights to hold at 90 degrees.
 Start stop watch when clients has arms straightened (cue if necessary).
 Stop test when either client cannot achieve 90 degrees of shoulder flexion (from set-up); client is unable to
maintain 90 degree position or begins to tire in arms; or client chooses to end the test and passes you the
weights.
 Record the test including weight used, total time in seconds and whether fatigue or pain was the reason for
stopping.
Performance Standards
 Not available
References
1. Shipp KM, Purser JL, Gold DT, Pieper CF, Sloane R, Schenkman M, Lyles KW. (2000). Time loaded standing: A
measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis. Osteoporosis
International; 11: 914-922.
19
BACK SCRATCH TEST (also known as SCRATCH TEST, ZIPPER TEST, APLEY’S SCRATCH TEST)
Purpose
 This test is used to test shoulder and upper body flexibility which is important in functional tasks such as combing
one’s hair, putting on overhead garments and reaching for a seat belt.
Content
 The client is asked to scratch his or her back while reaching over the head with one hand and behind the back with
the other hand. The test requires abduction and lateral rotation of one shoulder and adduction and medial rotation
of the other shoulder.
Equipment
 Ruler or tape measure
Protocol
 This test is done in the standing position. The client is asked to place one hand behind the head and back over the
shoulder, and reach as far as possible down the middle of his/her back, with his/her palm touching their body and
their fingers directed downwards.
 The client is then asked to place his/her other arm behind their back, palm facing outward and fingers upward and
to reach up as far as possible attempting to touch or overlap the middle fingers of both hands.
 The tester directs the client so that their fingers are aligned, and then measure the distance between the tips of the
middle fingers.
 If the fingertips touch then the score is zero. If they do not touch, measure the distance between the finger tips (a
positive score); if they overlap, measure by how much (a negative score).
 Practice two times, and then test two times. Stop the test if the client experiences pain.
 Record the best score to the nearest centimeter or 1/2 inch.
20
Performance Standards
Women
Age
Below Average
Average (inches)
Above Average
60-64
> 3.0
3.0 to 1.5
< 1.5
65-69
> 3.5
3.5 to 1.5
< 1.5
70-74
> 4.0
4.0 to 1.0
< 1.0
75-79
> 5.0
5.0 to 0.5
< 0.5
80-84
> 5.5
5.5 to 0
<0
85-89
> 7.0
7.0 to -1.0
< -1.0
90-94
> 8.0
8.0 to -1.0
< -1.0
Age
Below Average
Average (inches)
Above Average
60-64
> 6.5
6.5 to 0
<0
65-69
> 7.5
7.5 to -1.0
< -1.0
70-74
> 8.0
8.0 to -1.0
< -1.0
75-79
> 9.0
9.0 to -2.0
< -2.0
80-84
> 9.5
9.5 to -2.0
< -2.0
85-89
> 10.0
10.0 to -3.0
< -3.0
90-94
> 10.5
10.5 to -4.0
< -4.0
Men
References
1. Edwards TB, Bostick RD, Greene CC, Baratta RV, Drez D. (2002). Inter-observer and intra-observer reliability of
the measurement of shoulder internal rotation by vertebral level. J Shoulder Elbow Surg; 11:40-42.
2. Hoving JL, Buchbinder R, Green S, Forbes A, Bellamy N, Brand C, Buchanan R, Hall S, Patrick M, Ryan P, Stockman
A. (2002). How reliably do rheumatologists measure shoulder movement? Ann Rheum Dis.; 61: 612-616.
3. Jones CJ, Rikli RE. (2002). Measuring functional fitness of older adults. The Journal on Active Aging, March April:
24–30
4. Konin JG, Wiksten DL, Isear JA, Brader H. Special tests for orthopedic examination. 3rd ed. Thorofare, NJ: SLACK
incorporated; 2006.
5. Rikli RE, Jones CJ. (1999). Development and validation of a functional fitness test for community-residing older
adults. Journal of Aging and Physical Activity; 7: 129-161.
6. Różańska-Kirschke A, Kocur P, Wilk M, Piotr Dylewicz P. (2006). The Fullerton Fitness Test as an index of fitness
in the elderly. Medical Rehabilitation; 10(2): 9-16.