Clinical Measures of Balance in Community-Dwelling Elderly Female Fallers and Non-Fallers.

O'Brien K, Pickles B, Culham E (Health and Community Services Western, Corner Brook, Newfoundland; Division of Physical Therapy, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada), Physiotherapy Canada. 1998;50:212-217, 221.

Clinical instruments are often used to assess patient function because of ease of application, low cost, relative accessibility, and direct clinical relevance. The purpose of this study was to use the Berg Balance Scale (BBS), the Functional Reach Test (FRT), and a modified version of the Timed Get Up and Go Test (GUGT) to determine whether elderly, community-dwelling people who are fallers could be distinguished from elderly, community-dwelling people who are non-fallers. The researchers noted that, while all 3 clinical tests have been proven to be valid and reliable measures of balance in the elderly, most prior studies have involved elderly people who live in institutions. For the purposes of this study, a fall was defined as "an event during which a subject comes to rest on the ground or at some lower level, but not as the result of a major intrinsic event or overwhelming hazard."

The subjects were 48 elderly women, aged 65 years or older, who were community dwellers. Thirteen of the subjects were classified as fallers and 35 were classified as non-fallers; subject recall of fall events over a 1-year period was used for the classification. The inclusion criteria included a score of above 24 on the Folstein Mini-Mental Status Examination, independence in unsupervised ambulation with or without use of a cane, and independent living in a community. The exclusion criteria included postural hypotension, vestibular disorders severe musculoskeletal disorders, active neurological disorders, active major depressive or affective disorders, or the necessity of using more than a cane for ambulation.

The BBS, FRT, and GUGT were administered to all subjects. The data were then analyzed retrospectively to determine whether these instruments could be used to distinguish fallers from non-fallers and to determine the sensitivity and specificity of these measurements.

Fallers scored significantly lower on the BBS and FRT, and required significantly greater time to complete the GUGT. However, the scores on all 3 tests failed to indicate a clear-cut threshold that would differentiate fallers from non-fallers. All 3 tests were highly specific at identifying non-fallers. However, the sensitivity of all 3 tests was low, meaning that several fallers were not accurately identified by scores on these tests. The correlations between balance and fall status were strongest when using the BBS.

The authors said that they made no effort to distinguish between subjects who fell only once and those who fell more than once. They mentioned that the memory of the subjects may have affected reported fall status. The researchers believed that the low number of fallers compared with non-fallers may have influenced the outcomes of this study. In addition, the authors said that causal relationships between risk factors and falls were not established. In conclusion, the authors suggested that the BBS is the most suitable of the 3 tests to assess fall risk in elderly, community-dwelling women.

Sondra E Dunkle, EdD, PT Pocatello, Idaho