Jeremy R Crenshaw1, Kathie A Bernhardt2, Elizabeth J Atkinson3, Sundeep Khosla4, Kenton R Kaufman2, Shreyasee Amin5. 1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. Electronic address: crenshaw@udel.edu. 2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. 3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. 4. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA. 5. Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Electronic address: amin.shreyasee@mayo.edu.
Abstract
BACKGROUND: Compensatory stepping thresholds evaluate the response to postural disturbances. Although such fall-recovery measures are a promising indicator of fall risk, the relationships between stepping thresholds and other measures used to predict falls are not well established. RESEARCH QUESTION: We sought to quantify the relationships between stepping thresholds and other measurements used to assess fall risk in older women, a population at high risk for falls and related injuries, including fractures. METHODS: We studied 112 ambulatory, community-dwelling women, age 65 years or older. Using a treadmill to deliver standing postural disturbances, we determined anterior and posterior single-stepping and multiple-stepping thresholds. These thresholds represented the magnitude of the disturbance that elicited one step or more than one step, respectively. We also assessed balance confidence, functional reach, unipedal stance time, isometric strength, obstacle crossing, postural sway, and gait kinematics. Outcomes were normalized to body size. RESULTS: After accounting for age, stepping thresholds were, at most, moderately correlated (Pearson partial correlation coefficients r = 0.20 to 0.40 and r = -0.21 to -0.31) to several assessments of gait, postural control, and strength. Approximately 24-52% of the variance in stepping thresholds was explained by a combination of age and other fall risk assessments, which frequently consisted of balance confidence, unipedal stance time, obstacle crossing, the Romberg ratio of postural sway, and/or strength. SIGNIFICANCE: Our results suggest that anteroposterior fall-recovery ability, as assessed by stepping thresholds, can only be partially inferred from age and a combination of assessments of sway, strength, unipedal tasks, and balance confidence. Compensatory stepping thresholds may provide information on stability maintenance unique from other assessments of fall risk. Further investigation would be necessary to determine whether stepping thresholds are better predictors of falls in older women.
BACKGROUND: Compensatory stepping thresholds evaluate the response to postural disturbances. Although such fall-recovery measures are a promising indicator of fall risk, the relationships between stepping thresholds and other measures used to predict falls are not well established. RESEARCH QUESTION: We sought to quantify the relationships between stepping thresholds and other measurements used to assess fall risk in older women, a population at high risk for falls and related injuries, including fractures. METHODS: We studied 112 ambulatory, community-dwelling women, age 65 years or older. Using a treadmill to deliver standing postural disturbances, we determined anterior and posterior single-stepping and multiple-stepping thresholds. These thresholds represented the magnitude of the disturbance that elicited one step or more than one step, respectively. We also assessed balance confidence, functional reach, unipedal stance time, isometric strength, obstacle crossing, postural sway, and gait kinematics. Outcomes were normalized to body size. RESULTS: After accounting for age, stepping thresholds were, at most, moderately correlated (Pearson partial correlation coefficients r = 0.20 to 0.40 and r = -0.21 to -0.31) to several assessments of gait, postural control, and strength. Approximately 24-52% of the variance in stepping thresholds was explained by a combination of age and other fall risk assessments, which frequently consisted of balance confidence, unipedal stance time, obstacle crossing, the Romberg ratio of postural sway, and/or strength. SIGNIFICANCE: Our results suggest that anteroposterior fall-recovery ability, as assessed by stepping thresholds, can only be partially inferred from age and a combination of assessments of sway, strength, unipedal tasks, and balance confidence. Compensatory stepping thresholds may provide information on stability maintenance unique from other assessments of fall risk. Further investigation would be necessary to determine whether stepping thresholds are better predictors of falls in older women.
Authors: Benjamin C Conner; Drew A Petersen; Jamie Pigman; James B Tracy; Curtis L Johnson; Kurt Manal; Freeman Miller; Christopher M Modlesky; Jeremy R Crenshaw Journal: Gait Posture Date: 2019-07-03 Impact factor: 2.840
Authors: Jeremy R Crenshaw; Drew A Petersen; Benjamin C Conner; James B Tracy; Jamie Pigman; Henry G Wright; Freeman Miller; Curtis L Johnson; Christopher M Modlesky Journal: Dev Med Child Neurol Date: 2020-03-02 Impact factor: 5.449
Authors: Farwa Ali; Stacy R Loushin; Hugo Botha; Keith A Josephs; Jennifer L Whitwell; Kenton Kaufman Journal: J Neurol Sci Date: 2021-08-25 Impact factor: 4.553
Authors: Jamie Pigman; Darcy S Reisman; Ryan T Pohlig; John J Jeka; Tamara R Wright; Benjamin C Conner; Drew A Petersen; Jeremy R Crenshaw Journal: Clin Biomech (Bristol, Avon) Date: 2019-07-26 Impact factor: 2.063
Authors: Jamie Pigman; Darcy S Reisman; Ryan T Pohlig; John J Jeka; Tamara R Wright; Benjamin C Conner; Drew A Petersen; Michael S Christensen; Jeremy R Crenshaw Journal: Clin Biomech (Bristol, Avon) Date: 2020-12-23 Impact factor: 2.063
Authors: Jeremy R Crenshaw; Kathie A Bernhardt; Elizabeth J Atkinson; Sara J Achenbach; Sundeep Khosla; Shreyasee Amin; Kenton R Kaufman Journal: Aging Clin Exp Res Date: 2020-02-14 Impact factor: 3.636