A RANDOMIZED TRIAL OF PRIMAL MOVEMENTS TO ASSESS FUNCTIONAL MOBILITY IN THE ELDERLY ADULT. Len McCullough; Bini Litwin*; Kelli O'Conner; Eric Weiser Nova Southeastern University, Ft. Lauderdale, FL PURPOSE: The purpose of this study was to establish the validity and reliability of using primal movements as an alternative assessment tool for functional mobility in the elderly. BACKGROUNDS/SIGNIFICANCE: To improve physical function, particularly among the elderly population, one must consider balance, strength, flexibility, endurance and coordination. Tools utilized by physical therapists to assess function, including the Timed Up and Go (TUG), have been shown to be valid and reliable for measuring function, balance and risk of falls in the elderly. However, no one functional assessment tool incorporates all of the various movements needed to assess function from a holistic standpoint. Current literature has proposed that primal movements are those holistic human movements that are basic to function and allow us to perform independently. Chek proposes that primal movements are comprised of 7 basic primitive movements identified as squatting, lunging, bending, pushing, pulling, turning, and gait. Although there is limited research on the efficacy of using these 7 primal movements in a clinical setting, physical therapists have begun to incorporate primal movements into their assessment and treatment of functional disabilities. This research has been conducted to determine if primal movements can be used as a valid and reliable tool to assess functional mobility of the elderly patient in a clinical setting. SUBJECTS: 30 subjects, consisting of 22 females and 8 males, were recruited as a sample of convenience from a senior adult independent living center in Broward County, Fl. The subjects ages ranged from 68 to 98, with an average age of 81.6. Criteria for inclusion consisted of community dwelling seniors, age 65 or older who were ambulatory with or without an assistive device. Subjects were excluded from the study that reported a history of MI, stroke or unstable angina within the previous 6 months, or any condition that might be worsened by exercise. METHODS AND MATERIALS: Subjects were randomly assigned to 2 stations: Station 1 performed 3 different primal movements (Turn, Squat, Walk) in front of 2 separate testers who used a self-designed functional grading scale to independently rate the subjects performance on the 3 primal movements. Station 2 performed 3 trials of the TUG, in which a 3rd tester recorded and averaged each subjects TUG times. Each group then changed stations and performed the alternate test. The order of the tests was randomized to eliminate subject fatigue. Instructions, demonstrations and 1 trial run were conducted to familiarize subjects with procedures prior to each test. A pilot study was conducted prior to the study to review procedures and determine face validity of the self-designed grading criteria. ANALYSES: A correlational study was performed to determine the relationship between the self-designed primal movement functional assessment tool and the Timed Up and Go (TUG) test. RESULTS: Data analysis revealed an inverse correlation between the self-designed primal movement grading scale and the functional mobility test (TUG). The Spearmans correlation coefficient revealed a fair degree of relationship between the Turn (rs= -.432, p<.05) vs. the TUG and a moderate to good relationship between the Squat (rs= -.683, p<. 01) and the Walk (rs= -.730, p<. 01) vs. the TUG. Strong inter-rater reliability was demonstrated between testers with an ICC of: Turn= 0.9088, ICC: Squat= 0.9175, and Walk= 1.0000 CONCLUSIONS: A statistically significant correlation between the primal movement functional assessment tool and the TUG suggests that the primal movement grading criteria is a valid tool to assess functional mobility in the community-dwelling senior adult. The inter-rater reliability findings demonstrate that the primal movement functional assessment tool is a reliable tool for assessing functional mobility in the elderly. These findings are not generalizable to all senior citizens since this was a small group of subjects chosen from a sample of convenience. There was also an unequal distribution of male and female subjects, all of whom regularly participated in a weekly exercise program provided at the retirement community center. Participation in an on-going exercise program may have conditioned these subjects so that they were more physically fit than the general senior adult population. Additionally, subjects and testers were not blinded to the study, and the environment was not controlled relative to noise, distractions and subject observation of procedures prior to testing. These findings support the use of primal movements in physical therapy assessment of functional disability in the elderly as well as show promise for use in physical therapy interventions and as a predictor of falls in the community dwelling elderly population. Further investigation is warranted to determine the efficacy of primal movements as a functional assessment tool. FUNDING SOURCE: None received and none anticipated KEYWORDS: Geriatrics, Functional Mobility, Assessment Tool Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. 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