Original Study| Volume 22, ISSUE 8, P1646-1651, August 2021

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

  • Sarah A. Welch
    Address correspondence to Sarah A. Welch, DO, MA, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN 37212 USA.
    Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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  • Rachel E. Ward
    New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA

    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA

    Department of PM&R, Harvard Medical School, Boston, MA, USA

    Spaulding Rehabilitation Hospital, Boston, MA, USA
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  • Marla K. Beauchamp
    School of Rehabilitation Science, Hamilton, Ontario, Canada

    Department of Medicine, McMaster University Hamilton, Hamilton, Ontario, Canada
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  • Suzanne G. Leveille
    College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA

    Beth Israel Deaconess Medical Center, Boston, MA, USA

    Department of Medicine, Harvard Medical School, Boston, MA, USA
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  • Thomas Travison
    Beth Israel Deaconess Medical Center, Boston, MA, USA

    Department of Medicine, Harvard Medical School, Boston, MA, USA

    Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
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  • Jonathan F. Bean
    New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA

    Department of PM&R, Harvard Medical School, Boston, MA, USA

    Spaulding Rehabilitation Hospital, Boston, MA, USA
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Published:November 13, 2020DOI:



      Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention.


      Prospective longitudinal cohort study.

      Setting and Participants

      417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices.


      The SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/−) based on self-reported fall history and balance self-efficacy using an adapted STEADI model.


      Participants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB.

      Conclusions and Implications

      The SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.


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