Development of a Clinical Multiple-Lunge Test to Predict Falls in Older Adults

Abstract

Wagenaar R, Keogh JW, Taylor D. Development of a clinical Multiple-Lunge Test to predict falls in older adults. ObjectiveTo develop a new Multiple-Lunge Test to distinguish between fallers and nonfallers in community-dwelling older adults. DesignA cross-sectional design was used to establish the sensitivity and specificity of the test to predict faller status based on retrospective self-reported fall history. SettingLocal retirement villages. ParticipantsCommunity-dwelling older adults (N=130; mean age ± SD, 77±7y) with (n=40) and without (n=90) a history of falls. InterventionsThe Multiple-Lunge Test required individuals to lunge forward to a step length determined as 60% of their leg length, and return to start, for 5 consecutive repetitions. Interday and intraday test-retest reliability of the Multiple-Lunge Test was established across 2 testing occasions. Main Outcome MeasuresNumber of steps performed correctly, total time to complete 5 steps. ResultsThe Multiple-Lunge Test was found to be reliable across trials (Intraday: intraclass correlation coefficient [ICC]=.79–.81 for steps, ICC=.86–.88 for time; Interday: ICC=.77 for steps; ICC=.84 for time). Sensitivity and specificity values were calculated as 73% and 63%, respectively, for predicting multiple fallers using the measure of all 5 steps done correctly. ConclusionsThe test is easily administered and because of its challenging nature, it may be well suited to detect subtle differences in abilities of higher functioning, community-dwelling older adults. A practitioner can be confident in 7 of 10 cases that an older adult who cannot complete all 5 steps of the Multiple-Lunge Test is at high risk of falls. The results suggest that there is potential for the Multiple-Lunge Test to be used in clinical practice; however, additional research on how to further increase its validity appears warranted.