title: Development of the common data base for the FICSIT trials. A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. Predicting the probability of falls in community-dwelling elderly individuals using the trail-walking test 'Faster counting while walking' as a predictor of falls in older adults. Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’ Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly. Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Systematic Reviews of Diagnostic Test Accuracy [Prediction of falls with performance on Timed "Up-and-Go" and one-leg-balance tests and additional cognitive tasks]. Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye A comparison of four functional tests in discriminating fallers from non-fallers in older people Do voluntary step reactions in dual task conditions have an added value over single task for fall prediction? A prospective study Evaluation of Falls Risk in Community-Dwelling Older Adults Using Body-Worn Sensors Adaptability to Perturbation as a Predictor of Future Falls: A Preliminary Prospective Study Predictors of falls in the elderly by location Risk factors for falls among elderly persons living in the community. The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. A Simple Clinical Scale to Stratify Risk of Recurrent Falls in Community-Dwelling Adults Aged 65 Years and Older Is timed up and go better than gait speed in predicting health, function, and falls in older adults? Validation of self-reported fall events in intervention studies Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Does Change in Gait while Counting Backward Predict the Occurrence of a First Fall in Older Adults? Which Neuromuscular or Cognitive Test Is the Optimal Screening Tool to Predict Falls in Frail Community-Dwelling Older People?
abstract: The eight FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) sites test different intervention strategies in selected target groups of older adults . To compare the relative potential of these interventions to reduce frailty and fall-related injuries , all sites share certain descriptive ( risk-adjustment ) measures and outcome measures . This article describes the shared measures , which are referred to as the FICSIT Common Data Base ( CDB ) . The description is divided into four sections according to the four FICSIT committees responsible for the CDB : ( 1 ) psychosocial health and demographic measures ; ( 2 ) physical health measures ; ( 3 ) fall-related measures ; and ( 4 ) cost and cost-effectiveness measures . Because the structure of the FICSIT trial is unusual , the CDB should expedite secondary analyses of various research questions dealing with frailty and falls OBJECTIVES To test the hypothesis that scores on 4 falls risk measures  will differ significantly in patients reporting recurrent falls compared with those who do not ; and to explore the validity of each measure to predict such falls status . DESIGN A convenience sample was tested to establish the sensitivity and specificity of the  Functional Reach Test , Timed Up & Go test , one-leg stance test ( OLST )  , and  balance subsection of the Performance Oriented Mobility Assessment ( B-POMA ) . A 12-month retrospective falls history was used to identify recurrent fallers . SETTING A day hospital for the elderly . PARTICIPANTS Convenience sample of 30 day hospital patients . The inclusion criteria were : ability to rise from a chair and walk 6 m ; no severe cognitive impairment or blindness ; age 65 years or older . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Scores on the 4 tests and retrospective falls histories . RESULTS Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers ( P<.05 ) . An  OLST time of 1.02 seconds or less ( odds ratio [OR]=15.2 ; 95 % confidence interval [ CI ] , 1.72 - 133.95 ) and B-POMA score of 11 or less ( OR=18.5 ; 95 % CI , 2.05 - 167.79 ) were predictive of day hospital patients having a history of recurrent falls . CONCLUSIONS OLST and B-POMA both have potential as screening tools for risk of falls , but this observation requires confirmation in a prospect i ve study Objective To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay . Design Cluster r and omised trial . Setting 24 elderly care wards in 12 hospitals in Sydney , Australia . Participants 3999 patients , mean age 79 years , with a median hospital stay of seven days . Interventions A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards . They provided a targeted multifactorial intervention that included a risk assessment of falls , staff and patient education , drug review , modification of bedside and ward environments , an exercise programme , and alarms for selected patients . Main outcome measure Falls during hospital stay . Results Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics . Overall , 381 falls  occurred during the study . No difference was found in fall rates during follow-up between intervention and control wards : respectively , 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days ( P=0.96 ) . The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 ( 95 % confidence interval 0.72 to 1.28 ) . Conclusion A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay . Trial registration Australian New Zeal and Clinical Trials Registry ACTRNO 12605000467639 BACKGROUND Executive function ( EF ) deficits may increase fall risk , even among older adults with no overt cognitive impairment . Indeed , the effects of dual tasking ( DT ) on gait , a challenge to executive control , are more exaggerated in persons with a history of falls . Prospect i ve evidence is , however , lacking . METHODS We prospect ively evaluated whether EF predicts falls over a 2-year period among 262 community-living , healthy , and well-functioning older adults , focusing on the 201 who reported no falls during the previous year . At baseline , participants completed a computerized cognitive battery that generated an index of EF and other cognitive domains .  Gait was assessed using performance-based tests and by quantifying walking during single- and dual-task conditions . RESULTS The 262 participants ( mean age : 76.3 ± 4.3 years , 60.3 % women ) had intact cognitive function on testing , a low comorbidity index , and good mobility . The EF index predicted future falls . Among those who reported no previous falls , participants in the worst EF quartile were three times more likely to fall during the 2 years of follow-up , and they were more likely to transition from nonfaller to faller sooner . DT gait variability also predicted future falls and multiple falls , whereas other measures of cognitive function , gait , and mobility did not . CONCLUSIONS Among healthy older adults , individuals with poorer EF are more prone to falls . Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that dem and s multitasking . Optimal screening , early detection , and treatment of falls should , apparently , also target this cognitive domain Background Falling is a common problem in the fast-growing elderly population .  Multitasking or engaging in two or more activities at the same time is common in daily living . Objective To determine the usefulness of the  trail-walking test ( TWT ) for predicting a fall in community-dwelling elderly individuals . Methods This was a prospect i ve study in which the TWT was used to evaluate the risk of falling among a group of community-dwelling elderly individuals ( n = 171 ) with a mean age of 80.5 ± 5.6 years . The following tests were conducted :  TWT , trail-making test ( TMT ) , timed-up- and -go test ( TUG ) , functional reach ( FR ) test , one-leg st and ing ( OLS ) test , and 10-m walking time test . Test – retest reliability was assessed by repeating the TWT within 2 weeks of the first trial , and there was a 1-year follow-up . Stepwise logistic regression analysis was used to analyze whether the TWT , TMT , TUG , FR , OLS , or 10-m walking tests predicted falling . Results The test – retest reliability  of TWT was high ( intraclass correlation coefficient 0.945 , p < 0.001 ) . Fifty-nine participants ( 34.5 % ) had reported a fall during the year preceding the 1-year follow-up . The stepwise logistic regression analysis revealed that only the TWT was significantly related to falling ( odds ratio 1.160 , 95 % confidence interval 1.107–1.214 ; p < 0.001 ) . In total , 77.8 % of cases were correctly classified . Conclusion When reliability and validity were considered , the TWT was most useful test of those evaluated for assessing the risk of fall among our elderly cohort OBJECTIVE To establish whether changes in a spoken verbal task performance while walking compared with being at rest could predict falls among older adults . DESIGN Prospect i ve cohort study of 12 months ' duration . SETTING Twenty-seven senior housing facilities . PARTICIPANTS Sample of 187 subjects aged 75 - 100 ( mean age 84.8 + /- 5.2 ) . During enrollment , participants were asked to count aloud backward from 50 , both at rest and while walking and were divided into two groups according to their counting performance . Information on incident falls during the follow-up year was monthly collected . MEASUREMENTS The number of enumerated figures while sitting on a chair and while walking  , and the first fall that occurred during the follow up year . RESULTS The number of enumerated figures under dual-task as compared to  single task  increased among 31.5 % of the tested subjects ( n = 59 ) and was associated with lower scores in MMSE ( P = 0.034 ) , and higher scores in Geriatric Depression Scale ( P = 0.007 ) and Timed Up & Go ( P = 0.005 ) . During the 12 months follow-up , 54 subjects ( 28.9 % ) fell . After adjusting for these variables , the increase in counting performance was significantly associated with falls ( adjusted OR = 53.3 , P < 0.0001 ) . Kaplan-Meier distributions of falls differed significantly between subjects who either increased or decreased their counting performance ( P < 0.0001 ) . CONCLUSIONS Faster counting while walking was strongly associated with falls , suggesting that better performance in an additional verbal counting task while walking might represent a new way to predict falls among older adults Background and aims The aim of this study was to describe the prevalence of falls  in a general older population , especially among the most elderly , and the risk markers associated with falls . Methods This is a cross-sectional study in which 38 fall risk markers were analysed in non- , occasional- and frequent-fallers . The population was 2,865 individuals ( aged 60–93 ) , r and omly selected from the general population register . The risk of falling was calculated as age-adjusted odds ratios . The relation between the number of risk markers  for an individual and falls was also analysed . Results About one in ten reported falling during the past 6 months , 35 % of which were over 90 years old . Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem . These included a variety of diseases , symptoms , medical and physical functions , life-style factors and the taking of certain drugs . The five risk markers with the highest odds ratio in frequent fallers were ‘ tendency to fall ’ ( 37.9 ) , ‘ low walking speed ’ ( 12.8 ) , consumption of ‘ neuroleptics ’ ( 10.9 ) , ‘ impaired mobility ’ ( 10.0 ) and ‘ dementia ’ ( 5.4 ) . Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling , especially among frequent fallers and those aged over 90 years . Conclusion Falls are common in the elderly population and the risk is multifactorial . The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers . The self-perceived clinical sign ‘ tendency to fall ’ seems highly sensitive as indicator of individuals at risk . Several risk markers may be treatable . Fall risk seems to increase in a non-linear , almost exponential way with increasing number of risk markers OBJECTIVES To compare the practicality , reliability , validity , and responsiveness of the timed up and go ( TUG ) , one-leg st and ( OLS ) , functional reach ( FR ) , and Tinetti balance ( TB ) performance measures in people aged 65 and older . DESIGN A prospect i ve study . SETTING Shin-Sher Township of Taichung County , west- central Taiwan . PARTICIPANTS Twelve hundred community-dwelling older people . MEASUREMENTS During an initial assessment at their residences , participants were interviewed for demographics , cognition , fall history , use of a walking aid , and activities of daily living ( ADLs )  , in addition to completing the four balance tests . Falls were ascertained by telephone every 3 months for a 1-year follow-up ; the four balance measures and ADLs were also reassessed at the end of the follow-up year . RESULTS Of the four balance measures , the OLS had the lowest participation rate , and participation of people who were cognitively impaired had fallen in the previous year , used a walking aid , or suffered from an ADL disability was lower than for their counterparts . The time to complete the tests ranged from 58 seconds for OLS , to 160 seconds for the TB . All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status . The TB showed better discriminant , convergent , and predictive validities and responsiveness to ADL changes than the other three tests . CONCLUSION According to psychometric properties , the most suitable performance measure for evaluating balance in community-dwelling older people was the TB , followed by the TUG OBJECTIVE To determine the accuracy of the Timed Up and Go Test ( TUGT ) for screening the risk of falls among community-dwelling elderly individuals . METHOD This is a prospect i ve cohort study with a r and omly by lots without reposition sample stratified by proportional partition in relation to gender involving 63 community-dwelling elderly individuals . Elderly individuals who reported having Parkinson 's disease , a history of transitory ischemic attack , stroke and with a Mini Mental State Exam lower than the expected for the education level , were on a wheelchair and that reported a single fall in the previous six months were excluded . The TUGT , a mobility test , was the measure of interested and the occurrence of falls was the outcome . The performance of basic activities of daily living ( ADL ) and instrumental activities of daily living ( IADL ) was determined through the Older American Re sources and Services , and the socio-demographic and clinical data were determined through the use of additional question naires . Receiver Operating Characteristic Curves were used to analyze the sensitivity and specificity of the TUGT . RESULTS Elderly individuals who fell had greater difficulties in ADL and IADL ( p<0.01 ) and a slower performance on the TUGT ( p=0.02 ) . No differences were found in socio-demographic and clinical characteristics between fallers and non-fallers . Considering the different sensitivity and specificity , the best predictive value for discriminating elderly individuals who fell was 12.47 seconds [ ( RR=3.2 ) 95%CI : 1.3 - 7.7 ] . CONCLUSIONS The TUGT proved to be an accurate measure for screening the risk of falls among elderly individuals . Although different from that reported in the international literature , the 12.47 second cutoff point seems to be a better predictive value for Brazilian elderly individuals Background The Functional Gait Assessment ( FGA ) is a reliable and valid measure of gait-related activities . Objective The purpose of this study was to determine the concurrent , discriminative , and predictive validity of the FGA in community-dwelling older adults . Design This was a prospect i ve cohort study . Methods Thirty-five older adults aged 60 to 90 years completed the Activities-specific Balance Confidence Scale ( ABC ) , Berg Balance Scale ( BBS ) , Dynamic Gait Index ( DGI ) , Timed “ Up & Go ” Test ( TUG ) , and Functional Gait Assessment ( FGA ) during one session . Falls were tracked by having participants complete a monthly fall calendar for 6 months . Spearman correlation coefficients were used to determine concurrent validity among the ABC , BBS , TUG , DGI , and FGA . To determine the optimum scores to classify fall risk , sensitivity ( Sn ) , specificity ( Sp ) , and positive and negative likelihood ratios ( LR+ and LR− ) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA , TUG , and DGI in identifying prospect i ve falls . Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI , TUG , and FGA in identifying prospect i ve falls . Results The FGA correlated with the ABC ( r=.053 , P<.001 ) , BBS ( r=.84 , P<.001 ) , and TUG ( r=−.84 , P<.001 ) . An  FGA  score of ≤22/30 provides both discriminative and predictive validity . The FGA ( scores ≤22/30 ) provided 100 % Sn , 72 % Sp , LR+ of 3.6 , and LR− of 0 to predict prospect i ve falls . Limitations The study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade . Conclusions The FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults To determine the physiological factors and medications predicting injurious falls among the elderly population , the authors conducted a prospect i ve study in a rural home-dwelling population aged 70 years or over , initially 979 persons ( 377 men and 602 women ) , from 1 January 1991 to 31 December 1992 , in Northern Finl and . The independent risk factors for all falling injuries , falls leading to minor injuries and ones leading to major injuries were determined . In men , the independent risk factors for all injuries were gait disturbances [ odds ratio ( OR ) = 3.5 ] and the use of digitalis ( OR = 2.2 ) , those for minor injuries were gait disturbances ( OR = 2.7 ) and the use of calcium blockers ( OR = 3.0 ) , and those for major injuries were the absence of a quadriceps reflex ( OR = 4.8 ) , gait disturbances ( OR = 2.8 ) and the use of digitalis ( OR = 2.9 ) . In women , the corresponding independent risk factors were short step length ( OR = 32.1 ) , the use of calcium blockers ( OR = 2.5 ) and the use of medications for improving peripheral circulation ( OR = 3.7 ) for all injurious falls , path deviation ( OR = 2.3 ) the use of calcium blockers ( OR = 2.8 ) and the use of anti-inflammatory drugs ( OR = 2.1 ) for minor injuries , and foot deformity ( OR = 2.0 ) , short step length ( OR = 15.8 ) , the use of long-acting benzodiazepines ( OR = 4.0 ) and the use of calcium blockers ( OR = 2.4 ) for major injuries . In order to prevent injurious falls , attention should be given to the prescription of tranquillizers , cardiovascular medications and anti-inflammatory drugs . The walking abilities of elderly people should be maintained and chronic diseases leading to peripheral neuropathy should be treated adequately Diagnosis is a critical component of health care , and clinicians , policymakers , and patients routinely face a range of questions regarding diagnostic tests . They want to know whether testing improves outcome ; what test to use , purchase , or recommend in practice guidelines ; and how to interpret test results . Well- design ed  diagnostic test accuracy studies can help in making these decisions , provided that they transparently and fully report their participants , tests , methods , and results as facilitated , for example , by the STARD ( St and ards for Reporting of Diagnostic Accuracy ) statement ( 1 ) . That 25-item checklist was published in many journals and is now adopted by more than 200 scientific journals worldwide . As in other areas of science , systematic review s and meta- analysis of accuracy studies can be used to obtain more precise estimates when small studies addressing the same test and patients in the same setting are available . Review s can also be useful to establish whether and how scientific findings vary by particular subgroups , and may provide summary estimates with a stronger generalizability than estimates from a single study . Systematic review s may help identify the risk for bias that may be present in the original studies and can be used to address questions that were not directly considered in the primary studies , such as comparisons between tests . The Cochrane Collaboration is the largest international organization preparing , maintaining , and promoting systematic review s to help people make well-informed decisions about health care ( 2 ) . The Collaboration decided in 2003 to make preparations for including systematic review s of diagnostic test accuracy in their Cochrane Data base of Systematic Review s. To enable this , a working group ( Appendix ) . was formed to develop methodology , software , and a h and book The first diagnostic test accuracy review was published in the Cochrane Data base in October 2008 . In this paper , we review recent method ological developments concerning problem formulation , location of literature , quality assessment , and meta- analysis of diagnostic accuracy studies by using our experience from the work on the Cochrane H and book . The information presented here is based on the recent literature and up date s previously published guidelines by Irwig and colleagues ( 3 ) . Definition of the Objectives of the Review Diagnostic test accuracy refers to the ability of a test to distinguish between patients with disease ( or more generally , a specified target condition ) and those without . In a study of test accuracy , the results of the test under evaluation , the index test , are compared with those of the reference st and ard determined in the same patients . The reference st and ard is an agreed-on and accurate method for identifying patients who have the target condition . Test results are typically categorized as positive or negative for the target condition . By using such binary test outcomes , the accuracy is most often expressed as the test 's sensitivity ( the proportion of patients with positive results on the reference st and ard that are also positive on the index test ) and specificity ( the proportion of patients with negative results on the reference st and ard that are also negative on the index test ) . Other measures have been proposed and are in use ( 46 ) . It has long been recognized that test accuracy is not a fixed property of a test . It can vary between patient subgroups , with their spectrum of disease , with the clinical setting , or with the test interpreters and may depend on the results of previous testing . For this reason , inclusion of these elements in the study question is essential . In order to make a policy decision to promote use of a new index test , evidence is required that using the new test increases test accuracy over other testing options , including current practice , or that the new test has equivalent accuracy but offers other advantages ( 79 ) . As with the evaluation of interventions , systematic review s need to include comparative analyses between alternative testing strategies and should not focus solely on evaluating the performance of a test in isolation . In relation to the existing situation , 3 possible roles for a new test can be defined : replacement , triage , and add-on ( 7 ) . If a new test is to replace an existing test , then comparing the accuracy of both tests on the same population and with the same reference st and ard provides the most direct evidence . In triage , the new test is used before the existing test or testing pathway , and only patients with a particular result on the triage test continue the testing pathway . When a test is needed to rule out disease in patients who then need no further testing , a test that gives a minimal proportion of falsenegative results and thus a relatively high sensitivity should be used . Triage tests may be less accurate than existing ones , but they have other advantages , such as simplicity or low cost . A third possible role of a new test is add-on . The new test is then positioned after the existing testing pathway to identify false-positive or false-negative results after the existing pathway . The review should provide data to assess the incremental change in accuracy made by adding the new test . An example of a replacement question can be found in a systematic review of the diagnostic accuracy of urinary markers for primary bladder cancer ( 10 ) . Clinicians may use cytology to triage patients before they undergo invasive cystoscopy  , the reference st and ard for bladder cancer . Because cytology combines high specificity with low sensitivity ( 11 ) , the goal of the review was to identify a tumor marker with sufficient accuracy to either replace cytology or be used in addition to cytology . For a marker to replace cytology , it has to achieve equally high specificity with improved sensitivity . New markers that are sensitive but not specific may have roles as adjuncts to conventional testing . The review included studies in which the test under evaluation ( several different tumor markers and cytology ) was evaluated against cystoscopy or histopathology . Included studies compared 1 or more of the markers , cytology only , or a combination of markers and cytology . Although information on accuracy can help clinicians make decisions about tests , good diagnostic accuracy is a desirable but not sufficient condition for the effectiveness of a test ( 8) . To demonstrate that using a new test does more good than harm to patients tested , r and omized trials of test- and -treatment strategies and review s of such trials may be necessary . However , with the possible exception of screening , in most cases , such r and omized trials are not available and systematic review s of test accuracy may provide the most useful evidence available to guide clinical and health policy decision making and use as input for decision and cost-effectiveness analysis ( 12 ) . Identification and Selection of Studies Identifying test accuracy studies is more difficult than search ing for r and omized trials ( 13 ) . There is not a clear , unequivocal keyword or indexing term for an accuracy study in literature data bases comparable with the term r and omized , controlled trial . The Medical Subject Heading sensitivity and specificity may look suitable but is inconsistently applied in most electronic bibliographic data bases . Furthermore , data on diagnostic test accuracy may be hidden in studies that did not have test accuracy estimation as their primary objective . This complicates the efficient identification of diagnostic test accuracy studies in electronic data bases , such as MEDLINE . Until indexing systems properly code studies of test accuracy , search ing for them will remain challenging and may require additional manual search es , such as screening reference lists . In the development of a comprehensive search strategy , review authors can use search strings that refer to the test(s ) under evaluation , the target condition , and the patient description or a subset of these . For tests with a clear name that are used for a single purpose , search ing for publications in which those tests are mentioned may suffice . For other review s , adding the patient description may be necessary , although this is also often poorly indexed . A search strategy in MEDLINE should contain both Medical Subject Headings and free text words . A search strategy for articles about tests for bladder cancer , for example , should include as many synonyms for bladder cancer as possible in the search strategy , including neoplasm , carcinoma , transitional cell , and hematuria . Several method ological electronic search filters for diagnostic test accuracy studies have been developed , each attempting to restrict the search to articles that are most likely to be test accuracy studies ( 1316 ) . These filters rely on indexing terms for research methodology and text words used in reporting results , but they often miss relevant studies and are unlikely to decrease the number of articles one needs to screen . Therefore , they are not recommended for systematic review s ( 17 , 18 ) . The incremental value of search ing in language s other than English and in the gray literature has not yet been fully investigated . In systematic review s of intervention studies , publication bias is an important and well-studied form of bias in which the decision to report and publish studies is linked to their findings . For clinical trials , the magnitude and determinants of publication bias have been identified by tracing the publication history of cohorts of trials review ed by ethics committees and research boards ( 19 ) . A consistent observation has been that studies with significant results are more likely to be published than studies with nonsignificant findings ( 19 ) . Investigating publication bias for diagnostic tests is problematic , because many studies are done without ethical review or study registration ; therefore , identification of cohorts of studies from registration to final publication status OBJECTIVE This study aim ed to determine whether ordinary clinical performance on the timed " up- and -go " and one-leg-balance tests varied with additional cognitive tasks and the predictive value of this combination for future falls . METHODOLOGY The sample comprised 95 women with osteoporosis who lived independently in the community and were older than 70 years ( mean 73.4+/-1.7 years ) who were r and omized to perform the timed " up- and -go " ( TUG ) and one-leg-balance ( OLB ) tests . The tests were performed with or without an additional cognitive task ( math task involving subtraction by 2 s or 5 s or addition by 3 s ) . RESULTS For both TUG and OLB , performance decreased in the dual-task condition ( P<0.05 ) but did not differ in older women with and without a history of falling , whatever the test , and with or without an additional cognitive load . CONCLUSION Performance on the  TUG and OLB tests  was less efficient when patients simultaneously performed a cognitive task . Performance on these tests , without or with cognitive tasks , did not predict falls in a sample of women who lived independently Background : The  ‘ timed up and go ’ test ( TUG ) is a simple , quick and widely used clinical performance-based measure of lower extremity function , mobility and fall risk . We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults . Objective : To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test ( BBT ) and the Dynamic Gait Index ( DGI ) . Methods : The  TUG , DGI and BBT  were assessed in 265 healthy older adults ( 76.4 ± 4.3 years ; 58.3 % women ) who participated in a 3-year prospect i ve study . The  Mini-Mental State Examination , digit span and verbal fluency measured cognitive function . The one- sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson ’s correlation coefficients quantified associations . Results : The mean scores of the BBT , DGI and TUG were : 54.0 ± 2.4 , 22.8 ± 1.5 , 9.5 ± 1.7 s , respectively . The BBT and the DGI were not normally distributed ( p < 0.001 ) , but the TUG was ( p = 0.713 ) . The TUG times were mildly associated ( p < 0.01 ) with digit span and verbal fluency and were related to future falls , while the BBT and the DGI were not . Conclusions : The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults . It does not suffer from ceiling effect limitations , is normally distributed and is apparently related to executive function . The BBT and the DGI do not share these beneficial properties . Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive re sources Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear . This study aims to compare the  Berg Balance Scale ( BBS ) , Tinetti Mobility Score ( TMS ) , Elderly Mobility Scale ( EMS ) and Timed Up and Go test ( TUG )  in discriminating fallers from non-fallers in older people . Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in r and om sequence .  Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic , and 39 community-dwellers without fall history and whose age , sex and BMI matched those of the fallers . All subjects underwent the mobility and balance assessment within one day . Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS , TMS and TUG . The BBS demonstrated the best discriminating ability , with high sensitivity and specificity . The BBS item ` pick up an object from the floor ' was the best at screening fallers . Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller Background and aims : Stepping reactions play a critical role in responding to balance perturbations , whether they are a consequence of external perturbation or self-induced in nature . The aim of the present study was to determine prospect ively the capacity of voluntary stepping performance in single and dual-task conditions , to predict future falls among older community-dwelling persons . We also aim ed to assess whether dual task conditions have an added value over single tasks for fall prediction . Methods : A total of 100 healthy old volunteers ( mean age 78.4±5.7 yrs ) , from two self-care protected retirement homes for older adults , performed the Voluntary Step Execution Test in single- and dual-task conditions as a reaction time task while st and ing on a single force platform . Step initiation , preparatory and swing phases , and foot-contact time were extracted from data on center of pressure and ground reaction force . One-year fall incidences were monitored . Results : Ninety-eight subjects completed the one-year follow-up , 49 non-fallers , 32 one-time fallers , and 17 recurrent fallers ( two or more falls ) . Recurrent fallers had significantly slower voluntary step execution times in both single- and dual-task conditions , especially due to a slower preparation phase . Two stepwise ( backward ) logistic regression models showed that longer step execution times have strong predictive value for falls in both single- and dual-task conditions ( odds ratio ( OR ) 8.7 and 5.4 , respectively , p<0.05 ) . Conclusions : Voluntary Step Execution Test in both single- and dual-task conditions is a simple and safe examination which can potentially and effectively predict future falls , with no added value to dual- over single-task condition Background : Falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide . This study aim ed to determine if a method based on body-worn sensor data can prospect ively predict falls in community-dwelling older adults , and to compare its falls prediction performance to two st and ard methods on the same data set . Methods : Data were acquired using body-worn sensors , mounted on the left and right shanks , from 226 community-dwelling older adults ( mean age 71.5 ± 6.7 years , 164 female ) to quantify gait and lower limb movement while performing the ‘ Timed Up and Go ’ ( TUG ) test in a geriatric research clinic . Participants were contacted by telephone 2 years following their initial assessment to determine if they had fallen . These outcome data were used to create statistical models to predict falls . Results : Results obtained through cross-validation yielded a mean classification accuracy of 79.69 % ( mean 95 % CI : 77.09–82.34 ) in prospect ively identifying participants that fell during the follow-up period . Results were significantly ( p < 0.0001 ) more accurate than those obtained for falls risk estimation using two st and ard measures of falls risk ( manually timed TUG and the Berg balance score , which yielded mean classification accuracies of 59.43 % ( 95 % CI : 58.07–60.84 ) and 64.30 % ( 95 % CI : 62.56–66.09 ) , respectively ) . Conclusion : Results suggest that the quantification of movement during the TUG test using body-worn sensors could lead to a robust method for assessing future falls risk Background Falls often result from failed responses to unexpected , externally applied perturbations . Whether performance-based , reaction-based , and /or adaptation-based assessment tools can predict future falls among community-dwelling older adults is unknown . Purpose This preliminary prospect i ve study examined the relationship between older adults ' future fall risk and their reactive responses and adaptations to repeated slips , and their functional status . Methods Thirteen community-dwelling adults ( > 64 years ) were exposed initially to a session of repeated slips . About 30 months later , self-reported falls experience data were collected for the preceding year from these participants . Slip outcome ( fall , loss of balance , or recovery ) , slip score ( weighted sum of slip outcomes ) , Timed Up and Go scores , and future fall incidence were recorded . Results Four participants who reported at least 1 fall had significantly higher slip scores than the rest . In contrast , neither failed recovery on the first slip nor a higher TUG score predicted greater odds of future falls . Conclusion Community-dwelling older adults ' adaptability to externally imposed perturbations may reveal their future fall risk Background and aims : In the elderly , balance and walking impairments are assumed to play an important role in causing falls . We have assessed prospect ively the predictive ability of health , function and balance variables regarding falls and their location . Methods : Falls which occurred during one year in a r and om sample of 307 women aged 75 years and over ( mean 80.8 years , response rate 74.5 % ) living in the community were recorded and related to baseline registration s of health , medication and tests of walking and balance . Results : In all , 155 women ( 50.5 % ) reported 308 falls . Outdoor falls were significantly more frequent than indoor falls ( 57.5 vs 42.5 % ) . The variables having had a fall before the start of the study , osteoporosis , hypertension , feeling depressed , unable to climb 40 cm high steps and walking slowly , all independently predicted a higher number of falls overall . Regarding fall location , having experienced a fall before study start was associated with more falls indoors as well as outdoors . Vision impairment , symptoms of depression , a faster comfortable walking speed , and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure . A slower comfortable walking speed , a higher amplitude of the center of pressure movements in the frontal plane , a poorer score on the Timed Up & Go test , multi-morbidity , poor cognition and hypertension were independent risk factors for indoor falls . Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study . Conclusions : The findings of this study suggest that risk factors for  indoor and outdoor falls  are different . Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling BACKGROUND the Falls Risk for Older People in the Community assessment ( FROP-Com ) tool was design ed for use in targeted multi-factorial falls prevention programmes . It fills the gap between the short screening tools and the longer assessment tools , e.g. the physiological profile assessment ( PPA ) . The aim of this study was to determine the reliability and predictive accuracy of the FROP-Com . METHODS the intra-rater and inter-rater reliability studies were performed with 20 participants each . The prospect i ve study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home . Following a home-based assessment , including the FROP-Com , Timed Up and Go ( TUG ) and functional Reach ( FR )  , participants were monitored for falls for 12 months . RESULTS the intra-class correlation coefficient ( ICC ) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 ( 95 % CI 0.84 - 0.97 ) and 0.81 ( 95 % CI 0.59 - 0.92 ) respectively . The AUC for the  FROP-Com  was 0.68 ( 95 % CI 0.63 - 0.74 ) . At the cut-off 18/19 , sensitivity was 71.3 % ( 95 % CI 64.4 - 78.3 ) and specificity was 56.1 % ( 95 % CI 48.9 - 63.4 ) . The AUC for the TUG was 0.63 ( 95 % CI 0.57 - 0.69 ) and for the FR was 0.60 ( 95 % CI 0.54 - 0.66 ) . CONCLUSION the FROP-Com demonstrated good reliability and a moderate capacity to predict falls Background Correct identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults . Objective The purpose s of this study were : ( 1 ) to develop and vali date a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and ( 2 ) to evaluate the added value of 3 clinical balance tests in predicting this risk . Design This was a prospect i ve measurement study . Methods A population of 1,618 community-dwelling people over 65 years of age underwent a health checkup , including performance of 3 clinical balance tests : the One-Leg-Balance Test , the Timed “ Up & Go ” Test , and the Five-Times-Sit-to-St and Test . Falls were recorded using a self-administered question naire that was completed a mean ( SD ) of 25±5 months after the visit . Participants were r and omly divided into either group A ( n=999 ) , which was used to develop the scale , or group B ( n=619 ) , which was used to prospect ively vali date the scale . Results Logistic regression analysis identified 4 variables that independently predicted recurrent falls in group A : history of falls , living alone , taking ≥4 medications per day , and female sex . Thereafter , 3 risk categories of recurrent falls ( low , moderate , and high ) were determined . Predicted probability of recurrent falls increased from 4.1 % to 30.1 % between the first and third categories . This scale subsequently was vali date d with great accuracy in group B. Only the Five-Times-Sit-to-St and Test provided added value in the estimation of risk for recurrent falls , especially for the participants who were at moderate risk , in whom failure on the test ( duration of > 15 seconds ) doubled the risk . Limitations Falls were assessed only once , and length of follow-up was heterogeneous ( 18–36 months ) . Conclusions Clinicians could easily classify older patients in low- , moderate- , or high-risk groups of recurrent falls by using 4 easy-to-obtain items . The Five-Times-Sit-to-St and Test provides added value to stratify risk for falls in people at moderate risk OBJECTIVES To assess whether the Timed Up and Go ( TUG ) is superior to gait speed in predicting multiple geriatric outcomes . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care clinics . PARTICIPANTS Adults aged 65 and older ( N=457 ) . MEASUREMENTS Baseline gait speed and TUG  were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) global health ; functional decline according to National Health Interview Survey ( NHIS ) activities of daily living ( ADLs ) score and SF-36 physical function index ; hospitalization ; and any falls and multiple falls over 1 year . RESULTS Mean age was 74 , and 44 % of participants were female . Odds ratios for all outcomes were equivalent for gait speed and TUG . Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability , gait speed and TUG each alone predicted decline in global health , new ADL difficulty , and falls , with no difference in predictive ability between performance measures . Neither performance measure predicted hospitalization , EuroQol decline , or physical function decline . As a continuous variable , TUG did not add predictive ability to gait speed for any outcome . CONCLUSION Gait speed predicts most geriatric outcomes , including falls , as does TUG . The time taken to complete TUG may not add to information provided by gait speed , although its qualitative elements may have other utility Objective : To determine if self-reported data recalling at least one fall over a sixmonth recall period could be used as a reliable measure of falls by comparing retrospective self-report with a ‘ gold st and ard ' method of reporting these events using a prospect i ve calendar-reported method . Design : Prospect i ve study . Setting : Community-dwelling older people living in New South Wales ( NSW ) and Queensl and in Australia . Subjects : A stratified sample of 264 r and omly selected participants from a concurrent r and omized controlled trial ( RCT ) of preventive health assessment for people over the age of 70 years . Interventions : Intervention and control group participants in the RCT kept a calendar of fall events for a six-month validation sub study . At the end of six months , participants were asked to retrospectively report their falls over the six-month period . Main results : Results indicated that percentage agreement between retrospective self-report and the calendar report of falls was 84 % , however , sensitivity was 56 % ( 95 % confidence interval ( CI ) 44.1−67.5 ) . Ten participants ( 4 % ) gave false positive self-reports of falls , and 33 ( 13 % ) participants gave false negative self-reports of falls . Therefore , retrospective self-reported fall rates were likely to involve under-reporting of falls . Significant differences were found in the sensitivity of retrospectively selfreported falls reported by the intervention group participants ( sensitivity=71 % ; 95 % CI 56.6−85.5 ) compared with the control group ( sensitivity=40.5 % ; 95 % CI 24.7−56.4 , P = 0.008 ) . Validity of self-reported injuries as a result of a fall was less accurate ( 71 % agreement ; sensitivity 24 % ( 95 % CI 16.0−33.6 ) . Conclusions : As recall of falls was more accurate in the intervention group than in the control group , it could appear that the intervention had the effect of increasing falls compared to the control group . Using these results , a method was devised to weight self-reported retrospective data to compensate for the poorer recall demonstrated in the control group , so that a more accurate estimate of falls could be derived from the self-reported data Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls Background : Dual-task-based assessment tests failed to establish a dependable relationship between dual-task-related gait changes and the risk of falls in the elderly . Objective : The aim of this study was to examine whether changes in gait while counting backward could be associated with the occurrence of a  first fall among older adults . Methods : Walking while counting backward was investigated prospect ively in a cohort of 187 older adults living independently in senior housing facilities . During enrollment , walking time , number of steps , and frequency of lateral line stepping-over and stops were measured while walking only and while walking with backward counting aloud . Information on the incident falls during the follow-up year was collected monthly . Results : Walking time and the number of steps increased significantly under the dual-task condition compared to the single-task condition among fallers and non-fallers ( p < 0.001 ) . Compared to non-fallers , fallers had significantly lower scores in the Mini-Mental State Examination ( p = 0.029 ) and higher scores in the 15-item Geriatric Depression Scale ( p = 0.003 ) and Timed Up & Go Test ( p = 0.006 ) and increased walking time under both walking conditions ( p = 0.030 for single-task condition and p = 0.007 for dual-task condition ) . After adjusting for these variables , depressive symptoms ( adjusted OR = 2.6 with p = 0.041 and adjusted OR = 2.5 with p = 0.045 when walking time while walking only and walking with backward counting is considered , respectively ) and walking time while walking only ( OR = 2.3 with p = 0.032 ) were significantly associated with falls . Conclusion : Dual-task-related gait changes were poorly associated with the occurrence of a first fall and provided no additional predictive value compared to gait performance under a single task , suggesting that changes in basic clinical gait parameters while counting backward are unsuccessful to predict the first fall among older adults Background : The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit . Objective : To determine the optimal physical or cognitive test to screen for falls risk in frail older people . Methods : This prospect i ve cohort study involved recruitment from 213 day-care centers in Japan . The feasibility study included 3,340 ambulatory individuals aged 65 years or older enrolled in the Tsukui Ordered Useful Care for Health ( TOUCH ) program . The external validation study included a sub sample of 455 individuals who completed all tests . Physical tests included  grip strength ( GS ) , chair st and test ( CST ) , one-leg st and ing test ( OLS ) , functional reach test ( FRT ) , t and em walking test ( TWT ) , 6-meter walking speed at a comfortable pace ( CWS ) and at maximum pace ( MWS )  , and timed up- and -go test ( TUG ) . The  mental status question naire ( MSQ )  was used to measure  cognitive function . The incidence of falls during 1 year was investigated by self-report or an interview with the participant ’s family and care staff . Results : The most practicable tests were the GS and MSQ , which could be administered to more than 90 % of the participants regardless of the activities of daily living status . The FRT and TWT had lower feasibility than other lower limb function tests . During the 1-year retrospective analysis of falls , 99 ( 21.8 % ) of the 455 validation study participants had fallen at least once . Fallers showed significantly poorer performance than non-fallers in the OLS ( p = 0.003 ) , TWT ( p = 0.001 ) , CWS ( p = 0.013 ) , MWS ( p = 0.007 ) , and TUG ( p = 0.011 ) . The OLS , CWS , and MWS remained significantly associated with falls when performance cut-points were determined . Logistic regression analysis revealed that the TWT was a significant and independent , yet weak predictor of falls . A weighting system which considered feasibility and validity scored the CWS ( at a cut-point of 0.7 m/s ) as the best test to predict risk of falls . Conclusion : Clinical tests of neuromuscular function can predict risk of falls in frail older people . When feasibility and validity were considered , the CWS was the best test for use as a screening tool in frail older people , however , these preliminary results require confirmation in further research
target: Conclusion The Timed Up and Go test has limited ability to predict  falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting
background: Background The Timed Up and Go test ( TUG ) is a commonly used screening tool to assist clinicians to identify patients at risk of falling .
  The purpose of this systematic review and meta- analysis is to determine the overall predictive value of the TUG in community-dwelling older adults .