UTILIZAÇÃO DOS INSTRUMENTOS IFBR E WHODAS 2.0 NO CONTEXTO BRASILEIRO: UMA REVISÃO INTEGRATIVA DA LITERATURA

Introdução: o Índice de Funcionalidade Brasileiro e o World Health Organization Disability Assessment Schedule 2.0 são instrumentos padronizados criados para avaliar as deficiências em diversos grupos populacionais. Objetivo: analisar a utilização do Índice de Funcionalidade Brasileiro e World Health Organization Disability Assessment Schedule 2.0  no Brasil. Métodos: foi realizada uma revisão integrativa da literatura. As fontes de informação utilizadas foram a Web of Science, SciELO Citation Index, SciELO.Org, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde e a Embase. Resultados: foram identificados 21 artigos que atenderam os critérios de seleção: estudos que analisam o perfil da funcionalidade em determinadas condições de saúde, sobre propriedades psicométricas, medida de desfecho e opinião de especialistas. O único estudo sobre o Índice de Funcionalidade Brasileiro foi uma análise de especialistas sobre as dificuldades e potencialidades do seu uso. Conclusão: a revisão expõe a necessidade em compreender melhor as propriedades do Índice de Funcionalidade Brasileiro para balizar a concessão de benefícios a pessoas com deficiência e que o World Health Organization Assessment Schedule (2.0) se mostra um instrumento prático e genérico que contribui para o entendimento da funcionalidade das pessoas em uma visão biopsicossocial

Avaliação das propriedades psicométricas da versão brasileira do WHODAS 2.0 em indivíduos pós-acidente vascular encefálico

Introdução: os efeitos oriundos do acidente vascular encefálico (AVE) são complexos, e seguidamente ultrapassam as barreiras que correspondem ao quadro clínico do paciente, não sendo considerado, portanto, uma doença sistêmica apenas do ponto de vista clínico, dado que suas consequências podem ser ainda mais graves quando avaliado o contexto biopsicossocial envolvido. O World Health Organization Disability Assessment Schedule (WHODAS 2.0.) é um instrumento de avaliação de saúde e deficiência abrangente, capaz de mensurar o nível funcional nos principais âmbitos da vida do indivíduo, além de apresentar de propriedades psicométricas válidas e confiáveis, capazes de oferecer indícios importantes na prática clínica. O objetivo deste estudo foi analisar as propriedades psicométricas da versão brasileira do WHODAS 2.0 em indivíduos pós-AVE crônicos. Métodos: trata-se de um estudo de validação composto por 53 indivíduos pós-AVE crônico que apresentavam os critérios necessários de inclusão: ter no mínimo grau 2 de deficiência na Escala de Rankin Modificada (ERM) e função cognitiva satisfatória avaliada pelo Mini Exame do Estado Mental (MEEM). Em seguida, foram coletados os principais dados clínicos e socioeconômicos e o comprometimento motor através da Escala de Fugl Meyer (EFM) para a caracterização da amostra. Para a avaliação das propriedades psicométricas os participantes responderam ao WHODAS 2.0 versão de 36 itens (com omissão dos itens de trabalho) em três momentos distintos, por dois pesquisadores, com intervalo de 7 a 14 dias entre cada avaliação. Foram aplicadas também a Stroke Impact Scale 3.0 (SIS 3.0) e Medida de Independência Funcional (MIF) concomitantemente às aplicações do WHODAS 2.0. As variáveis para a caracterização da amostra foram obtidas através de medidas de tendência central e dispersão, e de frequências absolutas e relativas. A análise psicométrica foi realizada pelo software estatístico SPSS - Statistical Package for Social Science, versão 21.0, com nível de significância de 5%. A consistência interna foi calculada pelo alpha de Cronbach, a confiabilidade interavaliadores e teste-reteste pelo Coeficiente de Correlação Intraclasse (ICC) e a validade concorrente através do coeficiente de correlação de Spearman, por intermédio da correlação entre o WHODAS 2.0 e os instrumentos MIF e SIS. Resultados: o valor da consistência interna foi considerado excelente (α=0,93), o ICC exibiu bom resultado na confiabilidade interavaliadores (ICC=0,85) e excelente confiabilidade teste-reteste (ICC= 0,92). Os resultados da validade concorrente indicaram correlação de moderada a forte (ρ= -0,51 a ρ= -0,88; p<0,0001), os valores mais elevados foram associados à correlação com a escala SIS. Conclusão: este estudo demonstrou que o WHODAS 2.0 apresenta evidências de confiabilidade e validade para indivíduos pós-AVE crônico.Introduction: the effects arising from stroke are complex, and then go beyond the barriers that correspond to the patient's clinical condition, therefore, it is not considered a systemic disease only from a clinical point of view, since its consequences can be even more serious when assessed the biopsychosocial context involved. The World Health Organization Disability Assessment Schedule (WHODAS 2.0.) is a comprehensive health and disability assessment tool, capable of measuring functional level in the main areas of an individual's life, in addition to presenting valid and reliable psychometric properties, capable of offering important evidence in clinical practice. The aim of this study was to analyze the psychometric properties of the Brazilian version of WHODAS 2.0 in chronic post-stroke individuals. Methods: this is a validation study composed of 53 individuals after chronic stroke who had the necessary inclusion criteria: having at least grade 2 disability on the Modified Rankin Scale (ERM) and satisfactory cognitive function assessed by the Mini Examination of the Mental State (MMSE). Then, the main clinical and socioeconomic data and motor impairment were collected using the Fugl Meyer Scale (EFM) to characterize the sample. For the assessment of psychometric properties, participants responded to the WHODAS 2.0 version of 36 items (omitting work items) at three different times, by two researchers, with an interval of 7 to 14 days between each assessment. Stroke Impact Scale 3.0 (SIS 3.0) and Functional Independence Measure (MIF) were also applied concurrently to WHODAS 2.0 applications. The variables for the characterization of the sample were obtained through measures of central tendency and dispersion, and of absolute and relative frequencies. The psychometric analysis was performed using the statistical software SPSS - Statistical Package for Social Science, version 21.0, with a significance level of 5%. Internal consistency was calculated by Cronbach's alpha, inter-rater reliability and test-retest by the Intraclass Correlation Coefficient (ICC) and concurrent validity using Spearman's correlation coefficient, through the correlation between WHODAS 2.0 and the MIF and SIS. Results: the value of internal consistency was considered excellent (α = 0.93), the ICC showed a good result in inter-rater reliability (ICC = 0.85) and excellent test-retest reliability (ICC = 0.92). Concurrent validity results indicated a moderate to strong correlation (ρ = -0.51 to ρ = -0.88; p <0.0001), the higher values were associated with the correlation with the SIS scale. Conclusion: this study demonstrated that WHODAS 2.0 presents evidence of reliability and validity for individuals after chronic stroke

Medidas de resultados auto relatadas por doentes renais crónicos: análise de indicadores de experiência da doença crónica

There is often a discrepancy between clinical data, including laboratory tests, and the patients’ experience of being ill. The goal of this work was to search for Key Performance Indicators (KPI) of disease other than the usual numeric data. As research model, we have used Chronic Kidney Disease (CKD). Those indicators should express the experience of living with the disease and be sensible to medical decisions so that they can be targeted for intervention. In chapter 2, a contextualization of CKD is made, presenting an extensive list of the standard indicators that currently drive physicians’ decisions. A general approach to chronic diseases is presented in chapter 3, highlighting models of interventions. Some existing indicators are also covered. The experimental work is presented in chapter 4. Our hypothesis was based on a conceptual model which postulated that a given Patient Reported Outcome Measure (PROM) would be suitable for daily use in the clinical context provided that it would link predictors (demographic variables, comorbidity indices, estimates of Glomerular Filtration Rate – eGFR - and untoward events of the previous year) to Endpoints (death, dialysis, hospitalizations and emergency episodes) with statistically significant relationships and serve as indicator as surrogate of well-being. We conducted an observational study and recruited 60 patients with CKD to whom several questionnaires of PROM were administered: Short Physical Performance Battery (SPPB), World Health Organization Disability Assessment Schedule (WHODAS), Satisfaction With Life Scale (SWLS) and Kidney Disease Quality of Life (KDQoL). Follow-up period was 24 months. Lastly, we wanted to know the relevancy of the endpoints to the patients. For that, they were asked to rank six endpoints according to what they think their physician’s priority should be (avoid death, avoid dialysis, avoid worsening of lab tests, prevent further deterioration of medical condition, avoid hospital admissions and avoid emergency episodes). We conclude that: 1) SPPB could predict death, dialysis and hospital admissions. 2) WHODAS could predict death and dialysis. 3) Physical Functioning domain of KDQoL could predict death and hospital admissions. 4) Role Emotional domain of KDQoL could predict death. 5) Energy/Vitality domain of KDQoL could predict hospital admissions. 6) Role Physical domain of KDQoL could predict dialysis. 7) Mental Health domain of KDQoL could predict hospital admissions and emergency episodes. 8) Pain, Social Function and General Health domains of KDQoL, and SWLS were not useful in predicting any of the proposed endpoints. 9) The Cockcroft-Gault (CG) formula to compute eGFR is the only that could predict mortality. 10) All eGFR formulae predicted beginning of dialysis. 11) Only the CG formula could predict the scores of some PROM scales: SPPB, Physical Function domain of KDQoL and WHODAS. 12) Both the Charlson comorbidity scales (1987 and 2011) are useful for the prediction of studied endpoints: the first predicts death and hospital admissions while the second predicted mortality, dialysis, hospitalizations and emergency episodes. 13) The highest priority of patients is that their physician’s main concern should be to “Avoid death” whereas options “Avoid dialysis” and “Avoid worsening of laboratory tests” came next, in a tie. 14) Patients ranked “Avoid hospitalization” and “Avoid emergency episodes” in the last places, after all the others. Finally, 15) Eight possible schemes were drawn from the analysis of the conceptual model. Four of them have shown to have clinical utility. Longitudinal exploration of these PROM is needed in order to reinforce their clear place at office and bedside and in disease management.Há frequentemente uma discrepância entre os dados clínicos, incluindo análises laboratoriais, e a experiência de se estar doente. O objetivo deste trabalho foi procurar indicadores-chave de desempenho de doença para além dos dados numéricos habituais. Como modelo de investigação, utilizamos a Doença Renal Crónica (DRC). Esses indicadores devem traduzir a experiência de viver com a doença e serem sensíveis às decisões médicas, para que possam ser alvo de intervenção. No capítulo 2, é feita uma contextualização da DRC, apresentando-se uma extensa lista dos indicadores que actualmente orientam as decisões dos médicos. No capítulo 3, faz-se uma abordagem geral das doenças crónicas, destacando modelos de gestão da doença crónica. Alguns indicadores actualmente usados também são referidos. O trabalho experimental é apresentado no capítulo 4. A nossa hipótese baseou-se num modelo conceptual que postulava que uma determinada medida de resultados autorelatados pelos doentes (PROM: Patient Reported Outcome Measures) seria adequada para uso diário em contexto clínico se tivesse uma correlação estatisticamente significativa entre os preditores (variáveis demográficas, índices de comorbilidade, estimativas de Taxa de Filtração Glomerular - TFGe - e eventos adversos do ano anterior) e os resultados (morte, diálise, hospitalizações e idas ao serviço de urgência), servindo assim como indicador de bem-estar. Realizámos um estudo observacional, tendo recrutado 60 doentes renais crónicos que responderam a vários questionários de PROM: “Short Physical Performance Battery” (SPPB), “World Health Organization Disability Assessment Schedule” (WHODAS), “Satisfaction With Life Scale” (SWLS) e “Kidney Disease Quality of Life” (KDQoL). O período de acompanhamento foi de 24 meses. Finalmente, estudámos a relevância dos resultados para os doentes. Para isso, foi-lhes pedido que classificassem seis desfechos, de acordo com o que acham que deveria ser a prioridade do seu médico (“evitar a morte”, “evitar a diálise”, “evitar o agravamento dos exames laboratoriais”, “evitar a deterioração do seu estado geral”, “evitar internamentos hospitalares” e “evitar idas ao serviço de urgência”). Os resultados permitiram concluir que: 1) O SPPB previu morte, diálise e hospitalizações. 2) O WHODAS previu morte e diálise. 3) O domínio Função Física do KDQoL previu morte e hospitalizações. 4) O domínio Saúde Mental do KDQoL previu morte. 5) O domínio Energia/vitalidade do KDQoL previu hospitalizações. 6) O domínio físico do KDQoL previu diálise. 7) Domínio de Saúde Mental do KDQoL previu hospitalizações e idas ao serviço de urgência. 8) Os domínios Dor, Função Social e Saúde Geral do KDQoL, bem como o SWLS não foram úteis na previsão de nenhum dos resultados propostos. 9) A fórmula de Cockcroft-Gault (CG) para calcular a TFGe é a única que previu a morte. 10) Todas as fórmulas de cálculo da TFGe previram o início da diálise. 11) Apenas a fórmula de CG pôde prever a pontuação de algumas escalas do PROM: SPPB, domínio da Função Física do KDQoL e WHODAS. 12) Ambas as escalas de comorbilidade de Charlson (de 1987 e 2011) são úteis para a predição dos resultados estudados: a primeira prevê mortes e internamentos hospitalares, enquanto a segunda prediz morte, diálise, hospitalizações e idas ao serviço de urgência. 13) A principal prioridade dos doentes é que a principal preocupação do seu médico seja “evitar a morte”, enquanto as opções “evitar diálise” e “evitar o agravamento dos exames laboratoriais” vêm a seguir, empatadas. 14) Os doentes classificaram as opções “evitar hospitalização” e “evitar episódios de urgência” nos últimos lugares, depois de todas as demais. Finalmente, 15) O modelo conceptual proposto permitiu identificar oito possibilidades diferentes de relação entre preditores, PROM e resultados. Quatro deles mostraram ter utilidade clínica. São necessários estudos longitudinais com PROM para reforçar o seu papel no consultório e na enfermaria, e também na gestão da doença.Programa Doutoral em Ciências e Tecnologias da Saúd

Escala de Independência Funcional e Expressiva: construção e qualidades psicométricas iniciais

RESUMO Trabalho com objetivo de desenvolver uma escala para avaliar independência funcional (Escala de Independência Funcional e Expressiva – EIFE) e investigar suas evidências de validade baseadas no conteúdo e na estrutura interna. A construção dos itens seguiu 5 etapas: Revisão das escalas de independência funcional ( n =50 itens); Criação de novos itens ( n =79); Avaliação por seis juízes especialistas (57 sugestões); Dois estudos piloto (10 cuidadores e dois cuidadores com baixa escolaridade). A versão inicial ficou com 122 itens e foi submetida a análises de confiabilidade e fatorial exploratória, em uma amostra de 241 cuidadores. A EIFE passou a ter 95 itens, divididos em oito subescalas, variando de uma a quatro dimensões internas. As análises mostraram bons índices de ajuste e replicabilidade da estrutura fatorial. A consistência interna das subescalas variou entre 0,83 e 0,94. Conclui-se que a EIFE avalia funcionalidade e expressão emocional e pode ser utilizada na população brasileira

Measuring health status using wearable devices for patients undergoing radical cystectomy

Wearable devices (WDs) are an untapped resource for measuring patient health status during the peri-operative period. The overarching aim of this thesis is to explore the potential for WDs to be used in the clinical setting for patients undergoing radical cystectomy (RC) for bladder cancer. The lack of consensus regarding the optimal approach for RC presents an opportunity to design an RCT comparing open (ORC) and robotic (RARC) RC, in which a wearable device sub-study can be embedded. While the intracorporeal Robotic vs Open Cystectomy (iROC) trial will address the comparison between ORC and RARC, my thesis focuses on exploring the clinical utility of WDs. I present the results of a systematic review of RCTs comparing ORC and RARC. Meta-analysis shows no significant difference in peri-operative and oncological outcomes between ORC and RARC. Additionally, I systematically review healthcare studies using WDs and highlight the findings, device choices and device metrics used. Step-count is the most frequently collected WD metric, and chronic health conditions are the focus of majority of studies. Findings from these systematic reviews guided the design of the iROC trial protocol. I present the pre-planned interim analysis of the iROC trial, and explore associations between WD data and pre-operative health measures including cardiopulmonary exercise testing (CPET). Step-count correlates with the CPET variables (p < 0.01) routinely used to risk-stratify patients undergoing RC, and is the only predictor of major complications following RC in a logistic regression model. Finally, I evaluate recovery of baseline step-count at three months post-operatively as a predictor of overall survival. Applying a threshold of 50% recovery at 3 months, step-count predicts one-year survival to a sensitivity and specificity of 100% and 93% respectively. My findings highlight the potential of WDs in peri-operative care, and my post-doctoral work will progress this work further

Patient-Important Outcomes of Cardiac and Non-Cardiac Surgery: Describing the Landscape and Exploring Etiologies and Interventions

The patient-important outcomes of cardiac and non-cardiac surgery are well-recognized but poorly understood. The causes of major morbidity and mortality in patients undergoing non-cardiac are not known. This is not the case in cardiac surgery, which is provided to a homogenous patient population that has been well-described through clinical registries. Recent improvements to the care of cardiac surgical patients have led to dramatic decreases in major morbidity and mortality. However, neurocognitive and functional impairments after cardiac surgery remain the most feared by patients and least understood by clinicians. This thesis comprises 6 chapters that inform these knowledge gaps and establish the basis upon which future research will be based. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 reports the VISION Mortality study, which explores the relationship between major complications and death within 30-days of undergoing inpatient, noncardiac surgery. Chapter 3 reports a study validating the use of the Standardized Assessment of Global activities in the Elderly (SAGE) scale in patients undergoing cardiac surgery. Chapter 4 presents a pilot observational study that establishes the feasibility of conducting a large, prospective cohort study to determine the relationship between decreases in cerebral saturation during cardiac surgery and postoperative functional decline. Chapter 5 presents a pilot study conducted to inform the feasibility of a large, randomized cluster crossover trial examining whether an institutional policy of restricted benzodiazepine administration during cardiac surgery (compared to liberal administration) would reduce delirium after cardiac surgery. Chapter 6 discusses the conclusions, limitations, and implications of the research presented in this PhD thesis.ThesisCandidate in Philosoph

Validación de escalas de medida de discapacidad según la CIF en aragoneses de edad media y avanzada

Introducción La investigación sobre el funcionamiento se ha vuelto cada vez más necesaria para describir la salud de las personas. En investigación epidemiológica contamos con pocos estudios e instrumentos para la adecuada medida de la discapacidad dada la complejidad de su definición y de las interacciones entre la persona y su entorno. La discapacidad en las personas mayores es altamente prevalente en España, donde el aumento de la longevidad va a suponer un incremento de la prevalencia de las enfermedades crónicas. La OMS, desde una mirada psicosocial aprobó en 2001 la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), desarrollando dos herramientas para medir el funcionamiento en la evaluación de la salud: el World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) para uso epidemiológico y la Lista de Comprobación CIF (LCCIF) para uso clínico.Objetivos 1. Describir las frecuencias de discapacidad en diversos grupos de población de edad media y avanzada de la Comunidad Autónoma de Aragón utilizando los instrumentos de medida recomendados por la Clasificación CIF de la OMS. 2. Determinar la sensibilidad y especificidad de los instrumentos WHODAS 12 y WHODAS 36 para el cribado y medida de la discapacidad con respecto de la LCCIF como estándar. 3. Cuantificar los porcentajes de limitaciones en la Actividad y restricciones en la Participación de la LCCIF con los calificadores de capacidad y desempeño. 4. Analizar la concordancia entre ambos calificadores de capacidad y desempeño y la magnitud de sus diferencias, con objeto de diseñar estudios que identifiquen factores de riesgo, barreras y facilitadores ambientales de discapacidad en esta población.Metodología Se realizó un estudio transversal entre los años 2008-2011, utilizando los datos extraídos de una encuesta poblacional en dos áreas geográficas (una rural y otra urbana) de la Comunidad Autónoma de Aragón en el Noreste de España. Los participantes fueron personas ≥50 años. Para detectar los determinantes de discapacidad más relevantes, los participantes fueron doblemente cribados por discapacidad y deterioro cognitivo. El cribado de discapacidad se realizó mediante un instrumento de metodología CIF, el WHODAS de 12 preguntas y el de deterioro cognitivo con el Examen Cognoscitivo Mini-Mental (MEC). Los participantes con cribado positivo y todos los de una muestra probabilística como población de validación, se sometieron a un protocolo de evaluación, donde se estudiaba en detalle su discapacidad en visita puerta a puerta mediante el WHODAS de 36 preguntas, la LCCIF, estado de salud y una encuesta estructurada relativa a apoyo y servicios. Se midió la sensibilidad y la especificidad del WHODAS de 12 y 36 preguntas con respecto de la LCCIF como estándar. Se analizaron las diferencias y la concordancia entre los calificadores de capacidad y desempeño para los dominios del componente de Actividades y participación de la LCCIF.Resultados El sexo femenino, la edad avanzada y el nivel de estudios bajo están sobre-representados en la población con discapacidad moderada y grave. Tomando como estándar para detectar discapacidad la LCCIF, los valores de sensibilidad, los valores de VP- y de 1/RP(-) son algo más altos en el WHODAS 36 que el 12. La especificidad, VP+ y RP(+) toman valores similares en ambas versiones de WHODAS. Los dominios con peor capacidad y peor desempeño para discapacidad grave/total fueron: Tareas y demandas generales, Vida Doméstica y Movilidad. Los dominios con concordancia más baja entre capacidad y desempeño fueron: Vida Doméstica y Autocuidado.Conclusiones El WHODAS 2.0 es una herramienta válida y útil para para detectar a personas con discapacidad. Los resultados apuntan a posibles discordancias entre las medidas de puntuación de la LCCIF y el WHODAS 2.0. La concordancia entre capacidad y desempeño en los cuatro niveles de puntuación fue alta. Este estudio constituye un primer paso basado en la CIF hacia un abordaje más completo de la discapacidad.<br /

A review of screening, assessment and outcome measures for drug and alcohol settings.

Standardised tools cover a range of areas which may be relevant to Drug and Alcohol (D&A) services. This review provides an overview of some useful standardised tools that can be used to measure treatment outcomes and to screen and assess for mental health symptoms and conditions, drug and alcohol use and disorders and general functioning. Focus has been given to tools that require limited training to use and are freely available. It should be noted that some of these tools require specialist training, or else mislabelling, misinterpretation, or inappropriate use may occur (Groth-Marnat, 2003; Roche & Pollard, 2006). Some tools are copyright protected and need to be purchased, and/or require the user to have specific qualifications. It is important that workers are aware of what they are, and are not, trained to use, and seek training where required. Screening is designed only to highlight the existence of symptoms, not to diagnose clients. Most of the measures described are completed as a self-report (i.e., they are completed by the client). Others, however, need to be administered by a worker. It should be noted that, unfortunately, there are no brief measures with established reliability and validity for the identification of possible personality disorders. The possible presence of these disorders needs to be assessed by a health professional that is qualified and trained to do so (e.g., a registered or clinical psychologist, or psychiatrist). There is a general lack of a standardised approach to screening, assessment and outcome measurement in the D&A sector. A variety of different tools are used, some of which are empirically established instruments whilst others are purpose-built, internally designed tools with increased practicality and utility but unknown validity and reliability (Roche & Pollard, 2006). This review focuses solely on the former. Similarly, it is important to note that this review, in and of itself is not exhaustive, as the number of available instruments is vast. Nevertheless, all attempts have been made to include the most relevant and useful measures. This review is broken down into several categories: 1. Global measures – tools that measure a range of client factors (e.g., substance use, psychological and physical health, social functioning). 2. General health and functioning measures – tools that rate an individual’s functioning abilities and limitations. 3. General mental health measures – tools that measure a range of psychological symptoms (e.g. distress). 4. Specific mental health measures – tools that measure the symptoms of one disorder class only. 5. Positive mental health measures – an emerging area for outcome measurement in mental health has come from the philosophies of recovery, wellbeing, empowerment and rehabilitation. 6. General substance misuse measures – brief tools to ascertain the existence/nature of the substance problem 7. Severity of substance misuse measures – more specific tools to measure the severity of the substance use problem 8. Craving measures – this section provides an outline of some potentially useful drug craving measures For each tool, information has been included on its psychometric properties (according to available research), its suitability for particular client groups, availability/cost and scoring administration and expertise required

Incident Depression and Daily-life Mobility in Middle-aged and Older Adults

Depression is among the most prevalent mental disorders in middle-aged and older adults, with a global prevalence of up to 11%. Effective preventive measures for depression are often costly and labour-intensive and therefore require risk screenings to be practical. Recent studies suggested that clinically measured walking speed is a risk factor for depression, while little is known about whether other aspects of mobility are also predictive. To explore the temporal association between mobility, in particular daily-life mobility, and incident depression in older adults, one systematic review, one study on method development and validation, and three large-scale cohort studies were conducted. Significant findings include: • The Timed Up and Go Test, which incorporates multiple aspects of mobility (i.e., gait initiation, turning, and sit-to-stand time), is more predictive of depressive trajectories than the Six-Metre Walk Test and Five Times Sit to Stand Test. • Duration of the longest daily walking bout, measured with a waist-worn sensor, independently and significantly predicts incident depression over two years. • Daily-life walking speed, quality, quantity, and distribution can be reliably and validly measured with a wrist-worn sensor. • Daily-life gait quality and quantity, measured with a wrist-worn sensor, independently and significantly predict incident depression over nine years of follow-up. These findings add to the understanding of the association between human locomotion and depression. Gait quality and daily-life gait performances are independent and potentially modifiable predictors of depression. These measures, therefore, may have value for upcoming screening program development. Future research should investigate whether interventions addressing daily-life gait can play a role in preventing depression in middle-aged and older adults