Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool?
Nathalie Frisendahl, Stina Ek, Erik Rosendahl and 3 others
PMID 35947043WHAT IT FOUND
Replacing the physical one-leg stand with a simple self-report question maintained the screening tool's predictive ability for first-time injurious falls in older adults.
This allows physical therapists to use the tool in e-health settings or waiting rooms, though the physical test alone was a stronger predictor.
Key findings
01The modified tool (m-FIF), which replaces the physical balance test with a self-report question, showed similar predictive ability (Harrell's C 0.70-0.71) and hazard ratios for injurious falls as the original FIF tool.
02When examined individually, the objective 1-leg standing test was a stronger predictor of injurious falls (Harrell's C 0.69-0.70) than the self-reported balance question (Harrell's C 0.60-0.65).
03Both tools had low sensitivity (29-38%) but high specificity (93-94%) for detecting first-time injurious falls, meaning they are better at ruling out risk than identifying every person who will fall.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study population was an urban, well-educated group from Sweden, which may limit generalizability to other demographics. Participants in their 70s were excluded from the analysis, creating a gap in the age range that might affect the tool's performance in that specific decade. The outcome relied on national registers for inpatient care, which may miss injurious falls that did not result in hospital admission. Self-reported balance questions are subject to reporting bias, and older adults may underestimate their physical capabilities. The question about balance was general and did not specifically ask about the ability to stand on one leg, which might explain the slight difference in predictive power compared to the physical test.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume the self-reported question is as strong as the physical test in isolation. The physical 1-leg stand alone had higher predictive values (Harrell's C 0.69-0.70) than the self-reported balance question alone (Harrell's C 0.60-0.65). The modified tool performs similarly to the original only because the self-report question is combined with other risk factors; it should not replace the physical test if the goal is to assess balance specifically.