Intrarater and Interrater Reliability and Concurrent Validity of the 3-Meter Backward Walk Test in Non-frail, Pre-frail, and Frail Older Adults in Residential Care Homes.
Ali Kapan, Milos Ristic, Andreas Konrad and 1 others
PMID 40324212WHAT IT FOUND
In 217 residential care residents, a 3-meter backward walk gave repeatable times and matched forward walking and fall history.
Frail residents' second-round times were less stable, especially when slower than 15 seconds.
Key findings
01The 3-meter backward walk separated frailty groups: non-frail walked 3 meters backward in 5.0 seconds, pre-frail in 5.9 seconds, and frail in 11.8 seconds, with fall history 0%, 24%, and 76% respectively.
02Intrarater reliability was good to excellent: ICC 0.89 in non-frail, 0.93 in pre-frail, and 0.93 in frail; the frail group's MDC95 was 3.67 seconds.
03The 3-meter backward walk correlated strongly with the 10-meter walk (r = 0.91) and SPPB walking speed (r = 0.94), and with falls in the past 12 months (r = 0.74).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used a convenience sample from only 2 residential care homes in Vienna, so results may not transfer to other settings or countries. No formal power analysis was performed. Residents with MMSE score ≤17, unsafe walkers, and those unable to understand German or English were excluded, so findings do not apply to people with significant cognitive impairment or severe mobility limitations. Frail participants showed wider limits of agreement and larger MDC95 values, especially when backward walk times exceeded 15 seconds, so repeated test results are less stable in this group. The study measured falls in the previous 12 months, not future falls, so it does not show that the 3-meter backward walk predicts falls. The protocol changed the usual SPPB by adding a 1-meter acceleration zone and asking participants to walk as fast as safely possible, which may reduce comparability with standard tests. Participants could use walking aids, and the same aid was required for all tests; aid use may affect backward walking performance and interpretation.
The easy way to misread this
Do not treat the 3-meter backward walk as a proven fall predictor. The study found correlations with falls in the previous 12 months, including r = 0.74, but did not follow participants forward in time to see whether slow backward walking predicts future falls.