Prospective study for balance impairment and falls

Pebble Balancing

Here is the second study I read on the plane. I have several patients who came to mind when I read the title. I plan to re-read the study on my return, but it got me thinking about testing and treating balance.

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Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study. Phys Ther 2010; 90: 338-347. DOI: 10.2522/ptj.20090163

Background: Screening should have simple and easy-to-administer methods that identify impairments associated with future fall risk, but there is a lack of literature supporting validation for their use.

Objective: The aim of this study was to evaluate the independent contribution of balance assessment on future fall risk, using 5 methods to quantify balance impairment, for the outcomes “any fall” and “any injurious fall” in community-dwelling older adults who are higher functioning.

Design: This was a prospective cohort study.

Methods: A sample of 210 community-dwelling older adults (70% male, 30% female; mean age=79.9 years, SD=4.7) received a comprehensive geriatric assessment at baseline, which included the Berg Balance Scale to measure balance. Information on daily falls was collected for 12 months by each participant’s monthly submission of a falls log calendar.

Results: Seventy-eight people (43%) fell, of whom 54 (30%) sustained an injurious fall and 32 (18%) had recurrent falls (≥2 falls). Different balance measurement methods identified different numbers of people as impaired. Adjusted relative risk (RR) estimates for an increased risk of any fall were 1.58 (95% confidence interval [CI]=1.06, 2.35) for self-report of balance problems, 1.58 (95% CI=1.03, 2.41) for one-leg stance, and 1.46 (95% CI=1.02, 2.09) for limits of stability. An adjusted RR estimate for an increased risk of an injurious fall of 1.95 (95% CI=1.15, 3.31) was found for self-report of balance problems.

Limitations: The study was a secondary analysis of data.

Conclusions: Not all methods of evaluating balance impairment are associated with falls. The number of people identified as having balance impairment varies with the measurement tool; therefore, the measurement tools are not interchangeable or equivalent in defining an at-risk population. The thresholds established in this study indicate individuals who should receive further comprehensive fall assessment and treatment to prevent falls.

Photo credit: Pebble Balancing, originally uploaded by Bemep

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