title: A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study.
abstract: BACKGROUND
  people with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures.
  
  
  OBJECTIVE
  to investigate if balance tests, in conjunction with a falls history, can predict falls in older women with vertebral fractures.
  
  
  METHODS
  a cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180 degrees ), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured.
  
  
  METHODS
  fallers (at least one fall in a 12 month follow-up period) versus non-fallers.
  
  
  RESULTS
  one hundred and four women aged 63-91 years [mean=78 +/- 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR=6.52; 95% CI=1.69-25.22], 5 m-TUG test [OR=1.03; 1.00-1.06], timed 10 m walk [OR=1.07; 1.01-1.13] and the TURN180 test [OR=1.22; 1.00-1.49] [P <0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR=5.60; 1.40-22.45] and the 5 m-TUG test [OR=1.04; 1.00-1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC=60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR=16.79, specificity=100%, sensitivity=13%].
  
  
  CONCLUSIONS
  a previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures.
authors.affiliation: Nottingham City Hospital, UK. rmorris2@ncht.trent.nhs.uk
authors.forename: Rob
authors.initials: R
authors.lastname: Morris
authors.forename: Rowan H
authors.initials: RH
authors.lastname: Harwood
authors.forename: Ros
authors.initials: R
authors.lastname: Baker
authors.forename: Opinder
authors.initials: O
authors.lastname: Sahota
authors.forename: Sarah
authors.initials: S
authors.lastname: Armstrong
authors.forename: Tahir
authors.initials: T
authors.lastname: Masud
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006620:Hip Fractures / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000150:complications / Q000503:physiopathology*