PHYSICAL FUNCTION EVALUATION Physical function (PF) was evaluated on examinees aged 60 years and over by a trained examiner using a battery of physical performance measures in the mobile examination center (MEC) and at examinees'homes. The protocol for this component did not detail any medical, safety or other exclusions. To determine which sample persons were home examinees, the DMPSTAT variable (3=home-examined) should be used. When analyzing data for combined home-examined and MEC-examined persons, the combined MEC- plus home-examined sample weight should be used (WTPFHX6). When using only MEC items or measures, the MEC examination sample weight should be used (WTPFEX6). For more information on the use of sample weights in NHANES III data analysis, refer to the NHANES III Analytic and Reporting Guidelines (U.S. DHHS, 1996b). Physical function was tested using certain movements that represent musculoskeletal activities needed to carry out daily activities. Gross shoulder joint movement, fine motor hand movement, lower extremity motor functions, and integrated movement of balance and gait were determined. Upper extremity functions were evaluated using Jette and Branch (1984) right and left shoulder, external and internal rotations (PFPRSER, PFPLSER, PFPRSIR, and PFPLSIR). The fine motor function examination was a modification of a manual ability examination in which a key was inserted into a lock and then was turned (PFPTKEY) (Williams, 1982). The lower extremity motor, balance, and gait evaluation items included time to get up from an armless chair five times (PFPTSTND), a full tandem stand with the heel of one foot directly in front of the toes of the other foot for a maximum time of 10 seconds (PFPTTAND), and left and right knee flexing (PFPLFLEX and PFPRFLEX). An eight-foot walk performed twice at the usual walking speed (PFPTWLKA, PFPTWLKB, PFPNSTPA, and PFPNSTPB) was used also (Jette, 1985; Tinetti, 1986; Nevitt, 1989). Items were scored by measuring the time required to perform the maneuver (lock and key, chair rising, tandem stand, eight-foot walk), by using scoring rules (shoulder rotation, knee flexing), and by counting steps (eight-foot walk). Examinees who were unable to perform a specific maneuver either because they felt that it would have been unsafe or because they knew they were unable to do it for reasons related to physical limitations or health conditions were not required to make an attempt. For example, if an examinee was in a wheelchair and was not able to stand up, he/she skipped the following maneuvers: time to complete five chair stands (PFPTSTND), right and left knee-hip flexion (PFPRFLEX and PFPLFLEX), and tandem stand (PFPTTAND). The examinee was then asked, "Are you able to walk alone without holding on to another person? You may use a cane or walker." If he/she answered affirmatively, the examinee did the measured walking (PFPTWLKA, PFPTWLKB, PFPNSTPA, and PFPNSTPB); otherwise, he/she skipped the measured walking and ended the test. In the data set, examinees unable to complete the maneuver for these reasons were coded as "Blank," whereas examinees who did not perform the test for reasons unrelated to physical limitations were coded as "8 Blank but applicable." Persons aged 60 and over who refused or were unable to come to the mobile examination center (MEC) were tested in their homes. Persons found to be bedbound were excluded from the lower extremities part of the PF evaluation (HXPBED). Aside from using an accessible, armless chair in the examinees' homes (HXPCHIR), technicians used equipment and procedures comparable to those used in the MEC. Because technicians used equipment and procedures in examinees' homes that were comparable to those used in the MEC, the home PF values were incorporated into the MEC PF measures data set. Refer to the Physical Function Examination Manual (U.S. DHHS, 1996b) and the Home Examination Manual (U.S. DHHS, 1996b) for descriptions of data collection procedures and methods. At the time of hire, MEC and home examination health technicians were trained to conduct the physical function evaluation. During annual site visits, examination administration was observed, and re-training took place. Applicable parts of the National Institute on Aging video "Assessing Physical Performance in the Home-Part 1" were used to demonstrate the PF procedures during initial training and re-training (NIA, 1988). Data processing and editing were performed to ensure internal data consistency. Notes have been provided for variables requiring additional explanation. NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ GENERAL INFORMATION ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6179-6180 Health status screener PFPHHS 4681 01 No apparent restriction 287 02 Presently in wheelchair 38 03 Recent surgery 56 04 Injury 23 05 Bedridden 228 06 Other health condition 90 07 Other 321 88 Blank but applicable 25587 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ SHOULDER EXERCISES ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6181 Right shoulder external rotation PFPRSER 4654 1 Full 644 2 Partial 83 3 Unable 343 8 Blank but applicable 25587 Blank 6182 Left shoulder external rotation PFPLSER 4640 1 Full 653 2 Partial 91 3 Unable 340 8 Blank but applicable 25587 Blank 6183 Right shoulder internal rotation PFPRSIR 4949 1 Full 346 2 Partial 87 3 Unable 342 8 Blank but applicable 25587 Blank 6184 Left shoulder internal rotation PFPLSIR 4965 1 Full 323 2 Partial 96 3 Unable 340 8 Blank but applicable 25587 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ KEY IN LOCK TIMED MANEUVER ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6185 Ability to pick up key See note PFPUKEY 5277 1 Yes 65 2 No (PFPWC) 382 8 Blank but applicable 25587 Blank 6186 Ability to hold key PFPHKEY 5214 1 Yes 62 2 No (PFPWC) 383 8 Blank but applicable 25652 Blank 6187-6190 Time to unlock lock (sec) See note PFPTKEY 5153 0002-0060 444 8888 Blank but applicable 25714 Blank 6191 Check item--bedbound HXPBED (home exam only) 27 1 Yes (PFPTECH) 389 2 No 6 8 Blank but applicable 30889 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ SINGLE CHAIR STAND ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6192 In wheelchair (MEC only) PFPWC 274 1 Yes 4707 2 No (PFPSCOOT) 321 8 Blank but applicable 26009 Blank 6193 Can you get up from your See note PFPUPWC chair/wheelchair by yourself? 192 1 Yes 96 2 No (PFPOWALK) 322 8 Blank but applicable 30701 Blank 6194 Use of arms to scoot forward PFPSCOOT 3180 1 Yes 1938 2 No 94 3 Unable to move 389 8 Blank but applicable 25710 Blank 6195 Ability to stand See note PFPUSTND 4865 1 Yes, without arms 182 2 Yes, with arms for pushing off (PFPRFLEX) 160 3 Unable (PFPOWALK) 394 8 Blank but applicable 25710 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ REPEATED CHAIR STAND TIMED MANEUVER ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6196-6199 Time to complete five stands (sec) See note PFPTSTND 1 0.0 4821 0002-92.3 16 5555 Able to stand but unable to do the maneuver 421 8888 Blank but applicable 26052 Blank 6200-6201 Number of stands PFPNSTND 3 01 1 stand 3 02 2 stands 7 03 3 stands 2 04 4 stands 4805 05 5 stands 16 55 Able to stand but unable to do the maneuver 423 88 Blank but applicable 26052 Blank 6202-6205 Chair height home exam only (in) HXPCHAIR 1 12.0 14 13.0 18 14.0 2 15.0 9 16.0 90 17.0 55 18.0 15 19.0 1 20.0 70 8888 Blank but applicable 31036 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ HIP AND KNEE EXERCISES ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6206 Right hip and knee flexion PFPRFLEX 4663 1 Full 370 2 Partial 24 3 Unable 384 8 Blank but applicable 25870 Blank 6207 Left hip and knee flexion PFPLFLEX 4677 1 Full 356 2 Partial 25 3 Unable 383 8 Blank but applicable 25870 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ TANDEM STAND TIMED MANEUVER ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6208 Are you able to stand by yourself PFPSTAND without holding on to anything? 4844 1 Yes 235 2 No (PFPOWALK) 362 8 Blank but applicable 25870 Blank 6209-6212 Time tandem stand held (sec) See note PFPTTAND 4686 0001-0010 520 8888 Blank but applicable 26105 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ MEASURED WALK ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6213 Observed walking without help PFPOWALK 5105 1 Yes (PFPTWLKA) 265 2 No 327 8 Blank but applicable 25614 Blank 6214 Are you able to walk alone without PFPRWALK holding on to another person? 91 1 Yes 174 2 No (PFPTECH) 327 8 Blank but applicable 30719 Blank 6215-6218 Time to complete 8-foot walk, PFPTWLKA trial A (sec) 5059 0002-0060 464 8888 Blank but applicable 25788 Blank 6219-6220 Number of steps, trial A PFPNSTPA 5131 03-38 392 88 Blank but applicable 25788 Blank 6221-6224 Time to complete 8-foot walk, PFPTWLKB Trial B (sec) 5011 0002-56.2 512 8888 Blank but applicable 25788 Blank 6225-6226 Number of steps, trial B PFPNSTPB 5121 03-33 402 88 Blank but applicable 25788 Blank 6227 Pain reported on walking PFPPAIN 544 1 Yes 4592 2 No 387 8 Blank but applicable 25788 Blank NHANES III Examination Data File ------------------------------------------------------------------------ PHYSICAL FUNCTION EVALUATION ------------------------------------------------------------------------ GENERAL INFORMATION ------------------------------------------------------------------------ Positions Item description SAS name Counts and code Notes ------------------------------------------------------------------------ 6228 Type of device used PFPDEVIC 4821 1 None 220 2 Cane 76 3 Walker 18 4 Other 388 8 Blank but applicable 25788 Blank 6229-6233 Examiner number PFPTECH 5064 01001-09018 660 88888 Blank but applicable 25587 Blank NOTES PFPTKEY: Time to unlock lock (sec) If the examinee was not able to open the lock within 60 seconds, the maneuver was terminated, and his/her time was entered as 60 seconds. PFPTSTND and PFPUSTND: Time to complete five stands (sec) and ability to stand A standardized wooden cube, 50-cm in height, was used as a prop for the armless chair maneuvers in the MEC. PFPTTAND: Time tandem stand held (sec) The examiner stopped timing after 10 seconds even if the examinee was able to maintain the tandem stand for a longer period of time, and the examinee's time was entered as 10 seconds. PFPUKEY: Ability to pick up key The examinee had a maximum of 30 seconds to pick up the key. If the examinee was not able to pick up the key within 30 seconds, the maneuver was terminated, and the examinee proceeded to the next item (PFPWC). PFPUPWC: Can you get up from your chair/wheelchair by yourself? This question was asked during the MEC and home exam; PFPWC was recorded by the technician from observation in the MEC only. PFPUSTND: Ability to stand See note for PFPTSTND.