Performance of a screening strategy for identifying locomotor disorders in older patients during pre-kidney transplantation assessment

Locomotor disorders are common with ageing, particularly in patients with chronic kidney disease (CKD), and are associated with numerous complications in the context of kidney transplantation (KT). Numerous tools and locomotor tests are available to assess these disorders. This study aimed to assess whether the Short Physical Performance Battery (SPPB) could be used as a screening tool to identify older patients with CKD undergoing pre-KT assessment who require a comprehensive physiotherapy assessment. This retrospective observational study included patients aged 65 years or older with end-stage CKD who were referred for pre-KT assessment. An abnormal locomotor assessment was defined as the presence of an impairment in at least one of the following tests: Timed Up and Go test; Tinetti test; 6-minute walk test; and single-leg stance test. The ability of the SPPB and its sub-scores to identify an abnormal comprehensive locomotor assessment was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC), with 95% confidence intervals. A total of 217 patients were included; mean age was 73.5 ± 3.2 years. The SPPB demonstrated excellent performance in identifying an abnormal locomotor assessment, with an AUC of 0.88 (95% CI 0.83–0.94). An SPPB threshold score of 10 provided a sensitivity > 90%, whereas a score < 8 indicated a specificity of >90% for abnormal locomotor assessment. The SPPB sub-tests also performed well, although their performance remained inferior to that of the total SPPB. The SPPB demonstrated good performance as a screening tool to identify older patients undergoing pre-KT assessment who may require comprehensive physiotherapy assessment, supporting a more targeted use of specialized assessment resources.