Original article
A Pilot Study to Explore the Predictive Validity of 4 Measures of Falls Risk in Frail Elderly Patients

https://doi.org/10.1016/j.apmr.2005.03.004Get rights and content

Abstract

Thomas JI, Lane JV. A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients.

Objectives

To test the hypothesis that scores on 4 falls risk measures will differ significantly in patients reporting recurrent falls compared with those who do not; and to explore the validity of each measure to predict such falls status.

Design

A convenience sample was tested to establish the sensitivity and specificity of the Functional Reach Test, Timed Up & Go test, one-leg stance test (OLST), and balance subsection of the Performance Oriented Mobility Assessment (B-POMA). A 12-month retrospective falls history was used to identify recurrent fallers.

Setting

A day hospital for the elderly.

Participants

Convenience sample of 30 day hospital patients. The inclusion criteria were: ability to rise from a chair and walk 6m; no severe cognitive impairment or blindness; age 65 years or older.

Interventions

Not applicable.

Main Outcome Measures

Scores on the 4 tests and retrospective falls histories.

Results

Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers (P<.05). An OLST time of 1.02 seconds or less (odds ratio [OR]=15.2; 95% confidence interval [CI], 1.72–133.95) and B-POMA score of 11 or less (OR=18.5; 95% CI, 2.05–167.79) were predictive of day hospital patients having a history of recurrent falls.

Conclusions

OLST and B-POMA both have potential as screening tools for risk of falls, but this observation requires confirmation in a prospective study.

Section snippets

Participant Selection

A convenience sample of 30 subjects was recruited from day hospital patients between December 2002 and February 2003. The inclusion criteria were: ability to rise from a chair and walk 6m; no severe cognitive impairment or blindness; and age 65 years or older. Subjects had been referred for a variety of reasons, and none had commenced rehabilitation prior to entry to the study. Ethics approval was obtained from the local research ethics committee and written informed consent was obtained from

Intrarater Reliability

ICCs were in the range of fair to excellent35 (TUG test=.75; FRT=.87; OLST=.69; B-POMA=.84).

Demographics

Thirty subjects consented to take part in the study, of whom 18 were fallers and 12 were nonfallers. Demographics are described in table 1. There was a significant difference in the body mass index (BMI) between the 2 groups (t=-3.011, P=.005, effect size [ES]=1.07). We found no significant difference in the proportion of fallers using a walking aid (Fisher exact test=.066) or in sex of fallers (Fisher

Discussion

The B-POMA and OLST differentiated between fallers and nonfallers and predicted fallers in a day hospital setting, whereas TUG and FRT did not differentiate between fallers and nonfallers, although a TUG time above 32.6 seconds was associated with a significant OR of being a faller.

Several versions of the B-POMA are in use, and the version we used was taken from Tinetti et al.17 The results showed good sensitivity and specificity, although neither was as high as those reported by Chiu et al,11

Conclusions

The B-POMA, OLST, and TUG can be recommended as measures to identify patients at risk of falling because of physical factors in a day hospital setting, although this finding must be confirmed in a larger scale prospective study. The OLST and TUG may be more useful as a quick screening tool or objective marker. The B-POMA examines several different aspects of balance and so may be seen as the measure of choice during a full physical assessment. After rehabilitation, the measures can be used to

Acknowledgment

We thank Alasdair MacSween, PhD, for his helpful comments in the preparation of this manuscript.

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      Only five studies provided unadjusted and adjusted estimates, with the adjusted association remaining in Muir et al. (2010) only (Fig. 3C). Two studies compared median or mean balance times of recurrent fallers; Porto et al. (2020) reported no difference in mean balance time between single fallers and recurrent fallers (19.1 s ± 10.4 vs 18.2 s ± 10.2; p = 0.84), while Thomas and Lane (2005) reported lower median balance times in recurrent fallers (0.43 s (interquartile range: 1.57) compared to single fallers and non-fallers (2.71 s (2.59); p < 0.05). All other studies that examined recurrent falls used regression models, with sample sizes ranging from 30 (Thomas and Lane, 2005) to 7643 (Rossat et al., 2010).

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