PT Critically Appraised Topics

Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

The patient who led me to pursue this question was an 84 year old (y.o.) female who was admitted to the skilled nursing facility (SNF) due to decreased level of independence after a hysterectomy. Co-morbidities included tremors of unclear etiology and recently diagnosed dementia. This patient presented to physical therapy with moderate low back pain, decreased gait speed, altered gait pattern of looking down and shuffling, requiring the use of a front wheeled walker (FWW) to ambulate, and difficulty with bed mobility and transfers requiring min assist and use of bed rails, elevating height of bed, and a FWW. Also, she presented with decreased endurance with rapid onset of fatigue and increased tremors. The patient’s original goals included wanting to discharge home to live with her son and to be independent while home alone.

Clinical Question

Does functional training result in more clinically significant changes in strength and functional status than resistance training in older adults?

Clinical Bottom Line

The two articles included in this CAT provide moderate support for the use of 6-12 weeks of functional training for older adults with functional impairments as compared to strength training. These articles supported improvements in strength and function for both groups as compared to baseline (Krebs et al.) or a control group (de Vreede et al.); however, the change from baseline to end of treatment was significantly greater in the functional training group than in the strength training group for Assessment of Daily Activity Performance (ADAP), gait speed, and efficiency of chair rise. The two studies did not agree regarding strength measures. de Vreede, et al. demonstrated a greater increase in strength as measured by an Isometric Knee Extensor Strength test for the strength training group than the functional group. This reached statistical significance (p=0.001) with an effect size of 1.11 (0.56 – 1.66). Krebs and colleagues demonstrated a greater change for the functional training group in lower extremity strength as measured by a dynamometer, but this did not reach statistical significance. Thus, from these two articles it can be concluded that functional training results in more functional improvements and strength training results in strength improvements. These outcomes support the concept of specificity of training. Based on these results, it would be appropriate to focus on functional training over resistance training with older adults experiencing any functional deficits. The generalizability of these studies was limited due to small sample size and exclusion criteria. More research is needed to strengthen the results of these studies with a larger sample size and slightly less restrictive exclusion criteria.