The Short Physical Performance Battery (SPPB) as a Rehabilitation Compass in Geriatric Physical Therapy: A Focused Narrative Review

Background/Objectives: The Short Physical Performance Battery (SPPB) is an established measure of lower-extremity physical performance in older adults, with well-documented prognostic associations. Less clearly defined is how longitudinal SPPB change should be interpreted during geriatric rehabilitation and used to support treatment monitoring and subsequent clinical decisions. This focused narrative review examines how repeated SPPB assessment can be interpreted as a measure of rehabilitation-related change and contribute to treatment-response monitoring and broader decision support in geriatric physical therapy. Methods: We conducted a focused narrative review supported by a structured search of PubMed (MEDLINE), Web of Science, and Scopus from database inception to 24 May 2026. After broader mapping of predictive value, responsiveness, and clinical implementation, the synthesis focused on responsiveness, meaningful change, treatment-response monitoring, and rehabilitation decision support. Results: The SPPB can detect functional change across multiple geriatric populations, although minimal detectable change (MDC), minimal clinically important difference (MCID), minimal important change, and other meaningful-change estimates vary by population, baseline function, protocol, confidence level, and derivation method. A change around 1 point is frequently cited as clinically informative in some older populations, but it should not be treated as a universal individual-patient threshold. Across rehabilitation studies, the SPPB was used primarily as an outcome measure and in selected models, as one component of functional stratification or pathway assignment; exercise prescription and progression remained dependent on broader clinical assessment and where applicable, clinician judgment. The proposed rehabilitation-compass framework is an author-developed, hypothesis-generating conceptual synthesis and has not been prospectively validated. Conclusions: Repeated SPPB assessment can help characterize functional change over time and may contribute to decisions about maintaining, progressing, or modifying rehabilitation when interpreted alongside measurement error, patient goals, symptoms, safety, and complementary functional assessment. It should not be used as a stand-alone prescription or progression rule.