title: Accuracy of Clinical Techniques for Evaluating Lower Limb Sensorimotor Functions Associated With Increased Fall Risk.
abstract: BACKGROUND
  In prior work, laboratory-based measures of hip motor function and ankle proprioceptive precision were critical to maintaining unipedal stance and fall/fall-related injury risk. However, the optimal clinical evaluation techniques for predicting these measures are unknown.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of common clinical maneuvers in predicting laboratory-based measures of frontal plane hip rate of torque development (Hip(RTD)) and ankle proprioceptive thresholds (AnkPRO) associated with increased fall risk.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Biomechanical research laboratory.
  
  
  METHODS
  A total of 41 older subjects (aged 69.1 ± 8.3 years), 25 with varying degrees of diabetic distal symmetric polyneuropathy and 16 without.
  
  
  METHODS
  Clinical hip strength was evaluated by manual muscle testing (MMT) and lateral plank time, defined as the number of seconds that the laterally lying subject could lift the hips from the support surface. Foot/ankle evaluation included Achilles reflex and vibratory, proprioceptive, monofilament, and pinprick sensations at the great toe.
  
  
  METHODS
  Hip(RTD), abduction and adduction, using a custom whole-body dynamometer. AnkPRO determined with subjects standing using a foot cradle system and a staircase series of 100 frontal plane rotational stimuli.
  
  
  RESULTS
  Pearson correlation coefficients (r) and receiver operator characteristic (ROC) curves revealed that LPT correlated more strongly with Hip(RTD) (r/P = 0.61/<.001 and 0.67/<.001, for abductor/adductor, respectively) than did hip abductor MMT (r/P = 0.31/.044). Subjects with greater vibratory and proprioceptive sensation, and intact Achilles reflexes, monofilament, and pin sensation had more precise AnkPRO. LPT of <12 seconds yielded a sensitivity/specificity of 91%/80% for identifying Hip(RTD) < 0.25 (body size in Newton-meters), and vibratory perception of <8 seconds yielded a sensitivity/specificity of 94%/80% for the identification of AnkPRO >1.0°.
  
  
  CONCLUSIONS
  LPT is a more effective measure of Hip(RTD) than MMT. Similarly, clinical vibratory sense and monofilament testing are effective measures of AnkPRO, whereas clinical proprioceptive sense is not.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI(∗).
authors.forename: Alex
authors.initials: A
authors.lastname: Donaghy
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI(†).
authors.forename: Trina
authors.initials: T
authors.lastname: DeMott
authors.affiliation: University of Applied Sciences, Geneva, Switzerland(‡).
authors.forename: Lara
authors.initials: L
authors.lastname: Allet
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI(§).
authors.forename: Hogene
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI(‖).
authors.forename: James
authors.initials: J
authors.lastname: Ashton-Miller
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 East Eisenhower Pkwy, Ann Arbor, MI 48108(¶). Electronic address: jkrich@umich.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Richardson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D015203:Reproducibility of Results