title: Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.
abstract: BACKGROUND
  Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls.
  
  
  OBJECTIVE
  First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination.
  
  
  METHODS
  To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults.
  
  
  METHODS
  Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality.
  
  
  METHODS
  Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35.
  
  
  RESULTS
  Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus.
  
  
  CONCLUSIONS
  Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests.
  
  
  CONCLUSIONS
  No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps.
authors.affiliation: 1Department of Physical Therapy and Human Movement Science, College of Health Professions, Sacred Heart University, Fairfield, Connecticut 2Department of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia 3Division of Rehabilitation Sciences and Center for Recovery, Physical Activity and Nutrition, University of Texas Medical Branch, Galveston 4Department of Physical Therapy, Winston Salem State University, Winston Salem, North Carolina 5University of Vermont Medical Center, Colchester 6University of North Carolina Memorial Hospitals, Chapel Hill 7Physical Therapy Program, Chatham University, Pittsburgh, Pennsylvania 8Care One at the Highlands, Edison, New Jersey 9Geriatric Residency Program, Brooks Rehabilitation Institute of Higher Learning, Jacksonville, Florida 10School of Physical Therapy, Pacific University, Hillsboro, Oregon.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Lusardi
authors.forename: Stacy
authors.initials: S
authors.lastname: Fritz
authors.forename: Addie
authors.initials: A
authors.lastname: Middleton
authors.forename: Leslie
authors.initials: L
authors.lastname: Allison
authors.forename: Mariana
authors.initials: M
authors.lastname: Wingood
authors.forename: Emma
authors.initials: E
authors.lastname: Phillips
authors.forename: Michelle
authors.initials: M
authors.lastname: Criss
authors.forename: Sangita
authors.initials: S
authors.lastname: Verma
authors.forename: Jackie
authors.initials: J
authors.lastname: Osborne
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chui
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D057187:Independent Living; D026741:Physical Therapy Modalities; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity