A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study.
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.
Morris
Rob
R
Nottingham City Hospital, UK. rmorris2@ncht.trent.nhs.uk
Harwood
Rowan H
RH
Baker
Ros
R
Sahota
Opinder
O
Armstrong
Sarah
S
Masud
Tahir
T
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*