Short Physical Performance Battery and all-cause mortality: Systematic review and meta-analysis

Rita Pavasini, Jack Guralnik, Justin C. Brown, Mauro di Bari, Matteo Cesari, Francesco Landi, Bert Vaes, Delphine Legrand, Joe Verghese, Cuiling Wang, Sari Stenholm, Luigi Ferrucci, Jennifer C. Lai, Anna Arnau Bartes, Joan Espaulella, Montserrat Ferrer, Jae Young Lim, Kristine E. Ensrud, Peggy Cawthon, Anna TurushevaElena Frolova, Yves Rolland, Valerie Lauwers, Andrea Corsonello, Gregory D. Kirk, Roberto Ferrari, Stefano Volpato, Gianluca Campo

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198 Scopus citations


Background: The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality. Methods: Articles were searched in MEDLINE, the Cochrane Library, Google Scholar, and BioMed Central between July and September 2015 and updated in January 2016. Inclusion criteria were observational studies; >50 participants; stratification of population according to SPPB value; data on all-cause mortality; English language publications. Twenty-four articles were selected from available evidence. Data of interest (i.e., clinical characteristics, information after stratification of the sample into four SPPB groups [0-3, 4-6, 7-9, 10-12]) were retrieved from the articles and/or obtained by the study authors. The odds ratio (OR) and/or hazard ratio (HR) was obtained for all-cause mortality according to SPPB category (with SPPB scores 10-12 considered as reference) with adjustment for age, sex, and body mass index. Results: Standardized data were obtained for 17 studies (n=16,534, mean age 76±3years). As compared to SPPB scores 10-12, values of 0-3 (OR 3.25, 95%CI 2.86-3.79), 4-6 (OR 2.14, 95%CI 1.92-2.39), and 7-9 (OR 1.50, 95%CI 1.32-1.71) were each associated with an increased risk of all-cause mortality. The association between poor performance on SPPB and all-cause mortality remained highly consistent independent of follow-up length, subsets of participants, geographic area, and age of the population. Random effects meta-regression showed that OR for all-cause mortality with SPPB values 7-9 was higher in the younger population, diabetics, and men. Conclusions: An SPPB score lower than 10 is predictive of all-cause mortality. The systematic implementation of the SPPB in clinical practice settings may provide useful prognostic information about the risk of all-cause mortality. Moreover, the SPPB could be used as a surrogate endpoint of all-cause mortality in trials needing to quantify benefit and health improvements of specific treatments or rehabilitation programs. The study protocol was published on PROSPERO (CRD42015024916).

Original languageEnglish (US)
Article number215
JournalBMC medicine
Issue number1
StatePublished - Dec 22 2016

Bibliographical note

Funding Information:
B. Vaes and D. Legrand participated in the BELFRAIL study (B40320084685), which was supported by an unconditional grant from the Fondation Louvain. The Fondation Louvain is the support unit of the Universit? catholique de Louvain and is charged with developing the educational and research projects of the university by collecting gifts from corporations, foundations, and alumni. J. Verghese participated in The Einstein Aging Study, which was supported by US National Institute on Aging grants (P01 AGO3949 and R01 AGO25119). r. Verghese received funding support from National Institute on Aging grants (R01 AG039330, R01 AGO44007, AGO44829, and R01 AG036921). C. Wang received funding support from National Institute on Aging grants (P01 AGO3949, R01 AG039330, R01 AGO44007, AGO44829, and R01 AG036921). A. Arnau Bartes received a grant from the Fund for Health Research of Spain (PI042370) and the European Regional Development Fund (FEDER). K. Ensrud and P. Cawthon participated in the Study of Osteoporotic Fractures (SOF), which is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. A. Turusheva and E. Frolova received a Grant of the President of the Russian Federation (grant 192-RP) and the Foundation Louvain. G. Kirk participated in the AIDS Linked to the IntraVenous Experience (ALIVE) study, which was supported by the National Institutes of Health (grants U01-DA-036297, R01-DA-04334, R01-DA-12568, RC1-AI-086053, and K24-AI118591).

Publisher Copyright:
© 2016 The Author(s).


  • All-cause mortality
  • Meta-analysis
  • Physical function
  • Short Physical Performance Battery


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