Jeremy R Crenshaw1,2, Kathie A Bernhardt1, Elizabeth J Atkinson3, Sara J Achenbach3, Sundeep Khosla4, Shreyasee Amin5,6, Kenton R Kaufman7,8. 1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. 2. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, 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. 6. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. 7. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. kaufman.kenton@mayo.edu. 8. Motion Analysis Laboratory, DAHLC 4-214, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. kaufman.kenton@mayo.edu.
Abstract
BACKGROUND: Falls are a leading cause of injury in older women. Stepping thresholds quantify balance-reaction capabilities. It is unclear how such evaluations predict falls in comparison to, or as a complement to, other objective measures of gait, standing postural control, strength, and balance confidence. AIMS: The objective of this study was to determine if stepping thresholds are prospectively related to falls in older women. METHODS: For this prospective cohort study, 125 ambulatory, community-dwelling women, age ≥ 65 years were recruited. Using a treadmill to deliver perturbations to standing participants, we determined anteroposterior single- and multiple-stepping thresholds. Here, thresholds represent the minimum perturbation magnitudes that consistently evoke one step or multiple steps. In addition, gait kinematics, obstacle-crossing kinematics, standing sway measures, unipedal stance time, the functional reach, lower extremity isometric strength, grip strength, balance confidence, and fall history were evaluated. Falls were prospectively recorded for one year. RESULTS: Seventy-four participants (59%) fell at least once. Posterior single-stepping thresholds were the only outcome that predicted future fall status (OR = 1.50, 95% CI 1.01-2.28; AUC = .62). A multivariate approach added postural sway with eyes closed as a second predictive variable, although predictive abilities were not meaningfully improved. DISCUSSION: These results align with the previous evidence that reactive balance is a prospective indicator of fall risk. Unlike previous studies, strength scaled to body size did not contribute to fall prediction. CONCLUSION: Posterior single-stepping thresholds held a significant relationship with future fall status. This relationship was independent of, and superior to that of, other measures of standing balance, gait, strength, and balance confidence.
BACKGROUND: Falls are a leading cause of injury in older women. Stepping thresholds quantify balance-reaction capabilities. It is unclear how such evaluations predict falls in comparison to, or as a complement to, other objective measures of gait, standing postural control, strength, and balance confidence. AIMS: The objective of this study was to determine if stepping thresholds are prospectively related to falls in older women. METHODS: For this prospective cohort study, 125 ambulatory, community-dwelling women, age ≥ 65 years were recruited. Using a treadmill to deliver perturbations to standing participants, we determined anteroposterior single- and multiple-stepping thresholds. Here, thresholds represent the minimum perturbation magnitudes that consistently evoke one step or multiple steps. In addition, gait kinematics, obstacle-crossing kinematics, standing sway measures, unipedal stance time, the functional reach, lower extremity isometric strength, grip strength, balance confidence, and fall history were evaluated. Falls were prospectively recorded for one year. RESULTS: Seventy-four participants (59%) fell at least once. Posterior single-stepping thresholds were the only outcome that predicted future fall status (OR = 1.50, 95% CI 1.01-2.28; AUC = .62). A multivariate approach added postural sway with eyes closed as a second predictive variable, although predictive abilities were not meaningfully improved. DISCUSSION: These results align with the previous evidence that reactive balance is a prospective indicator of fall risk. Unlike previous studies, strength scaled to body size did not contribute to fall prediction. CONCLUSION: Posterior single-stepping thresholds held a significant relationship with future fall status. This relationship was independent of, and superior to that of, other measures of standing balance, gait, strength, and balance confidence.
Authors: Daina L Sturnieks; Jasmine Menant; Jos Vanrenterghem; Kim Delbaere; Richard C Fitzpatrick; Stephen R Lord Journal: Gait Posture Date: 2012-06-26 Impact factor: 2.840
Authors: Christopher P Carty; Neil J Cronin; Deanne Nicholson; Glen A Lichtwark; Peter M Mills; Graham Kerr; Andrew G Cresswell; Rod S Barrett Journal: Age Ageing Date: 2014-06-10 Impact factor: 10.668
Authors: Christopher P Carty; Rod S Barrett; Neil J Cronin; Glen A Lichtwark; Peter M Mills Journal: J Gerontol A Biol Sci Med Sci Date: 2012-08-09 Impact factor: 6.053
Authors: Daina L Sturnieks; Jasmine Menant; Kim Delbaere; Jos Vanrenterghem; Mark W Rogers; Richard C Fitzpatrick; Stephen R Lord Journal: PLoS One Date: 2013-08-09 Impact factor: 3.240