Reliability and Validity Assessment of the Health-Related Quality of Life Scale Developed for Active Older Adults

Short Form-36 Health Survey (SF-36)

The Short Form-36 Health Survey (SF-36) was developed in 1992 as part of the Medical Outcomes Study, a multi-year and multi-center project aimed at explaining differences in patient outcomes. The SF-36 is a self-reported instrument that assesses overall health from both physical and mental perspectives. It consists of 36 items across 8 subscales: physical functioning, social functioning, physical role limitations, emotional role limitations, pain, general health, vitality, and mental health. The scale ranges from 0 to 100, with higher scores indicating better health status.

Time frame: Day 1

EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L)

As a general quality of life scale based on self-report and available in multiple languages including Turkish, the EuroQol-5 Dimension-5 Level Questionnaire (EQ-5D-5L) was introduced in 2009 by the EuroQol Group. It was developed as a five-level version to improve the sensitivity and reduce the ceiling effect of the previously created EQ-5D-3L Questionnaire by the same group. The EQ-5D-5L consists of two parts. The first part is an index that describes health status across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension includes five ordered response levels. To calculate the index score, participants are asked to select the most appropriate statement for each of the five dimensions. The resulting five-digit number is converted into a value between 0 (representing death) and 1 (representing perfect health) using value sets developed by the EuroQol Group. The second part of the questionnaire is a standard visual analogue sc

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Lower Extremity Functional Scale (LEFS)

The Lower Extremity Functional Scale (LEFS), developed in 1999 by Binkley et al., is a self-reported measure designed to identify and assess the functional status of patients with lower extremity dysfunctions. The scale consists of 20 items, each with five possible response options arranged in order. The total score ranges from 0 to 80, with higher scores indicating better functional status.

Time frame: Day 1

Apathy Evaluation Scale (AES)

The Apathy Evaluation Scale (AES) was developed in 1991 by Marin et al. This scale is designed to measure the level of apathy by assessing individuals' interest in daily activities, the pleasure they derive from these activities, and their general lack of motivation. The scale has three different versions, all containing the same items: the Clinician Version (AES-C), the Informant Version (AES-I), and the Self-Report Version (AES-S). Participants are asked to respond based on their experiences over the past four weeks. The scale consists of 18 items, each rated on a four-point Likert scale. Each item is scored from 1 (not at all) to 4 (very much), resulting in a total score ranging from 18 to 72. Items 6, 10, and 11 are reverse scored, and higher total scores indicate greater levels of apathy.

Time frame: Day 1

Hand Grip Strength Test

The Grip Strength Test is a key tool used to assess hand muscle function by measuring the maximum force generated by the forearm muscles. It is well established that grip strength declines with aging, which in turn leads to a decrease in individuals' quality of life. This test is considered a reliable indicator of many age-related health conditions and is recognized as a marker of overall muscle strength. In our study, the Takei brand TKK 5401 model hand dynamometer (Grip-D, Takei Scientific Instruments Co. Ltd., Tokyo, Japan) was used for the Grip Strength Test. The device displays the strength of the left and right forearm flexor muscles on a three-digit digital LCD screen in kgf units. Measurements were taken while the participant was standing, with the test arm extended at a 30° angle from the body, without bending the elbow or touching the torso. The highest value obtained was recorded, and the sum of the highest values from both hands was considered the total test score.

Time frame: Day 1

Sit-Rise Test (SRT)

The Sit-to-Stand Test (SRT) is a test developed to assess individuals' flexibility, muscle strength, physical fitness, and balance skills. Various studies have reported that this test predicts all-cause mortality. The test measures the number of supports individuals use when sitting down and standing up from the floor, without shoes, on a flat, non-slippery surface, and assigns a score accordingly. Each unsupported sit-to-stand skill is scored 5 points; the maximum total score is 10, indicating good physical fitness. One point is deducted from the total score for each point of support used (hand, forearm, knee, lateral leg, hand on knee), and 0.5 points are deducted from the total score for each loss of balance observed. No time is held during the test.

Time frame: Day 1

2-Minute Walk Test (2MWT)

The 2-Minute Walk Test (2MWT) is a shorter version of the 6-Minute Walk Test (6MWT), which is frequently used in the literature as a measure of functional capacity. This test is conducted on a track of at least 30 meters, with start and end points marked by cones. Participants walk at their normal pace for 2 minutes, and the distance covered in this time is recorded in meters. This measurement provides information about an individual's functional capacity. Longer distances are considered indicators of better functional capacity. In our study, the Heel2Toe sensor (Mate et al., 2019), which was placed on the sides of the participants' shoes and provided data collection, was used to accurately measure walking quality and collect data.

Time frame: Day 1

Mini Balance Evaluation Systems Test (Mini-BESTest)

The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a scale used to assess posture and balance. It is used to explain balance disorders, fall risk, and their possible causes. Its short assessment time and lack of equipment make it easy to use. The test takes 10-15 minutes to administer. The test consists of 14 items under four headings (Anti-stimulating Postural Regulation, Reactive Postural Control, Sensory Orientation, and Dynamic Gait). Each item is scored on a three-point scale (0, 1, or 2), with a maximum total score of 28. Higher scores indicate better balance and a lower risk of falling.

Time frame: Day 1

Tragus Posture Test (TWT)

The Tragus Posture Test (TWT) was developed to objectively assess spinal mobility. In this test, the subject stands with their heels and hips against a wall to prevent rotation, and their knees extended. The subject is asked to tuck their chin in. In this position, the distance between the wall and the tragus prominence of the right ear is measured with a tape measure. Greater distances indicate poorer upper cervical posture.

Time frame: Day 1

Fullerton Advanced Balance Scale (FAB-T)

The Fullerton Advanced Balance Scale (FAB-T) is a performance-based scale that comprehensively assesses static and dynamic balance in different sensory environments. It was developed to assess the multiple dimensions that constitute balance in highly functional, independently functioning, active elderly individuals. The scale, which includes 10 individual test items, is evaluated on a 5-point scale (0-4), with a maximum score of 40. Higher scores indicate better balance ability and a lower risk of future falls. There are publications indicating that an elderly person scoring 25 or below on the test can be considered with greater than 70% confidence to be at high risk of falling and requiring urgent intervention. Administration takes approximately 10-15 minutes.

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Counter Movement Jump Test (CMJ)

The Countermovement Jump Test (CMJ) is a test developed to assess an individual's explosive lower extremity strength. This test assesses an individual's ability to jump off the ground. The participant first stands with their feet shoulder-width apart, bends their knees, and performs a squat. Then, from this position, they attempt to jump as high as possible. Force platforms can also be used in this test, and the data obtained after the participant jumps is evaluated. Because arm swinging enhances performance, care should be taken to determine whether the arms are free or stationary during the test. In this study, the participant was asked to perform the Countermovement Jump (CMJ) on a non-slip mat, facing a wall, with their feet shoulder-width apart. Measurements were taken three times, and the highest value achieved was recorded as the test score in centimeters.

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Symbol Digit Modalities Test (SDMT)

The Symbol Number Modalities Test (SDMT) was developed by Aaron Smith in 1982 to assess cognitive capacity. This test measures visual-spatial scanning, attention-concentration, and information processing speed. The test includes a kit that allows for verbal and/or written assessments. This kit contains a key that matches nine numbers and symbols. Next to the key are divided blocks of randomly arranged symbols. After the first 10 trials, the participant is asked to say the numbers corresponding to the symbols on the key as quickly as possible within 90 seconds and/or mark them on the kit. At the end of the test, the total number of correct answers is calculated, and the maximum possible score is 110. The test typically takes 5 minutes to complete, and higher scores indicate better cognitive capacity.

Time frame: Day 1

Raven's Standard Progressive Matrices Test (RSPMT)

The Raven Standard Progressive Matrices Test (RSPMT) is a scale developed by John Carlyle Raven in 1936. This test was designed to assess the general cognitive capacities of people from different cultures and languages, measuring abstract reasoning. It assesses cognitive skills such as recognition, discrimination, and analogy. For this reason, it is also known as a general intelligence test. The RSPMT is more practical than other tests because it is shorter and less affected by socioeconomic factors, sensory, and motor abilities. The test consists of five sections (A, B, C, D, and E), each with 12 patterns or designs of increasing difficulty, and a total of 60 multiple-choice questions. The first two sections (A and B) have 6 options, while the last three sections (C, D, and E) have 8 options. There is no time limit for administering the test. Scoring is based on the number of correct answers, with a maximum score of 60.

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