Age and Ageing Advance Access originally published online on December 15, 2006
Age and Ageing 2007 36(1):78-83; doi:10.1093/ageing/afl147
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A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study
1 Nottingham City Hospital, UK
2 Queen's Medical Centre, Nottingham, UK
3 Trent Research and Development Support Unit, University of Nottingham, UK
4 University of Derby, UK
Address correspondence to: R. Morris. Tel: +44 (0)1159 691169. Fax: +44 (0)1159 608409. Email: rmorris2{at}ncht.trent.nhs.uk; drbob{at}innotts.co.uk
Background: people with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures.
Aim: to investigate if balance tests, in conjunction with a falls history, can predict falls in older women with vertebral fractures.
Methods: a cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180°), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured.
Outcome measure: fallers (at least one fall in a 12 month follow-up period) versus non-fallers.
Results: one hundred and four women aged 63-91 years [mean = 78 ± 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR = 6.52; 95% CI = 1.69–25.22], 5 m-TUG test [OR = 1.03; 1.00–1.06], timed 10 m walk [OR = 1.07; 1.01–1.13] and the TURN180 test [OR = 1.22; 1.00–1.49] [P <0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR = 5.60; 1.40–22.45] and the 5 m-TUG test [OR = 1.04; 1.00–1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC = 60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR = 16.79, specificity = 100%, sensitivity = 13%].
Conclusions: a previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures.
Keywords: accidental falls, compression fractures, musculoskeletal equilibrium, elderly
Received 22 February 2006; accepted in revised form 20 October 2006.