Measuring balance in the elderly: preliminary development of an instrument
TL;DR: The goal for this study was to develop a measure of balance appropriate for elderly individuals and there was a high degree of internal consistency, a Cronbach's alpha of .96, which indicates the movements reflect a single underlying dimension.
Abstract: The goal for this study was to develop a measure of balance appropriate for elderly individuals. In total, 38 patients, ranging in age from 60 to 93 years, and 32 professionals, including nurses, physicians, and physical and occupational therapists were surveyed in three distinct phases to develop the content. Reliability of the measure was assessed by having physical therapists evaulate the videotaped performances of geriatric subjects at two different points in time. The intraclass correlation coefficients measuring the inter and intra rater reliability for the test as a whole were .98 and .99 respectively. The correlation coefficients for the individual items ranged from .71 to .99. In addition, there was a high degree of internal consistency, a Cronbach's alpha of .96, which indicates the movements reflect a single underlying dimension. The scale consists of 14 movements common in everyday life. It is easy to administer and score and has measurement properties that are better than expected for a new i...
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TL;DR: This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital and suggested that the timed “Up & Go’ test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.
Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
12,004 citations
TL;DR: The TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls and the ability to predict falls is not enhanced by adding a secondary task when performing the TUG.
Abstract: Background and Purpose. This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Subjects. Fifteen older adults with no history of falls (mean age578 years, SD56, range565‐ 85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age586.2 years, SD56, range576 ‐95) participated. Methods. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUG cognitive], and TUG while carrying a full cup of water [TUG manual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. Results. The TUG was found to be a sensitive (sensitivity587%) and specific (specificity587%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. Conclusions and Discussion. The results suggest that the TUG is a sensitive and specific measure for identifying communitydwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG. [Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896 ‐903.]
3,023 citations
TL;DR: Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS measurements, which showed high test-retest reliability.
Abstract: Background and Purpose. The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults. Subjects. Ninety-six community-dwelling elderly people (61–89 years of age) with independent functioning performed 4 clinical tests. Methods. Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60–69, 70–79, and 80–89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort. Results. The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95–.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects. Discussion and Conclusion. Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.
1,956 citations
TL;DR: A simple predictive model based on two risk factors can be used by physical therapists to quantify fall risk in community-dwelling older adults and Identification of patients with a high fall risk can lead to an appropriate referral into a fall prevention program.
Abstract: Background and Purpose. The objective of this retrospective case-control study was to develop a model for predicting the likelihood of falls among community-dwelling older adults. Subjects. Forty-four community-dwelling adults (≥65 years of age) with and without a history of falls participated. Methods. Subjects completed a health status questionnaire and underwent a clinical evaluation of balance and mobility function. Variables that differed between fallers and nonfallers were identified, using t tests and cross tabulation with chi-square tests. A forward stepwise regression analysis was carried out to identify a combination of variables that effectively predicted fall status. Results. Five variables were found to be associated with fall history. These variables were analyzed using logistic regression. The final model combined the score on the Berg Balance Scale with a self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity was 82%. Conclusion and Discussion. A simple predictive model based on two risk factors can be used by physical therapists to quantify fall risk in community-dwelling older adults. Identification of patients with a high fall risk can lead to an appropriate referral into a fall prevention program. In addition, fall risk can be used to calculate change resulting from intervention.
1,679 citations
TL;DR: This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments.
Abstract: The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments. The complete guideline is published on the American Geriatrics Society's Web site ( http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/).
1,504 citations