Yoshiro Okubo1, Daniel Schoene2, Maria Jd Caetano3, Erika M Pliner4, Yosuke Osuka5, Barbara Toson6, Stephen R Lord3. 1. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia. Electronic address: y.okubo@neura.edu.au. 2. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany; Robert-Bosch Hospital, Department of Geriatric Rehabilitation, Stuttgart, Germany. 3. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia. 4. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA. 5. Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan. 6. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Flinders Centre for Epidemiology and Biostatistics (FCEB), College of Medicine & Public Health, Flinders University, Adelaide, Australia.
Abstract
OBJECTIVE: To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE: PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS: A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
OBJECTIVE: To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE: PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS: A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
Authors: Joerg Bloeckl; Sebastian Raps; Michael Weineck; Robert Kob; Thomas Bertsch; Wolfgang Kemmler; Daniel Schoene Journal: Front Physiol Date: 2022-06-24 Impact factor: 4.755
Authors: Youngwook Kim; Michael N Vakula; David A E Bolton; Christopher J Dakin; Brennan J Thompson; Timothy A Slocum; Masaru Teramoto; Eadric Bressel Journal: Front Aging Neurosci Date: 2022-01-18 Impact factor: 5.750