doi: 10.33233/rbfex.v20i1.3852
ORIGINAL
ARTICLE
Correlation between the GDLAM functional fitness test
scores and the Katz functional scale of physically independent older people
Correlação
entre os scores dos testes de aptidão funcional GDLAM e escala funcional de
Katz de idosos fisicamente independentes
Gabriel
Vargas Malini Araujo1, Roberta Luksevicius Rica2, Ana Paula Lima Leopoldo1,
Angelica Castilho Alonso3, Marzo Edir Da Silva-Grigoletto4, Eduardo Cadore5,
Alexandre Lopes Evangelista6, Welmo
Alcântara Barbosa1, Michelli Christian
Soares Santos Gomes1,7, Danilo Sales Bocalini1
1Universidade Federal do Espírito Santo,
Vitória, ES, Brasil
2Universidade Estácio de Sá, Vitória, ES,
Brasil
3Universidade São Judas Tadeu, São Paulo,
SP, Brasil
4Universidade Federal de Sergipe,
Aracajú, SE, Brasil
5Universidade Federal do Rio Grande do
Sul, Porto Alegre, RS, Brasil
6Universidade Nove de Julho, São Paulo,
SP, Brasil
7Universidade Vila Velha, Vila Velha, ES,
Brasil
Received:
January 13, 2020; accepted:
July 14, 2020.
Correspondence: Danilo Sales Bocalini, Centro
de Educação Física e Desportos, Universidade Federal do Espírito Santo, Avenida
Fernando Ferrari, 514 Goiabeiras, 29075-910 Vitória ES
Gabriel Vargas Malini
Araujo: g.vargas_57@hotmail.com
Roberta Luksevicius
Rica: robertarica@hotmail.com
Ana Paula Lima Leopoldo:
ana.leopoldo@ufes.br
Angelica
Castilho Alonso: angelicacastilho@msn.com
Marzo Edir Da Silva-Grigoletto: dasilvame@gmail.com
Eduardo Cadore:
edcadore@yahoo.com.br
Alexandre Lopes Evangelista:
contato@alexandrelevangelista.com.br
Michelli
Christian Soares Santos Gomes: michelli.christi@hotmail.com
Welmo A.
Barbosa: welmoalcantara@hotmail.com
Danilo
Sales Bocalini: bocaliniht@hotmail.com
Aim: To evaluate the level of
agreement via correlational analysis between an objective (GDLAM) and a
subjective (Katz scale) measure of functional capacity in physically independent
older adult males and females. Methods: One hundred physically
independent subjects ≥ 60 years participated in the study. The following
parameters were investigated: body composition (height, body weight, body mass
index, and hip and waist circumference), objectively measured functional
capacity via the GDLAM test (walking 10m, rising from a sitting position,
rising from the prone position and standing up, get up of a chair and move
around the house), and the Katz functional scale (subjective perception of six
items for daily activities, namely: bathing, dressing, toileting, transferring,
continence, and feeding). Results: Correlational results between the
objective (GDLAM) and subjective (Katz) assessments showed a high degree of
agreement between the scores within the full sample (r = -0.6636), as well as
among females (r = -0.8662) and males (r = -0.8380), all p ? 0.001. Conclusion:
The two physical aptitude tests showed satisfactory levels of agreement and
correlation and presented good practical application. This suggests
interchangeability of the tests.
Keywords: elderly people; functional test;
functional fitness; aging.
Resumo
Objetivo: O objetivo deste estudo foi avaliar a
correlação entre os testes de aptidão funcional desenvolvido pelo Grupo de
Desenvolvimento Latino-Americano para a Maturidade (GDLAM) e a escala de
aptidão funcional de Katz em idosos fisicamente independentes. Métodos:
Cem idosos com idade ≥ 60 anos participaram do estudo. Os seguintes
parâmetros foram investigados: composição corporal (estatura, massa corporal, perimetria), funcionalidade objetiva por meio da aplicação
do teste objetivo GDLAM (andar 10m, levantar-se a partir de uma posição
sentada, subida da posição prona e levantar-se da cadeira e deslocar-se pela
casa) e escala funcional subjetiva de Katz (percepção do idoso seis itens para
atividades diárias, como, banhar-se, vestir-se, utilizar o banheiro ou ato de
ir ao banheiro para excreções, higiene pessoal, arrumar a roupa, transferência,
avaliada no desempenho de sair da cama e se sentar em uma cadeira e vice-versa,
continência, referente a autocontrole de eliminação de urina e fezes e
alimentação, ato de dirigir a comida à boca). Resultados: A comparação
dos resultados de concordância entre os testes de aptidão física objetivo
(GDLAM) e subjetivo (Katz) apresentaram alto grau de concordância entre os
scores, tanto na avaliação geral (r = 0,6636) quanto nos
grupos feminino (r = 0,8662) quanto masculino (r = 0,8380). Conclusão:
Os dois testes de aptidão física se correlacionaram moderadamente e apresentam
boa aplicação prática. Isto sugere a intermutabilidade dos testes.
Palavras-chave: envelhecimento; exercício físico;
atividades diárias; saúde.
In developing
countries, the prevalence of elderly people has been increasing rapidly [1]. In
Brazil, the number of elderly people increased from 3 million in 1960 to 20
million in 2008, with prospects for an even greater increase for the next years
[2]. Associated with aging, physical inactivity is considered an important risk
factor for diseases in general, and, in addition to social and environmental
aspects, it can lead to progressive loss of functional capacity, which is often
accompanied by reductions in the ability to perform activities of daily living
[3,4,5,6]. The practice of physical activity is considered an effective
non-pharmacological method to reduce physical disability, in addition to
decreasing the risk of several chronic diseases [4,5,7,8,9,10,11,12] recognized as
disabling in advanced clinical stages [5,13,14,15,16].
In view of all
the positive factors of physical activity and negative factors of aging, there
are countless tests that allow the assessment of the functional capacity of the
elderly, of which the objective and subjective tests stand out. Regardless,
both seek to obtain data related to general physical condition, showing the
individual's independence. The objective tests for the elderly consist of
exercises that represent everyday tasks; however, there are also tools that
assess certain physical valences in an individualized manner, facilitating the
identification of specific functional impairment [17].
Objectively, the
protocol for assessing functional fitness in the elderly developed by the Latin
American Development Group for Maturity (GDLAM) has been used frequently in the
literature [18,19,20]. This protocol aims to investigate changes resulting from
the pathological or physiological aging processes, in the presence or absence
of acute or chronic strategies and/or interventions [18,20], aiming to assess
the ability of the elderly to perform activities of daily living (ADL). Among
subjective tests, the Katz scale of functionality has become a frequently
explored method in the literature and has conclusive validity to functional
aspects [21,22,23,24,25]. With the instrument proposed by Katz (1963), known as the
functional capacity scale, the objective is to evaluate, through the perception
of the elderly, six items for daily activities, such as bathing, dressing,
toileting, transferring, continence, and feeding.
Although both
instruments have the same objective of assessing aspects of functionality,
there are no reports in the literature on the association between their
results. Being the investigation of different domains considered decisive for
geriatric characterization and/or evaluation, the objective of this study was
to evaluate the correlation between the tests of aptitude of the functional
capacity developed by the GDLAM and the scale Katz of functional fitness in
physically independent elderly.
Sample
Participated in
the present study, 100 physically independent older adults, in the region of
greater Vitória (ES, Brazil), ≥ 60 years, recruited through advertisement
in social media networks. All subjects were informed of the objective and the
voluntary nature of the study and signed an informed consent form. This
research is in the process of approval by the Ethics and Research Committee of
the Federal University of Espírito Santo (nº:
3.781.742, CAAE: 23557519.5.0000.5542- 2019).
The following
exclusion criteria were adopted: recent hospitalization, symptomatic
cardiorespiratory disease, hypertension or uncontrolled metabolic syndrome,
severe kidney or liver disease, cognitive impairment or progressive and
debilitating health conditions, obesity with the inability to perform physical
activity, recent bone fractures, or any other contraindications to perform
physical exercise.
Body composition
Height was
measured using a Cardiomed stadiometer (WCS model)
with an accuracy of 0.1 cm, and for body mass (BM) a Filizola
scale (Personal Line Model 150) was used with an accuracy of 0.1 kg. The body
mass index (BMI) was calculated according to the formula: BMI = weight/height².
Thus, the following parameters were evaluated: BM, BMI, waist and hip
circumference, and waist-to-hip ratio (WHR).
GDLAM Protocol
Functional
aptitude was assessed considering the scores and procedure proposed by the
protocol according to Dantas & Vale [18] which
consists of performing the following tests: walking 10 meters (W10m), standing
up from a seated position (SSP), getting up from the prone position (GUPP), get
up from the chair and move around the house (GUCMH). All GDLAM tests are scored
based in time to perform each test, recorded in seconds. All tests were
performed in the order described above, in a single day, using a 3-minute
interval between them to allow a good recovery. According to Dantas & Vale [18], the General GDLAM Index was
evaluated considering the following equation: IG = [(C10m + LPS + LPDV) x 2] +
LCLC / 3.
Katz scale of functional fitness
The Katz scale
of functionality has become a subjective method widely explored in the
literature and has conclusive validity to assess aspects of physical function
[21]. The Katz scale proposes to assess, through the elderly's perception, six
items related to ADL. More specifically, it assesses one’s ability to bathe,
dress, use the toilet, transfer (e.g., get out of bed and sit in a chair and
vice versa); continence (i.e., self-control over urination and defecation), and
feed (i.e., direct food to the mouth). Each activity above is matched by three
filling alternatives, the first consisting of “without help”, means that the
subject can perform the activity without assistance, with “partial help”, in
which the subject can only perform the activity if he/she receives some assistance
and with “total help”, in which the subject is completely unable to perform the
activity independently. The questionnaire is completed in the order described
with scores ranging from 0 to 6 points, where 0 indicates total independence
for the performance of activities and 6, dependence (total or partial) in
carrying out all the proposed activities. The intermediate score indicates
total or partial dependence on any of the activities and must be assessed
individually.
Statistical analyses
The
Kolmogorov-Smirnov test was applied to analyze normality. We determined
differences between males and females using an independent samples t-test.
Pearson's linear correlation was used to analyze the correlation between the
GDLAM and Katz scores. Data are presented as means ± standard deviation, and
all analyzes were performed using SPSS (IBM version 22.0). A two-tailed
significant level was set at p < 0.05. Data are presented as means ±
standard deviation, and all analyzes were performed using SPSS (IBM version
22.0).
Table I shows
the anthropometric and functional parameters of the general analyzes, also
identifying the male and female groups. Significant differences (p<0.05)
were found between males and females only in body mass, height and WHR values.
In the three analyzes, the subjects were classified as overweight, and only the
male group presented WHR values above the cutoff rate, with greater
probabilities of cardiovascular events.
Table I - Anthropometrics parameters of
study participants (See PDF annexed)
The performance
of the C10m, RSP and RPP functionality tests were classified as weak in all
analyzes, however, for the general and female group analyzes the GUCMH test
performance was classified as good, while the males were classified as very
good. Significant differences (p<0.05) were found between males and females
in the tests LPS and LCLC as shown in Table II.
Table II - Functional fitness parameters
of elderly people (See PDF annexed)
Regarding the
GDLAM functionality index, in the full sample (general analysis) was classified
as “weak”, and so were females, while males were classified as “regular”.
Therefore, significant differences were found between males and females in both
functional scores as shown in table II. The prevalence of the functionality
categories of both the GDLAM protocol and the Katz scale are showed at Figure
1.
Panel
A = classification considering the criteria of GDLAM index as very good (VG),
good (G), regular (R) and weak (W). Panel B = classification considering the
Katz scale criteria as independent (I), moderately dependent (MD) and dependent
(D)
Figure 1 - Prevalence of classifications
of functional fitness.
The correlation
results between the GDLAM tests and the Katz scale are shown in Figure 2.
Significant correlations were found in the three analyzes, full sample (r =
-0.6636; p < 0.0001), males (r = -0.8380; p < 0.0001) and females (r =
-0.8662; p < 0.0001).
Figure 2 - Correlations between the Katz
scale and the GDLAM index to general sample, male and female
The result of
the present study demonstrated that both assessment protocols have correlation
and agreement between them, given that both demonstrated significant
correlations in all analyzes (r = -0.6636; r = -0.8380; r = -0, 8662). The
present findings corroborate the hypothesis that both protocols have
applicability in fields of activity and validity in the results.
It is no longer
new that life expectancy is increasing, and population aging is present in all
countries, especially in developing countries [26]. In this perspective,
countless interventions have been applied aiming at promoting successful aging
[27,28], many of which targeting well-being and functionality. Thus,
initiatives aimed at promoting independence are important to help maintain
basic and instrumental ADL at a satisfactory level.
The assessment
of functional independence is important for numerous outcomes, such as the
progression of physical training, monitoring of independence in performing
daily activities, risk of chronic disease and overall mortality [29], and
dependency [30]. According to Ramos et al. [31], elderly people with a
high dependency index have a higher risk of mortality, and maintaining physical
independence is a preventive factor [31]. In addition, the progressive loss of
functionality can have repercussions in several other aspects of life, covering
the social, psychological, and biological domains [32].
This way, the
assessment of functional capacity becomes relevant to a broad approach, both in
the prevention and in the treatment of illnesses that can affect overall health
in older adults. Thus, tests that aim at the objective assessment of
independence are frequently used in the literature [18,19,33], however the
application is surrounded by barriers in their administration, especially when
performed in large populations. As such, the use of questionnaires and scales,
like the ones in the current study, allows feasible and practical assessment of
functional capacity in large groups of people.
The GDLAM
protocol has been used in several studies as a functional outcome measure
[18,19,20]. Of these, many proposed to investigate the effects of different types
of exercise programs on functional capacity in older adults. Interventions such
as water-based aerobic training [19,35,36,37], resistance training [38,39,40],
walking [41], and multimodal exercises [33,42]. Regardless of the investigated
modality, the duration of the exercise protocol, as well as the level of
functionality of the subjects submitted to the exercise programs, measurable
significant improvement in functional fitness were detected using the GLDAM
protocol.
The Katz
protocol was developed in the 1970s and is still used today to assess
functionality in the elderly, but over the decades, some versions have been
modified and adapted from the original test, as shown by Duarte et al.
[21]. Regardless, Lino et al. [43] presented a cross-cultural adaptation
of the Katz scale to the Portuguese language, showing fidelity both in the
back-translation and in the functionality of its application [43].
Although many
studies show the validity of using the GDLAM and Katz [18,19,33] protocols to
assess physical independence, little has been investigated regarding the
agreement between these assessment methods. To our knowledge, there are no
studies available in the literature that investigated the agreement between the
instruments investigated in this research. Thus, considering the moderate
correlation presented in this study for the general population (r = -0.6636),
and high correlation for females (r = -0.86620) and males (r = -0.8380), these
tests allows us greater versatility the use of both instruments according to
the need of the evaluator and the prerogative of use.
In conclusion,
the functional independence assessed by the GDLAM protocols and the Katz
functional fitness scale in physically independent older adults presented a
considerably high level of agreement and correlation, thus allowing
interchangeability between these instruments.
Acknowledgments
Thanks
to Fundação de Amparo à Pesquisa do Espírito Santo (grant numbers 84417625/2018). The
funders had no role in study design, data collection and analysis, decision to
publish or preparation of the manuscript.
Conflict of interest
The authors declare that they have no conflict of
interest.
Authors´s
contributions
Conception and design of the research: Araújo GVM,
Rica RL, Bocalini DS. Data collection: Araujo GVM,
Barbosa WA, Gomes MCSS. Analysis and interpretation of data: Rica RL, Alonso
AC, Lima-Leopoldo AP. Statistical analysis: Rica RL, Alonso AC, Lima-Leopoldo
AP, Bocalini DS. Writing of the manuscript: Araújo
GVM, Rica RL, Alonso AC, Bocalini DS. Critical revision of the manuscript
for important intellectual content: Lima-Leopoldo AP, Silva-Grigoletto
ME, Cadore E, Bocalini DS.