Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices.
Andrew Sawers, Brian J Hafner
PMID 30900830WHAT IT FOUND
For established unilateral lower limb prosthesis users, the Narrowing-Beam Walking Test gave the strongest clue to falls in the past year.
A score above the cutoff was associated with being three times more likely to be a faller. Combining tests did not add much.
Key findings
01When fallers were defined as one or more falls in the past year, the Narrowing-Beam Walking Test had an area under the curve of .81, specificity of 76%, and a positive likelihood ratio of 3.0.
02When fallers were defined as two or more falls in the past year, the Four Square Step Test had sensitivity 94% and a negative likelihood ratio of .08, while the Timed Up and Go had specificity 83% and a positive likelihood ratio of 4.7.
03A combined model using several balance tests and participant factors improved some validity indices only slightly compared with individual tests.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample had 40 participants, and the authors state that future research needs a larger sample. Falls were recalled over the past 12 months, so the number of falls may be wrong. The study group had 62.5% traumatic amputation, higher than the 17% to 60.2% range reported in larger samples. The mean age was 48.7 years, younger than the mean ages of 50 to 55 years reported in larger national samples. The study did not record fall-related injuries. The study did not include several known fall-risk factors such as strength, protective stepping, medications, or vibration sense. Because the design was cross-sectional and retrospective, it cannot show whether the test scores predict future falls. The cutoff scores apply only to established unilateral lower limb prosthesis users with the characteristics of this sample.
Declared interests
The authors declare no conflict of interest and no competing financial interest. The article is classified as research supported by NIH, U.S. government, and non-U.S. government sources.
The easy way to misread this
Do not read the three-times figure as proof that a patient will fall. It describes the probability of already having fallen in the past year in a cross-sectional sample of 40 people, not future fall risk.