Short Physical Performance Battery

What is the Short Physical Performance Battery (SPPB)?

The Short Physical Performance Battery (SPPB Test) is a physical assessment used by professionals to examine the physical function and mobility of elderly patients. This assessment consists of three tests that gauge certain aspects of a geriatric’s lower extremities, specifically their standing balance, gait speed, and the strength of their legs.

The first test is the standing balance test, which will have patients do three types of stands to see for how long they can maintain their balance. This test consists of the side-by-side stand, the semi-tandem stand, and the tandem stand. The goal is for the patients to be able to maintain their standing balance for each for at least ten seconds.

The second test is about their gait speed. The professional will be checking how fast they can reach a certain distance. For this test specifically, it’s three to four meters. It’s up to the professional which of the two distances they want for the test. The patient will have to perform this test twice.

The final test is a chair stand test. To avoid confusion, they won’t stand on the chair, but rather they have to stand up from a chair and assume a full standing position. They must be able to assume a full standing position five times.

You’re probably wondering, “You’re going to make old people do all of these?” It sounds really tough, but you’d be surprised. Though, they’re not going to do all three tests for no reason. Professionals will be using the test results to see who is at risk of developing functional limitations and disabilities, or see who is already developing such problems.

Feel free to check out this video to see a demonstration of how to perform the SPPB:

How to conduct the Short Physical Performance Battery (SPPB)

Since the SPPB Test has three components, let’s go through each one in the specific order they should be conducted..

The Standing Balance Tests:

For this test, there are three types of standing positions that patients must assume and maintain for ten seconds. They must be able to maintain these positions without the aid of a cane or walker. You may help them get up from their seat, though.

Before anything, tell the patients that you will describe and demonstrate the instructions to them. Let them know as well that if they are unable to perform the actions or if they feel unsafe doing them, they should tell you. Emphasize to them that you don’t want them to feel unsafe, so if they do feel unsafe, tell them that and move on to the next part.

Also, make sure to ask them if they have any questions. If none, then begin.

1. Side-by-Side Stand

• Demonstrate what a Side-by-Side Stand is, which is to assume a standing position with your feet together side-by-side. The patient must assume this position and maintain it for ten seconds.

• Tell them that they may use their arms, move their body, and even bend their knees to maintain their balance, however, their feet must stay together the whole time.

• Stand next to the participant to help them into the side-by-side position. Make sure that you are able to support the participant’s arm to prevent loss of balance.

• Once their feet are together, ask them if they’re ready. If they are, let go of the patient and then tell them to start. Make sure you have a stopwatch so you can begin timing as soon as you tell them to begin.

• The test stops after ten seconds or if the participant steps out of position or grabs your arm.

• If the patient is unable to maintain their balance for ten seconds, move on to the Gait Speed Test. If they are able to maintain it, move to the second standing position.

2. Semi-Tandem Stand

• Demonstrate what a Semi-Tandem Stand is, which is to assume a standing position with the side of the heel of one foot touching the big toe of the other foot. The patient can put either foot in front, so long as they’re comfortable.

• They may use their arms, move their body, and even bend their knees to maintain their balance, however, their feet must stay together the whole time.

• Stand next to the participant to help him/her into the semi-tandem position. Make sure that you are able to support the participant’s arm to prevent loss of balance.

• When they’ve assumed the proper position, ask them if they’re ready. If they are, let go of the patient and then tell them to start.

• The test stops after ten seconds or if the participant steps out of position or grabs your arm.

• If the patient is unable to maintain their balance for ten seconds, move on to the Gait Speed Test. If they are able to maintain it, move to the third standing position.

3. Tandem Stand

• Demonstrate the Tandem Stand, which is to assume a standing position with the heel of one foot in front of and touching the toes of the other foot. The patient can put either foot in front, so long as they’re comfortable.

• Again, they may use their arms, move their body, and even bend their knees to maintain their balance, however, their feet must stay together the whole time.

• Stand next to the participant to help him/her into the tandem position. Make sure that you are able to support the participant’s arm to prevent loss of balance.

• When they’ve assumed the proper position, ask them if they’re ready. If they are, let go of the patient and then tell them to start.

• The test stops after ten seconds or if the participant steps out of position or grabs your arm.

• If the patient is unable to maintain their balance for ten seconds, move on to the Gait Speed Test.

The Gait Speed Tests

For this test, you’re going to observe how your elderly patient walks and how fast they are able to do so. They may use a cane or a walking aid for this.

Make sure to have something that you can use to mark distances, like tape and a yardstick. Mark a distance of three or four meters.

Once you’ve prepared everything and you’ve marked the distance, get your patient to stand behind the starting line. Their toes should be touching the start line.

1. First Gait Speed Test

• For this one, tell your patient to walk to the other end of the course at their usual speed. Demonstrate this, of course.

• Tell them that they need to walk past the marker at the end before they stop. You should also tell them that you will walk with them so that they feel safe and so you can assist them if ever they lose their balance while walking.

• Tell them that they will start when you say “Begin.” Of course, tell them to get ready first.

• When the patient says they’re ready, say “Begin.” Make sure to activate the stopwatch as soon as you say that and then deactivate it once your patient crosses the marker.

2. Second Gait Speed Test

• Have your patient turn around. They will do the same thing, but this time they will walk back to the previous starting point.

• Once they’ve turned around, have them stand behind the marker with their toes touching the marker.

• Ask them if they’re ready. If they are, say “Begin” so they can start walking back to the start. Don’t forget to activate your stopwatch and make sure you walk with them.

The Chair Stand Test

This test comes in two parts, but the first one is more like a test to see if they can actually do this without using their arms. If they can, then they will do the second part, which is the real test. If they can’t, the Short Physical Performance Battery ends here.

1. Single Chair Stand

• Tell them that this test is for gauging their leg strength.
• Give them these instructions and demonstrate them: they must fold their arms across their chest, they must plant both feet on the floor.
• Once they’re in position, have them stand up while keeping their arms folded across their chest. They can’t use their arms to support themselves standing up.
• If they can’t do it, tell them to use their arms to stand up. The test ends here. If they can, then they will do the real Chair Stand Test.

2. Repeated Chair Stands

• This is the real test. They just need to assume a full standing position five times without the aid of their arms, so they simply need to maintain their position in the Single Chair Stand test, but they must do this five times as quickly as they can.
• Explain the above objective and demonstrate it.
• Ask them if they’re ready. If they say they’re ready, say “Begin” so they can start. Make sure to time them. The test stops for any one of the following reasons:

• The patient has accomplished assuming a full standing position five times
• If a minute has passed, even if they haven’t assumed a full standing position five times
• If you think it’s necessary to stop for the safety of the patient

How to score the Short Physical Performance Battery (SPPB)

You will have to score each test based on certain criteria, but before we get to that, it is possible for patients to be unable to do certain tests or fail them. If they are unable to do them or if they fail them, please indicate why using the following options for each test (as a whole, not per component):

• 1 = Tried but unable
• 2 = Participant could not hold position unassisted
• 3 = Did not attempt because I felt that the test was unsafe for them
• 4 = Did not attempt because the patient felt unsafe
• 5 = The participant was unable to understand the instructions
• 6 = Others (please specify)
• 7 = Patient refused

The Standing Balance Tests Scoring:

1. Side-by-Side Stand

• Maintained balance for 10 seconds = 1 point
• Unable to maintain balance for 10 seconds = 0 points
• Did not attempt = 0 points
• If the patient is unable to maintain their balance for 10 seconds, you must still record how long they were able to maintain it
• If they get 0 points, the test ends here, otherwise, you move to the next standing position

2. Semi-Tandem Stand

• Maintained balance for 10 seconds = 1 point
• Unable to maintain balance for 10 seconds = 0 points
• Did not attempt = 0 points
• If the patient is unable to maintain their balance for 10 seconds, you must still record how long they were able to maintain it
• If they get 0 points, the test ends here, otherwise, you move to the next standing position

‍3. Tandem Stand

• Maintained balance for 10 seconds = 2 points
• Maintained balance for 3 to 9.99 seconds = 1 point
• Maintained balance for less than 3 seconds = 0 points
• Did not attempt = 0 points
• If the patient is unable to maintain their balance for 10 seconds, you must still record how long they were able to maintain it

Once you get all the scores for each component, calculate the sum for the total score.

The Gait Speed Tests Scoring:

Make sure to indicate if they walked a three or four-meter walking course for both Gait Speed Tests. Also, make sure to indicate if they used a cane or walking aid.

The score will depend on how fast they were able to accomplish each walk. Make sure to record their times. The fastest time of the two will be used to find out their score. If they only did one of the two components, then that will be the one used to find out their score.

Please refer to these to know what score they will get:

1. For 3-meter courses:

• If the fastest time is more than 6.52 seconds = 1 point
• If the fastest time is 4.66 to 6.52 seconds = 2 points
• If the fastest time is 3.62 to 4.65 seconds = 3 points
• If the fastest time is less than 3.62 seconds = 4 points

2. For 4-meter courses:

• If the fastest time is more than 8.70 seconds = 1 point
• If the fastest time is 6.21 to 8.70 seconds = 2 points
• If the fastest time is 4.82 to 6.20 seconds = 3 points
• If the fastest time is less than 4.82 seconds = 4 points

If they were not able to complete both walks, they score 0 points.

The Chair Stand Tests

1. Single Chair Stand

• Indicate if it’s safe for them to stand without help.
• If the patient stood without using arms, proceed to the Repeated Chair Stand Test.
• If the patient used their arms to stand, end the test. This will count as 0 points.
• If they can’t complete the Single Chair Stand test, end the test. This will count as 0 points.‍

2. Repeated Chair Stands

• Indicate if it’s safe for them to stand five times without help.
• Record how long it took for them to complete five stands.
• If the patient is unable to complete 5 chair stands or completes stands beyond 60 seconds = 0 points
• If their chair stand time is 16.70 to 59.9 seconds = 1 point
• If their chair stand time is 13.70 to 16.69 sec = 2 points
• If their chair stand time is 11.20 to 13.69 sec = 3 points
• If their chair stand time is 11.19 sec or less = 4 points

Calculating the Total Score:

Add up the sum of all results to get the overall score. The maximum score is 12. While there are no score ranges to look at, keep in mind is that the higher their score is, the lower the risk of disability or injury.

For your benefit, there are comment boxes for each test, so you can write down any observations you’ve made for each test. This can help determine what goes into a patient’s care plan.

Short Physical Performance Battery (SPPB) Example

Now that you know what the Short Physical Performance Batter (SPPB) is all about, how to conduct all three tests, and how to score each of them, then it’s time for you to see what an SPPB Test sheet looks like. Since there are three tests, don’t be surprised at the length, but the instructions are easy and the scoring is nowhere near complicated, so it should be easy to accomplish.

If you like what you see and believe that the Short Physical Performance Battery (SPPB) is a good way to gauge your elderly patients, then feel free to download an SPPB Test PDF from us! You can choose to print it and fill it out physically, or you can go paperless and just answer the PDF by ticking the checkboxes!

Download this Short Physical Performance Battery (SPPB) Example (Sample) here:

When is it best to conduct the Short Physical Performance Battery (SPPB)?

When an elderly person is scheduled for a check-up with you and they are specifically doing so to have themselves checked for any potential disabilities or deteriorations in their motor functions, then that’s the best time to conduct the Short Physical Performance (SPPB) Test.

Even if an elderly patient is scheduled to have one thing about them checked, let’s say for the sake of example, their right leg, there might be a chance that there are not just potential problems for the right leg. There might be more to it. More often than not, healthcare professionals will conduct a comprehensive examination that involves numerous tests.

These comprehensive examinations are the best times to insert the SPPB Test, given that you will be assessing their standing balance, their gait speed, and if they are able to stand up without support.

Depending on your observation and the patient’s test results,, they might need to have someone support them with activities of daily living that involve standing up and reaching for something. They might also be recommended to use walking aids if they aren’t already using them.

Including the SPPB Test during comprehensive examinations is ideal since it is important to take into account the outcomes of other evaluations. The SPPB Test should not be the sole assessment to determine the kind of care a patient has because it only focuses on the lower extremities. Make sure to combine the SPPB Test results with other test results, so you’ll be better informed regarding your patient’s overall condition and risk of certain problems normally tied to elderly patients, like falling.

Who can conduct the Short Physical Performance Battery (SPPB)?

Since the Short Physical Performance Battery (SPPB) is a physical assessment and is meant to be administered to elderly patients, the healthcare professionals that can conduct the tests are:

• Geriatricians
• Physical Therapists
• Occupational Therapists
• Physiologists
• Nurses

First and foremost, geriatricians are one of the best professionals to use this assessment because they are highly trained, experienced, and specialize in treating elderly patients. They will be able to properly administer the test instructions, guide the patients accordingly, can interpret results, and make medical decisions based on their findings.

Physical and occupational therapists, as well as physiologists, can also definitely administer this just as well, provide support to patients, and even determine what are the next steps that they must take in order to ensure the patient gets the best treatment possible.

So long as the healthcare professional is familiar with the Short Physical Performance Battery and is trained to properly handle and treat elderly patients, they can definitely add this to their roster of clinical assessments as well as conduct it. They just need to make sure to administer other physical tests in order to gain a better understanding of the patient, their potential disabilities or deteriorations, what can be done in order to help improve their overall conditions, and see if they need support to do certain things (activities of daily living).

What are the benefits of using the Short Physical Performance Battery (SPPB)?

It is an inexpensive assessment to administer.

The Short Physical Performance Battery does not require any special equipment from the healthcare professional since it’s a non-invasive physical examination. The only things that the professional needs are:

• A stopwatch to record the patient’s times for each test
• A chair for patients to sit on. This is for both the first and third tests since they involve standing up
• Tape to mark the start and end points of a three or four-meter walking course
• A yardstick to measure the three or four-meter walking course so you know where to put the tape markers

Once you have these, you’re all set! This is perfect for housecalls, too, given these are the only things you need.

It is quick and easy to administer.

To jump off from the SPPB Test being inexpensive, it’s also a test that can be accomplished relatively quickly and easily!

The instructions for all three tests are easy to follow and the scoring is straightforward. The only difficulty that may arise from this test will depend on your patient’s capabilities. If they are having a hard time, that’s already indicative of potential problems with their motor function.

This could take anywhere between ten to thirty minutes for all three tests! Though, even if it’s quick and easy to administer, don’t be surprised if it takes longer for other patients. Some elderly patients are still spritely and strong enough to accomplish this with ease, while some will have a hard time. Some might not even be able to finish the test.

It can be used to predict adverse motor function outcomes.

Since you will be gauging their standing balance, gait speed, and their leg strength, you can make predictions depending on their scores and your observations. If they are having a difficult time doing each task, then that’s a sign that they might be developing disabilities or there is already an increasing decline in their motor functions. This is even more evident if they almost get into accidents during the test, like falling or slipping, which are not good, so make sure that you follow the instructions and remain by the patient’s side at all times to provide the necessary support.

It can be used to monitor patients over time.

Let’s say that you already developed and implemented a treatment or care plan for your patients based on the results of the SPPB Test as well as other assessments. You can re-administer the SPPB Test every now and then to check if they are improving or not. If they’re getting better, then it’s likely that your plan is effective and working, meaning you should maintain it. If not, then it’s either there’s something that needs to be adjusted in your plan, or the physical deterioration is just unavoidable at this point, so your focus should be on helping them live and cope with that reality.

Why use Carepatron for geriatric patient-related work?

If you are a physical therapist, a geriatrician, or an adjacent healthcare professional looking to expand your roster of clinical tools, then take the time to browse around Carepatron!

We have a massive repository of resources that covers a wide range of healthcare fields, especially physical therapy. You’re bound to find assessments, worksheets, general treatment plans, and a whole lot more that can help you treat your geriatric patients better and more efficiently!

Besides our treasure trove of resources, another Carepatron feature that you can enjoy is our storage system, which allows you to store your clinical files in a HIPAA-compliant manner! If you have filled-out Short Physical Performance Battery PDFs, then you can store them with us and even set up who can access them besides you! Storing your files with us essentially makes backups of your work, so if you want to create backups for safety reasons, we can definitely help you with that.

Storing them with us also makes them easily accessible to you whenever you want, wherever you are, so long as you have internet access. This is perfect for house calls! If you’re conducting the SPPB Test for a house call, you can just grab an empty SPPB PDF from your storage and fill it out on your laptop or even a smartphone.

We, at Carepatron, are all about helping healthcare professionals with their work, so take advantage of our platform so we can help streamline your workflows and help you preserve your work!