A Standard Procedure for Using TURN180: Testing dynamic postural stability among elderly people

Abstract

Summary Background and Purpose TURN180 is a clinically useful test of dynamic postural stability suitable for assessing frail elderly people. Previous research indicates that people who take more than four steps to complete a 180° turn have an increased risk of falling compared with people who take four steps or less. We describe in detail the development of a standard protocol which includes investigating whether direction of turning affects the number of steps taken to complete the turn and whether participants experienced fear of falling during the test. Methods A total of 142 inpatients (mean age 81 years, women 67%) agreed to participate. They were all mentally and physically able to co-operate in performing the tests and did not have any lower limb amputation or any recent acute condition affecting their mobility. While stepping around 180°, trustworthy handholds were placed close by so that people could steady themselves if necessary. Subjects chose the direction in which to perform the first of two trials of TURN180, then the second trial was made in the other direction. After the test participants were questioned about their fear of falling during the test. Results At the first trial, one-third of subjects turned anti-clockwise to the left, men and women equally. No statistically significant differences were found between the number of steps taken in either direction, nor between first and second tests. Using ratio data, the limits of agreement for the mean ratio between clockwise and anti-clockwise turn step counts were calculated and indicated that for 95% of these differences, turn step counts would lie within 60% of each other. The modal score was four steps whether clockwise (range 2 to 21) or anti-clockwise (range 3 to 20). TURN180 step counts correlated positively with number of falls recalled in the past six months, walking time over three metres, and perceived postural unsteadiness. The majority of participants (87.4%) were not afraid of falling while performing the test. Conclusion TURN180 is a valid measure of dynamic postural stability which allows quick identification and an indication of the severity of problems in people who have difficulty in maintaining a stable position. The test requires no apparatus apart from locally available sturdy furniture and can be performed in people's homes and doctors' surgeries and at hospital bedsides as well as in more spacious locations. It seems that providing handholds may reduce fear of falling during the test although this remains to be tested formally. People should turn in the same direction each time that they are tested. TURN180 is useful for both clinical and research purposes.