This study examined the diagnostic accuracy of common tests for assessing balance and postural in identifying fallers. In particular, the study examined the sensitivity/specificity and cut-off scores for these tests in identifying fallers versus non-fallers in a sample of community-dwelling older adults.
Using convenience sampling, participants were recruited from local senior centers, churches, and health clubs. English-speaking individuals aged ≥60 with no lower extremity impairments, no cognitive issues, and no reliance on a walker for outdoor mobility were recruited. Participants who had two or more unintentional falls in the past 6 months were deemed as fallers. Participants completed assessments for balance and physical performance, including the Four-Square Step Test (FSST), Short Physical Performance Battery (SPPB), Timed UP and Go Test (TUG), and 5-repetition Sit-to-Stand test (5STS). The testing sequence for these assessments was randomized to prevent order effects. The univariate analysis compared the demographics, health-related variables, and the scores for balance assessments between fallers and non-fallers. Receiver operating characteristic curves were plotted to examine the accuracy of FSST, SPPB, TUG, and 5STS in differentiating fallers from non-fallers. The area under the curve (AUC) values between 0.7-0.8 and >0.8 indicated acceptable and excellent accuracy, respectively. The sensitivity and specificity of scores for the tests that most accurately identified fall risk were calculated.
Of the 82 participants (72.1±6.8 years of age), 28 were fallers. There were no differences in the demographic profile of the fallers versus non-fallers. However, the fallers scored worse than non-fallers for the FSST (14.3±3.9 vs. 11.2±3.5; p=0.002), SPPB (8.9±2.6 vs. 10.8±1.4; p=0.002), 5STS (14.5±3 vs. 11.3±2.4; p0.001), and TUG (11.1±3.7 vs. 8.34±2.2; p0.001). The FSST showed moderate accuracy (AUC=0.75; 95% confidence interval [CI]:0.65-0.86), and 5STS showed excellent accuracy (AUC=0.81; 95% CI:0.69-0.92) in identifying fallers within the sample. The FSST scores of >13 seconds (sec) and 5STS scores of >12.5 sec showed acceptable sensitivity/specificity (74%/73% and 74%/75%, respectively) in identifying fall risk.
Screening for fall risk is vital to promoting timely interventions to reduce fall risk and prevent fall-related injuries. This study examined the accuracy of commonly used tests for physical performance and balance and suggested that the FSST or 5STS can be used for screening people at risk for falls.
Screening for fall risk is a crucial component of physiotherapy practice. Therapists can use the FSST scores of >13 sec or 5STS scores of >12.5 sec as the threshold for determining fall risk in community-dwelling elderly. Such screening can enable therapists to deliver interventions to mitigate fall risk in these individuals.
Four-Square Step Test
5-repetition Sit-to-Stand test
