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Development and validation of a cut-off for the chair stand test as a screening for mobility impairment in the context of the integrated care for older people (ICOPE) program.

BACKGROUND
The five-repetition chair stand test is increasingly being used to assess locomotion capacity in older adults. However, there is a lack of age-stratified cut-offs for adults aged ≥70 validated against a higher risk of functional loss.


METHODS
We used two population-based studies (SAGE Mexico and TSHA) and ROC analyses to develop and cross-validate age-stratified chair stand cut-offs with ADL disability as the outcome. Then, we used data from an RCT (MAPT) and a frailty day-hospital for external validation with cross-sectional and longitudinal measures of ADL disability. The merged sample of SAGE Mexico and TSHA was n=1595; sample sizes for external validation were: MAPT n= 1573 and Frailty day-hospital n= 2434. The Cox models for incident disability in MAPT had a mean follow-up of 58.6 months.


RESULTS
Cut-offs obtained were 14 s (ages 70-79) and 16 s (ages 80+). Those cut-offs identified older adults at higher odds of incident ADL disability OR=1.72 (95%IC 1.06; 2.78) for ages 70-79 and OR=2.27 (95%IC 1.07; 4.80) in those aged 80+. Being a slow chair stander according to the cut points was associated with ADL disability in cross-sectional and longitudinal measures.


CONCLUSIONS
14s and 16s cut points for the chair stand test are suitable to identify older adults at higher risk of functional decline in older adults in Mexico and Toledo, Spain. Adjusting the cut point from 14 to 16 s generally improved the psychometric properties of the test. The validation of these cut-offs can facilitate the screening for limited mobility and the implementation of the ICOPE program.