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

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


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.


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.


Standardized data were obtained for 17 studies (n = 16,534, mean age 76 ± 3 years). 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.


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).

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