Background: There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. Objective: To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). Design: Cross-sectional survey. Setting: Community sample. Method: 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. Results: The FES-I had excellent internal and test-retest reliability (Cronbach' α=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). Conclusions: The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity. © The Author 2005. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

/pdf/development-and-initial-validation-of-the-falls-efficacy-40sihwtkhv.pdf

Development and initial validation of the Falls Efficacy Scale-International (FES-I)

/pdf/white-paper-walking-speed-the-sixth-vital-sign-gtycujhxm3.pdf

White paper: "walking speed: the sixth vital sign".

Background and Purpose:The Timed Up and Go (TUG) test is widely employed in the examination of elders, but definitive normative reference values are lacking. This meta-analysis provided such values by consolidating data from multiple studies.Methods:Studies reporting TUG times for apparently

/pdf/reference-values-for-the-timed-up-and-go-test-a-descriptive-2mtcipvp1c.pdf

Reference values for the timed up and go test: a descriptive meta-analysis.

Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults.

Design: Random-effects meta-analysis.

Setting: English-language studies indexed in MEDLINE and CINAHL (1985–2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers.

Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included.

Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls.

Methods: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement.

Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31–2.37) for any fall and 3.06 (95% CI=1.86–5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01–2.32) for any fall and 1.41 (95% CI=1.25–1.59) for recurrent falls.

Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls.

Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta-Analysis

Background and Purpose: Distinguishing between a clinically significant change and change due to measurement error can be difficult. The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale (BBS), forward and backward functional reach, the Romberg Test and the Sharpened Romberg Test (SRT) with eyes open and closed, the Activities-specific Balance Confidence (ABC) Scale, the Six-Minute Walk Test (6MWT), comfortable and fast gait speed, the Timed “Up & Go” Test (TUG), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Unified Parkinson Disease Rating Scale (UPDRS) in people with parkinsonism.

Subjects: Thirty-seven community-dwelling adults with parkinsonism (mean age=71 years) participated. The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale; however, the scores ranged from 1 to 4.

Methods: Subjects were tested twice by the same raters, with 1 week between tests. Test-retest reliability was calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated using a 95% confidence interval (MDC95).

Results: The ICCs for test-retest reliability were above .90 for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and comfortable and fast gait speeds. The MDC95 values for those functional tests were: BBS=5/56, ABC Scale=13%, SRT with eyes closed=19 seconds, 6MWT=82 m, comfortable gait speed=0.18 m/s, and fast gait speed=0.25 m/s. The ICCs for test-retest reliability of SF-36 scores were above .80, with the exception of the social functioning subscale. The MDC95 values for the SF-36 ranged between 19% and 45%. The MDC95 values for the UPDRS Activities of Daily Living section, Motor Examination section, and total scores were 4/52, 11/108, and 13/176, respectively.

Discussion and Conclusion: Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinically significant. High test-retest reliability of scores for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and gait speed make them trustworthy functional assessments in people with parkinsonism. The SF-36 and UPDRS provide quality-of-life and disease severity rating values in the ongoing assessment of people with parkinsonism.

http://www.exercisepd.com/uploads/3/5/3/1/3531021/mdc.pdf

Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism

Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the "sixth vital sign". By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual's WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding predicted outcomes, as well as minimal detectable change values for specific populations and settings are provided.

https://digitalcommons.sacredheart.edu/cgi/viewcontent.cgi?article=1172&context=pthms_fac

Walking Speed: The Functional Vital Sign

BACKGROUND: Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. Purpose: First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. Data Sources: To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (>=65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. Study Selection: Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. Data Extraction: Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. Data Synthesis: Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. Limitations: Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. Conclusions: No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (=12 seconds), and 5 times sit-to-stand times (>=12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps. Copyright (C) 2016 the Section on Geriatrics of the American Physical Therapy Association Language: en

/pdf/determining-risk-of-falls-in-community-dwelling-older-adults-12iczy11sq.pdf

Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.

Purpose:Routinely, physical therapists use a variety of physical performance tests to determine functional status of older adults. Whereas many commonly used instruments have been evaluated for some aspects of reliability and validity, few studies report typical performance for community liv

Functional Performance in Community Living Older Adults

Orthotics and Prosthetics in Rehabilitation: The Multidisciplinary Approach Materials and Technology Clinical Assessment of Pathologic Gait Exercise, Energy Cost, and Aging in Orthotic and Prosthetic Rehabilitation Principles of Orthotic Design Assessment Strategies for Lower Extremity Orthoses Footwear: Foundation for Lower Extremity Orthotics Functional Foot Orthoses Ankle-Foot Orthoses Knee Orthoses Knee-Ankle-Foot Orthoses Hip-Knee- Ankle-Foot Orthoses Hip Orthoses Spinal Orthoses Orthotics and Exercise in the Management of Scoliosis Principles of Splinting for the Hand Management of Extremity Fractures: Principles of Casting and Orthotics Splinting, Orthotics, and Prosthetics in the Management of Burns Etiology of Amputation Conservative Management of Vulnerable Feet When Amputation is Necessary: Preoperative Assessment and Surgery Postsurgical Management of Partial Foot and Syme's Amputation Postoperative and Preprosthetic Care Prosthetic Feet Transtibial Prosthetics Transtibial Prosthetic Training and Rehabilitation Transfemoral Prosthetics Rehabilitation for Persons with Transfemoral Amputation Prosthetic Options for High-Level and Bilateral Amputation Rehabilitation for Children with Limb Deficiencies Upper Extremity Amputations and Prosthetic Management

Michelle M. Lusardi

Papers

White paper: "walking speed: the sixth vital sign".

Walking Speed: The Functional Vital Sign

Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.

Functional Performance in Community Living Older Adults

Orthotics and Prosthetics in Rehabilitation