Reliability, validity and minimal detectable change of 2-min walk test and 10-m walk test in frail older adults receiving day care and residential care.

BACKGROUND: The psychometric properties of the 2-min walk test (2MWT) and 10-m walk test (10MeWT) for frail older adults are unclear. AIMS: To determine the test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of these walk tests in frail older adults receiving day care and residential care services. METHODS: A cross-sectional study with repeated measures was conducted on frail older adults who could walk independently for at least 15 m. The participants completed the 2MWT and 10MeWT on three separate occasions over a 2-week period under two independent assessors. RESULTS: Forty-four frail older adults were examined. Excellent test-rest (ICC = 0.95-0.99) and inter-rater reliability (ICC = 0.95-0.97) were shown in both walk tests. Good to strong correlations were found between the walk tests and 6-min walk test (r = 0.89-0.92), Elderly Mobility Scale (r = 0.56-0.57), Berg Balance Scale (r = 0.66-0.66) and Modified Barthel Index (r = 0.55-0.59). The MDC95 were 7.7 m in the 2MWT and 0.13 m/s in the 10MeWT. DISCUSSION: Although the walking performances of the day care and residential care participants were similar, the validity of the walk tests was different between these two subgroups. CONCLUSIONS: The 2MWT and 10MeWT are reliable and valid measures in evaluating the walking performances of frail older adults. The MDC95 of the walk tests has been recommended.

The sitting and rising test for assessing people with chronic stroke.

[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test's validity.

Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis.

OBJECTIVES: To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS: Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS: A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION: A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.

The Ability of Physical Performance Measures to Identify Fall Risk in Older Adults Living With Dementia: A Systematic Review and Meta-Analysis.

OBJECTIVES: To determine whether physical performance measures commonly used in clinical settings can discriminate fallers from nonfallers and predict falls in older adults with dementia. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older adults with dementia residing in the community, hospitals, and residential care facilities. METHODS: MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, the Cochrane Library, and the PEDro databases were searched from inception until December 27, 2023 (PROSPERO registration number: CRD42022303670). Retrospective or prospective studies that evaluated the associations between physical performance measures and falls in older adults with dementia were included. A random effects model was used to calculate the standardized mean difference (SMD) and 95% CI for each physical performance measure between fallers and nonfallers. Sensitivity analyses were conducted on the longitudinal studies to determine the ability of physical performance measures to predict future falls. RESULTS: Twenty-eight studies were included in this review (n = 3542). The 5-time chair stand test [SMD = 0.23 (0.01, 0.45)], the Berg Balance Scale [SMD = -0.52 (-0.87, -0.17)], postural sway when standing on the floor [SMD = 0.25 (0.07, 0.43)] and on a foam surface [SMD = 0.45 (0.25, 0.66)], and the Short Physical Performance Battery total score [SMD = -0.46 (-0.66, -0.27)] could discriminate fallers from nonfallers. Sensitivity analyses showed that gait speed could predict future falls in longitudinal cohort studies [SMD = -0.29 (-0.49, -0.08)]. Subgroup analyses showed that gait speed [SMD = -0.21 (-0.38, -0.05)] and the Timed Up and Go test [SMD = 0.54 (0.16, 0.92)] could identify fallers staying in residential care facilities or hospitals. CONCLUSIONS AND IMPLICATIONS: The 5-time chair stand test, the Berg Balance Scale, postural sway when standing on the floor and a foam surface, and the Short Physical Performance Battery can be used to predict falls in older adults with dementia. Gait speed and the Timed Up and Go test can be used to predict falls in institutionalized older adults with dementia. Clinicians are recommended to use these physical performance measures to assess fall risk in older adults with dementia.

Reliability, Validity, and Minimal Detectable Change of the Backward Walk Test in Older Adults With Dementia.

BACKGROUND AND PURPOSE: The backward walk test (BWT) has been used to evaluate the balance, gait, and fall risk for older adults, but its psychometric properties in older adults with dementia have not been investigated. This study aims to examine the test-retest and interrater reliability, construct and known-group validity, and absolute and relative minimal detectable changes at the 95% level of confidence (MDC95) of the BWT in older adults with dementia. METHODS: This study was a cross-sectional study with repeated measures. Thirty older adults with a mean age of 83.3 years and a diagnosis of dementia who were able to walk backward independently for at least 3 m were recruited from day care and residential care units. The BWT was conducted on 3 separate testing occasions within 2 weeks under 2 independent raters using a modified progressive cueing system. The 10-m walk test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG) were used to assess the gait, balance, and mobility performances of the participants. RESULTS AND DISCUSSION: The BWT had excellent test-retest reliability-intraclass correlation coefficient (ICC) = 0.96-and interrater reliability (ICC = 0.97-0.97) in the participants. Moderate correlations between the BWT and BBS (Spearman's ρ = 0.60) and strong correlations between the BWT and 10MWT (ρ= 0.84) and TUG (ρ=-0.82) were found. The BWT could distinguish between the participants who ambulated with walking aids and those who did not (P = .005). The participants who had experienced a fall in the past year did not differ significantly in the BWT compared with those who had not fallen (P = .36). The absolute and relative MDC95 of the BWT in the participants were 0.10 m/s and 39.3%, respectively. CONCLUSIONS: The BWT is reliable and valid in assessing balance and gait performances in older adults with dementia. Further investigation is needed to determine whether the BWT can identify those with an increased risk of falls.

Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols.

OBJECTIVES: 1) To determine if there was a practice effect associated with walk tests performed by frail older adults with and without dementia, 2) to examine the role of systematic cueing in the walk tests for those with dementia, and 3) to make recommendations to testing protocols of the walk tests for frail older adults with and without dementia. SETTING: Residential and day care facilities. PARTICIPANTS: 44 frail older adults with normal cognition (NON-DEM) and 39 older adults with Alzheimer's disease or dementia (DEM) who were able to walk independently for at least 15 m. METHODS: All the participants completed multiple trials of 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions. The DEM group was facilitated to complete the walk tests using a progressive cueing system. RESULTS: Significant increases in the walking performance within the same testing occasion were found in the 2MWT (NON-DEM: p = .002; DEM: p ≤ .044) and 6MWT (NON-DEM: p ≤ .004; DEM: p ≤ .002) for both groups but only in the 10MeWT (p ≤ .023) for the DEM group. Significant increases in the walking performance across testing occasions were shown in the 2MWT (p ≤ .047), 6MWT (p ≤ .005) and 10MeWT (p ≤ .039) for the NON-DEM group but not the DEM group (all p > .05). Multivariate regression analyses showed that the cognitive function of the DEM group was independently and inversely associated with the level of cueing provided during the walk tests (p ≤ .007). CONCLUSION: Practice effect associated with the walk tests was found within and across testing occasions for frail older adults with normal cognition, and only within the same testing occasion for those with dementia. Systematic cueing should be provided for those with dementia to complete the walk tests. Testing protocols of the walk tests have been recommended for these two population groups.

Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia.

BACKGROUND: Walk tests are commonly used to evaluate walking ability in frail older adults with dementia but their psychometric evidence in this population is lacking. OBJECTIVES: 1) To examine test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of walk tests in frail older adults with dementia, and 2) to examine the feasibility and consistency of a cueing system in facilitating participants in completing walk tests. DESIGN: Psychometric study with repeated measures. SETTING: Day care and residential care facilities. PARTICIPANTS: Thirty-nine frail older adults with a mean age 87.1 and a diagnosis of dementia or Alzheimer's disease who were able to walk independently for at least 15 m. METHODS: The participants underwent a 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on 6 separate occasions under 2 independent assessors using a cueing system. Functional status was measured using the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and Modified Barthel Index (MBI). RESULTS: Excellent test-retest (ICC = 0.91-0.98) and inter-rater reliability (ICC = 0.86-0.96) were shown in the 2MWT, 6MWT and 10MeWT. The walk tests were strongly correlated with each other (ρ = 0.85-0.94). The correlations between the walk tests and the functional measures were moderate in general (ρ = 0.34-0.55). All the walk tests were able to distinguish between those who could walk outdoor and indoor only (p ≤ .036). The MDC95 were 9.1 m in the 2MWT, 28.1 m in the 6MWT, and.16 m/s in the 10MeWT. The cues provided by the assessors in the walk tests were generally consistent (ICC = 0.62-0.89). CONCLUSIONS: The 2MWT, 6MWT and 10MeWT are reliable and valid measures in evaluating walking ability in frail older adults with dementia. The MDC95 of the walk tests has been established. The cueing system is feasible and reliable to facilitate the administration of the walk tests in this population group.