title: Straight and Curved Path Walking Among Older Adults in Primary Care: Associations With Fall-Related Outcomes.
abstract: Most falls among community-dwelling older adults occur while walking. Simple walking tests that require little resources and can be interpreted quickly are advocated as useful screening tools for fall prone patients.
  
  
  
  To investigate 2 clinically feasible walking tests consisting of straight- and curved-path walking and examine their associations with history of previous falls and fall-related outcomes among community-living older adults.
  
  
  
  A cross-sectional analysis was performed on baseline data from a longitudinal cohort study.
  
  
  
  Participants were recruited through primary care practices.
  
  
  
  Participants included 428 primary care patients ≥65 years of age at risk for mobility decline. Participants had a median age of 76.5 years, 67.8% were women, and 82.5% were white.
  
  
  
  Straight-path walking performance was measured as the time needed to walk a 4-meter straight path at usual pace from standstill using a stopwatch (timed to 0.1 second). Curved-path walking performance was timed while participants walked from standstill in a figure-of-8 pattern around two cones placed 5 feet apart.
  
  
  
  Multivariable negative binomial regression analyses were performed to assess the relationship between straight-path walking or curved-path walking and self-reported history of number of falls. For fall-related injuries, and fall-related hospitalizations, logistic regression models were used.
  
  
  
  In the fully adjusted model, an increase of 1 second in straight path walking time was associated with 26% greater rate of falls (rate ratio 1.26, 95% confidence interval 1.10-1.45). An increase in curved-path walking time was associated with 8% greater rate of falls (rate ratio 1.08, 95% confidence interval = 1.03-1.14). Neither walk test was associated with history of fall-related injuries or hospitalizations.
  
  
  
  Poor performance on straight- and curved-path walking performance was associated with a history of greater fall rates in the previous year but not with a history of fall-related injuries or hospitalizations. This information helps inform how previous fall history is related to performance on walking tests in the primary care setting.
authors.affiliation: Spaulding Rehabilitation Hospital and Department of PM&R, Harvard Medical School, Boston, MA; Spaulding Hospital Cambridge, 1575 Cambridge St., Cambridge, MA 02138(∗). Electronic address: sawelch@partners.org.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Welch
authors.affiliation: Spaulding Rehabilitation Hospital, Department of PM&R, Harvard Medical School, and Health and Disability Research Institute, Boston University School of Health, Boston, MA(†).
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Ward
authors.affiliation: Spaulding Rehabilitation Hospital and Department of PM&R, Harvard Medical School, Boston, MA(‡).
authors.forename: Laura A
authors.initials: LA
authors.lastname: Kurlinski
authors.affiliation: Spaulding Rehabilitation Hospital, Boston, MA(§).
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kiely
authors.affiliation: Spaulding Rehabilitation Hospital, Boston, MA(¶).
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA(#).
authors.forename: Jessie
authors.initials: J
authors.lastname: VanSwearingen
authors.affiliation: School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA(∗∗).
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Brach
authors.affiliation: New England Geriatric, Research, Education, and Clinical Center, Veterans Administration Boston Health System, Boston, MA; Spaulding Rehabilitation Hospital and Department of PM&R, Harvard Medical School, Boston, MA(††).
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Bean
mesh_terms: D000058:Accidental Falls; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D016138:Walking