# Utility of the Short Physical Performance Battery for Determining Walking Independence in Patients With Stroke

## TL;DR

This study compares the Short Physical Performance Battery (SPPB) and Berg Balance Scale (BBS) to determine which is better at predicting walking independence in stroke patients.

## Contribution

The study identifies cutoff values for the SPPB and BBS for determining walking independence in stroke patients.

## Key findings

- The SPPB cutoff value of ≥10 points predicted walking independence with high sensitivity and specificity.
- The BBS cutoff value of ≥49 points also predicted walking independence with comparable accuracy.
- Both tools showed similar discriminative accuracy for walking independence in stroke patients.

## Abstract

Introduction

The Short Physical Performance Battery (SPPB) is a functional assessment tool comprising three components: balance, gait, and muscle strength. It is easier to administer than the Berg Balance Scale (BBS), which has been used to determine walking independence. However, the cutoff value of the SPPB for determining walking independence in patients with stroke remains unknown. Therefore, this study aimed to compare the utility and cutoff values of the SPPB and BBS for determining walking independence in patients with stroke.

Methods

A total of 301 patients with stroke (mean age: 71.8±12.3 years) who were admitted to the convalescent rehabilitation ward of our center between July 2021 and June 2024 were included in this study. The SPPB, BBS, Stroke Impairment Assessment Set (SIAS), Mini-Mental State Examination (MMSE), and Functional Ambulation Categories (FAC) were administered at discharge. Walking independence was defined as FAC ≥4, and non-independence was defined as FAC ≤3. Logistic regression analysis was performed to examine the relationship between walking independence and the SPPB and BBS, with adjustments for age, sex, body mass index, days since onset, history of stroke, SIAS, and MMSE as covariates. The cutoff values of the SPPB and BBS for determining walking independence were calculated by receiver operating characteristic curve analysis, and the areas under the curve (AUC) for both measures were compared. The significance level was set at 0.05.

Results

Of the 301 patients, 184 were classified as walking independent, and 117 were classified as non-independent. The SPPB (odds ratio (OR)=2.15; 95% confidence interval (CI): 1.69-2.73) and BBS (OR=1.14; 95% CI: 1.25-1.56) were significantly associated with walking independence at discharge (p<0.001). The cutoff values for walking independence were ≥10 points for the SPPB (AUC: 0.948, sensitivity: 0.940, and specificity: 0.855) and ≥49 points for the BBS (AUC: 0.945, sensitivity: 0.967, and specificity: 0.821), without significant difference in AUC.

Conclusions

The SPPB demonstrated high discriminative accuracy comparable to the BBS, indicating its usefulness as a simple and practical evaluation tool.