背景及目的：若能篩檢出即將發生初期失能(mobility disability)的高危險群，於初期就給予介入計劃，應能更有效地維持老人體能，始免於或減緩發生重度失能，而有助於維持老人的身、心健康及減輕國家醫療預算的重擔。首先需要一個有效的篩檢工具，及對所測得的結果該如何解釋，必須有參考值及切割值(無失能 vs. 輕度失能)供檢測人員使用。本研究的目的主要為社區研究的前導型計畫，針對工具的田野適用性、敏感性與專一性等基本特質，建立初步的計量證據，以供正規、較大規模的跨區研究使用。方法：218位居住於台中市社區中(自己家中)、年滿60歲或以上、能了解並能配合指令執行測試者。排案標準：罹患中樞或周邊神經系統疾患者、不穩定心臟病或高血壓曾受醫囑不能從事劇烈活動者、身體任何部位(頭頸痛、牙痛、軀幹、四肢)有疼痛且嚴重到會影響正常執行功能測試者。取得同意書後，所有參與者皆接受身體失能及身體功能測試(grip、TCS、TUG、FGS)之評估。結果：失能發生以階級式的情況發生，僅少數部份的人不符合階級。所檢驗的測試皆無人拒絕執行，但有極少數人因關節炎等問題無法執行。所以支持這些測試於社區中的適用性。用於區分無失能與輕度失能者，以TCS鑑別力最好(AUC=0.717)，其次為FGS(AUC=0.699)；TCS擁有最好的敏感度(73.6%)，適合用於rule out；FGS及TUG有最好的專一性(71.2%)，可用於rule in。用於區分輕度失能與中度失能者，以TUG鑑別力最好(AUC=0.774)，其次為FGS(AUC=0.748)；TUG擁有最好的敏感度(81.1%)，適合用於rule out；Grip及FGS有最好的專一性，分別是90.6%及87.0%，可用於rule in。臨床應用：本研究結果支持grip、TCS、TUG及FGS於社區中篩檢失能老人之適用性。
Background and Purpose: In order to screen older adults those at early stage of physical disability so that early intervention is possible, an effective screening tool is imperative to clinicians. The purpose of this study was to examine the applicability, sensitivity and specificity of a clinical tool in identifying early disabled elderly in the community.Method: 128 community-dwelling older adults who were aged at least 60 years, could follow simple commands, volunteered to participation in this study. Those who were suffered from central or peripheral nervous system disorders, unstable high blood pressure or heard disease, or restrict physical activity from physician’’s suggestion were excluded. All participants signed consent form and then their physical disability status and physical function performance were assessed.Results: A small portion of older adults not follow the hierarchical level of physical disability. No one rejected to perform the performance tests but a few older adults who were unable to perform FGS and TCS due to arthritis or other health conditions. To separate all able from the mildly disabled older adults, the TCS showed the best discrimination power and followed by FGS. TCS shows highest sensitivity and is suggested for rule out whereas the FGS and TUG shows the higher specificity and are suggested for rule in. To separate mildly disabled from the moderately disabled older adults, the TUG showed the best discrimination power and followed by FGS. TUG shows highest sensitivity and is suggested for rule out whereas the Grip and FGS shows the higher specificity and are suggested for rule in.Clinical application: The results of this study support the applicability of these tests in screening older adults at various stages of disability in the community.
