Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review.

BACKGROUND/OBJECTIVES: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk. METHODS: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons. RESULTS: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended. CONCLUSION: The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.

Bariatric Surgery: Consequences on Functional Capacities in Patients With Obesity.

Introduction: Bariatric surgery leads to loss of fat and fat-free mass (FFM). To preserve FFM it is recommended that weight loss interventions are accompanied by physical activity. However, it remains unknown if functional capacities spontaneously improve after a substantial weight loss. Study's aim was to assess the effect of bariatric surgery on strength, functional capacities and quality of life of participants with a body mass index (BMI) ≥ 35 kg/m2. Method: Anthropometric parameters (weight, BMI, waist circumference), physical functions (quadriceps strength, walking capacity, spatio-temporal gait parameters, dynamic balance, lower limb power) and quality of life were assessed before and at three months after the bariatric surgery in 33 individuals who did not follow any physical activity program. Results: The anthropometric parameters, quality of life and three functional abilities (walking capacity, normal gait speed and lower limb power) improved significantly three months post-surgery. In contrast, fast gait speed, absolute strength, normalized strength, and dynamic balance did not improve. Discussion: A massive weight loss should be accompanied by an exercise program aiming to maintain FFM and to enhance muscle strength and balance. Such a program might also enhance functional capacities and help to sustain the weight loss over time.

Reliability and validity of an adapted hip abductor strength measure as a potential new fall risk assessment for older persons: a study protocol.

BACKGROUND: Persons aged ≥ 65 years are currently the world's fastest growing age group. An important complication of age is the increasing risk of falls. Falls have multifactorial etiology and modifiable risk factors open for interventions in prevention and rehabilitation, are of high interest. In this context, strong hip abductors seem to be important to prevent falls. A newly adapted measurement device to measure hip abductor strength (HAS) in a closed chain position was developed. We aim to assess feasibility, intra- and inter-tester reliability and construct and criterion validity of the new measure. METHODS: In two subsequent parts a feasibility, reliability and validity study with an adapted measurement instrument for the assessment of HAS (index test) in a closed chain position in persons aged ≥ 65 years will be conducted. Part I investigates feasibility of the measure in clinical settings as well as reliability of the new HAS test (n = 26). Part II evaluates construct and criterion validity (n = 169). Construct validity will be assessed cross-sectional, criterion validity by comparison with prospectively followed up fall history for 12 months (external criterion) and other functional fall risk assessments (Short Physical Performance Battery, Timed Up and Go test, usual gait speed and hand grip strength). DISCUSSION: Results of feasibility, will give insight in its applicability in daily clinical life and clinimetric properties will show if measurements of HAS in a closed chain position should be encouraged to include in fall risk assessments in older adults.

The Role of Hip Abductor Strength in Identifying Older Persons at Risk of Falls: A Diagnostic Accuracy Study.

BACKGROUND/OBJECTIVES: Early detection of fall risk in persons older than 65 is of clinical relevance, but the diagnostic accuracy of currently used functional tests (eg short physical performance battery [SPPB] and timed up and go test [TUG]) to assess older persons' fall risks remains moderate. Recent literature highlights the importance of strong hip abductors to prevent falls. We thus aimed to assess the diagnostic accuracy of hip abductor strength measures to assess older persons' fall risks. METHODS: Hip abductor maximum voluntary isometric strength (ABD MVIS), rate of force generation (ABD RFG), and the SPPB and TUG functional fall risk assessments were assessed in 60 persons aged over 65 years (82.0 ± 6.1 years). The diagnostic accuracy (area under the curve [AUC], sensitivity [sens], specificity [spec], positive predictive value [PPV], negative predictive value [NPV], and positive and negative likelihood ratios [LR+, LR-]) was evaluated at a clinically important 90% sensitivity level. Cut-off values for clinical use were calculated. RESULTS: In our population, hip ABD MVIS (AUC 0.8, sens 90.6%, spec 57.1%, PPV 70.7%, NPV 84.2%, LR+ 2.1, LR- 0.2, and cut-off value ≤ 1.1 N/kg) and hip ABD RFG (AUC 0.8, sens 90.6%, spec 46.4%, PPV 65.9%, NPV 81.3%, LR+ 1.7, LR- 0.2, and cut-off ≤ 8.47 N/kg/s) show diagnostic accuracy comparable to other fall risk assessments (SPPB and TUG) and a high net sensitivity when used in a test battery. CONCLUSION: Hip ABD MVIS or RFG shows good diagnostic accuracy to differentiate between older fallers and nonfallers compared to the chosen external criterion history of falls. The high net sensitivity when hip ABD MVIS or RFG is combined with currently used fall risk assessments shows promise in contributing value to a test battery and should be investigated further in longitudinal studies.