Abstract
Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.
Highlights
Falls are a common occurrence among older adults that can result in injury, hospitalization, decreased mobility, fear of another fall, decreased quality of life, and even death. [1,2,3,4,5] Considering the higher fall incidence in older adults and its consequences, it is crucial to study factors that predispose older adults to falls and determine measures that can best identify those at fall-risk
The correlation between single limb stance (SLS) times and fall history was negative- suggesting that participants who could not balance as long on one lower limb were more likely to fall
The purpose of this study was to further examine the ability of the RIPPS system to differentiate between individuals with and without a fall history, but on the basis of the number of steps they took in response to a constant perturbation force (10% total body weight) applied at the waist via a spring scale
Summary
Falls are a common occurrence among older adults that can result in injury, hospitalization, decreased mobility, fear of another fall, decreased quality of life, and even death. [1,2,3,4,5] Considering the higher fall incidence in older adults and its consequences, it is crucial to study factors that predispose older adults to falls and determine measures that can best identify those at fall-risk. [15] The test was described by DePasquale and Toscano over 10 years ago They reported the maximum perturbation force (as a percentage of body weight) associated with an effective protective stepping response (limit 3 steps) had high test-retest reliability and was an excellent explanator of fall history. They found a force cut point of 10% of the total body weight as the most sensitive and specific explanator. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. Conclusions: The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years
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