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Life-Space Assessment composite score rationale

Life-Space Assessment composite score rationale In his recent manuscript, Siordia1 expressed concerns with the University of Alabama at Birmingham (UAB) Life-Space Assessment (LSA) as a measure of community mobility, suggesting that the logic for the composite score (LSA-CS) is problematic and proposing an alternative scoring method. Siordia indicated that “locating clear instructions for how the LSA-CS should be computed is difficult,” but failed to acknowledge that the authors of the original paper2 validating the LSA-CS invited readers to contact them for LSA instructions and SPSS scoring syntax . In fact Dr. Siordia contacted the authors in May 2013 and received instructions, scoring syntax, and copies of publications relevant to the LSA; he did not subsequently request any additional information. We agree with Dr. Siordia that it is important for “radical clarity” regarding the underlying assumptions of measurement tools and their scoring for clinicians or researchers using the assessments. The LSA was developed based upon the classical sociological perspective of life-space constriction associated with aging as older adults adapt to living with disability3 and was designed to enable researchers or clinicians to assess a person’s usual community mobility during the four weeks before the assessment. In contrast to other self-reported mobility measures that focus on specific mobilityrelated tasks (transferring, walking, or climbing stairs), the LSA reflects community participation by assessing where a person actually went, the frequency of movement, the use of help from others or assistive devices. Rather than assessing the person’s perceived ability to carry out a specific mobility-related task, the LSA obtains information about the person’s actual movement in the environment. Frequency and the independence of movement were incorporated into the LSA to capture important changes in mobility not captured by other assessments. Siordia1 highlighted the value of objective measures of mobility-related tasks such as observed gait speed, and pointed out potential difficulties in self-reported measures such as the LSA. For that reason, the original validation of the LSA included an examination of the correlation of four different scoring LSA methods with a composite measure of physical function that included gait speed, timed chair stands, and an assessment of balance.2 The LSA-CS was the most highly correlated score with observed physical performance and approximated a normal distribution; the test-retest reliability of the LSA-CS had an interclass correlation of 0.96.2 Subsequently, the LSA-CS has been validated as an important clinical measure of community mobility, predicting death, nursing home admissions, cognitive change, incident IADL disability, and as a measure reflecting important changes in mobility after hospitalizations and surgery.4–7 The LSA gives credit for the maximal values of life-space of a person, the greatest extent of the area in which they conduct their lives, while adjusting for person-specific adaptations to independent movement. Such scoring allows the assessment to be used clinically at a single point in time and to assess change in mobility at the individual level, perhaps as a trigger to understand factors amenable to intervention. In contrast to observations that require an in-home or clinic visit, the LSA can be administered by telephone or in person, providing a way to monitor changes in community-mobility in 614295 CRE0010.1177/0269215515614295Clinical RehabilitationBaker et al. research-article2015