Useful links
1000 Norms Project
A clinical catalogue of human variation
The 1000 Norms Project is an ongoing research program dedicated to improving our knowledge of normal physical function across the lifespan.
What does it mean to be healthy?
Health is difficult to define and measure. There is a great deal of variation in the healthy population- no two people are the same. Yet we need to know what it means to be healthy in order to manage disease and disability and to evaluate the effectiveness of treatments in clinical trials.
Physical function, the ability to perform the physical activities of day-today life, is an important indicator of health across all stages of development and ageing. Health professionals and clinical researchers use a range of tests, known as outcome measures, to measure physical function. Examples of outcome measures include tests of strength, balance and walking, as well as questionnaires that assess function, pain or quality of life from the individual’s perspective.
Outcome measures are used in clinical practice to identify a problem (impairment or disability) by comparing scores to 'normal' reference values. Reference data for outcome measures are also used in clinical trials to evaluate the effectiveness of treatments as they provide a comparison to normal - similar to a control group. However, prior to the 1000 Norms Project there was a lack of age and sex-specific normative reference data for many common outcome measures.
About the project
Led by Professor Joshua Burns, in 2014-2015, experienced physiotherapy researchers at the University of Sydney collected data for a comprehensive set of outcome measures assessing key aspects of physical function and self-reported health.
One thousand healthy Australians aged from 3-101 years volunteered their time to take part in a physical assessment. The 1000 Norms Project produced over one million data points, generating a comprehensive normative reference dataset. These data points have been crucial for understanding the severity of patients with a variety of disorders, and most importantly their response to treatment.
Around the world, the age-and sex-matched normative reference data from the 1000 Norms Project are being used to pioneer the development of whole-of-life functional scales, developing responsive clinical outcome assessments for a range of neurological and musculoskeletal disorders.
The following outcome measures were assessed in 1000 people:
- Isometric muscle strength of twelve major muscle groups using Citec hand-held dynamometry
- Flexibility of six joints, assessing thirteen joint movements
- Spatiotemporal gait characteristics using ZENO instrumented walkway
- Pedobarographic assessment of dynamic plantar pressure using EMED instrumented platform
- Functional assessment including; hand dexterity, dynamic and static balance, vertical and long jump, 30-second sit to stand, 6-minute walk test and stair climb test.
- Self-reported musculoskeletal pain, knee and ankle function, physical activity, workability, self-efficacy and quality of life
- Saliva DNA samples were also collected to investigate the prevalence of the ACTN3 ‘gene for speed’
The data from all of the performance measures collected in the 1000 Norms Project has now been “liberated” and is freely available at clinicaloutcomemeasures.org along with clinical outcome measures including the Charcot-Marie-Tooth disease Pediatric Scale (CMTPedS), CMT Infant Scale (CMTInfs), CMT Functional Outcome Measure (CMT-FOM), CMT Neuropathy Score (CMTNS).
For more information on the 1000 Norms Project, or to express your interest in collaborating, please contact the project lead, Dr Marnee McKay.
Funding for the study was granted by the National Health and Medical Research Council of Australia and the Australasian Podiatry Research Fund.
Images from the study
Results
The 1000 Norms Project has generated a number of publications in high impact journals, including two in Neurology. Normative reference data for the physical and self-reported outcome measures collected through the 1000 Norms Project are reported in these journal articles. In addition, publications have arisen from collaborations with researchers and clinicians within Australia and internationally.
Useful links
- Defining ‘normal’ or healthy
- Why do we need to know what is ‘normal’?
- Protocol of the 1000 Norms Project
- Normative reference data: muscle strength and joint flexibility
- Normative reference data: functional outcome measures
- Normative reference data: spatiotemporal gait and plantar pressure
- Normative reference data: work ability
- Normative reference data: Beighton hypermobility scores
- Can pedobarography predict the occurrence of heel rocker in children with lower limb spasticity?
- Ankle instability in healthy people
- Reference values of musculoskeletal symptoms in healthy people
- Exploring the relationship between physical and self-reported functional capabilities
- Knee pain and disability in healthy people and KOOS normative reference data
- The repeatability and accuracy of assessing plantarflexor muscle strength using handheld dynamometry
- Varus thrust prevalence and normative reference data
- Exploring lower limb function of children with Longitudinal Fibular Deficiency compared to healthy peers