title: Self-Selected and Maximal Walking Speeds Provide Greater Insight Into Fall Status Than Walking Speed Reserve Among Community-Dwelling Older Adults.
abstract: To determine the degree to which self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) are associated with fall status among community-dwelling older adults.
  
  
  
  WS and 1-year falls history data were collected on 217 community-dwelling older adults (median age = 82, range 65-93 years) at a local outpatient PT clinic and local retirement communities and senior centers. WSR was calculated as a difference (WSRdiff = MWS - SSWS) and ratio (WSRratio = MWS/SSWS).
  
  
  
  SSWS (P < 0.001), MWS (P < 0.001), and WSRdiff (P < 0.01) were associated with fall status. The cutpoints identified were 0.76 m/s for SSWS (65.4% sensitivity, 70.9% specificity), 1.13 m/s for MWS (76.6% sensitivity, 60.0% specificity), and 0.24 m/s for WSRdiff (56.1% sensitivity, 70.9% specificity). SSWS and MWS better discriminated between fallers and non-fallers (SSWS: AUC = 0.69, MWS: AUC = 0.71) than WSRdiff (AUC = 0.64).
  
  
  
  SSWS and MWS seem to be equally informative measures for assessing fall status in community-dwelling older adults. Older adults with SSWSs less than 0.76 m/s and those with MWSs less than 1.13 m/s may benefit from further fall risk assessment. Combining SSWS and MWS to calculate an individual's WSR does not provide additional insight into fall status in this population.
  
  
  
  Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the different methods for calculating walking speed reserve and discuss the potential of the metric as an outcome measure; (2) Explain the degree to which self-selected walking speed, maximal walking speed, and walking speed reserve are associated with fall status among community-dwelling older adults; and (3) Discuss potential limitations to using walking speed reserve to identify fall status in populations without mobility restrictions.
  
  
  
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  : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.
authors.affiliation: From the Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas (AM); Department of Physical Therapy, Clarkson University, Potsdam, New York (GDF); Department of Exercise Science, Division of Rehabilitation Sciences, University of South Carolina, Columbia, South Carolina (TMH, SLF); Department of Exercise Science, Division of Health Aspects of Physical Activity, University of South Carolina, Columbia, South Carolina (MWB); and Palmetto Health, Research Physical Therapy Specialists, Columbia, South Carolina (JD).
authors.forename: Addie
authors.initials: A
authors.lastname: Middleton
authors.forename: George D
authors.initials: GD
authors.lastname: Fulk
authors.forename: Troy M
authors.initials: TM
authors.lastname: Herter
authors.forename: Michael W
authors.initials: MW
authors.lastname: Beets
authors.forename: Jonathan
authors.initials: J
authors.lastname: Donley
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Fritz
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D000072797:Walking Speed