Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

S.C. Gafner; L. Allet; R. Hilfiker; C.H.G. Bastiaenen

doi:10.2147/CIA.S322506

Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

S.C. Gafner^*, L. Allet, R. Hilfiker, C.H.G. Bastiaenen

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Background/Objectives: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk.Methods: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.Results: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.Conclusion: The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.

Original language	English
Pages (from-to)	1591-1616
Number of pages	26
Journal	Clinical Interventions in Aging
Volume	16
DOIs	https://doi.org/10.2147/CIA.S322506
Publication status	Published - 2021

Keywords

aged
falls
criterion validity
post-test probability
clinical application
UP-AND-GO
MINIMAL DETECTABLE CHANGE
BERG BALANCE SCALE
MUSCLE STRENGTH
RISK-FACTORS
GAIT SPEED
ASSESSMENT TOOLS
COMMUNITY
ADULTS
PEOPLE

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Cite this

@article{edce1ecaecc14b99a21fb496e18974c7,

title = "Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review",

abstract = "Background/Objectives: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk.Methods: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.Results: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.Conclusion: The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.",

keywords = "aged, falls, criterion validity, post-test probability, clinical application, UP-AND-GO, MINIMAL DETECTABLE CHANGE, BERG BALANCE SCALE, MUSCLE STRENGTH, RISK-FACTORS, GAIT SPEED, ASSESSMENT TOOLS, COMMUNITY, ADULTS, PEOPLE",

author = "S.C. Gafner and L. Allet and R. Hilfiker and C.H.G. Bastiaenen",

year = "2021",

doi = "10.2147/CIA.S322506",

language = "English",

volume = "16",

pages = "1591--1616",

journal = "Clinical Interventions in Aging",

issn = "1178-1998",

publisher = "Dove Medical Press Ltd",

}

TY - JOUR

T1 - Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

AU - Gafner, S.C.

AU - Allet, L.

AU - Hilfiker, R.

AU - Bastiaenen, C.H.G.

PY - 2021

Y1 - 2021

N2 - Background/Objectives: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk.Methods: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.Results: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.Conclusion: The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.

AB - Background/Objectives: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk.Methods: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.Results: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.Conclusion: The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.

KW - aged

KW - falls

KW - criterion validity

KW - post-test probability

KW - clinical application

KW - UP-AND-GO

KW - MINIMAL DETECTABLE CHANGE

KW - BERG BALANCE SCALE

KW - MUSCLE STRENGTH

KW - RISK-FACTORS

KW - GAIT SPEED

KW - ASSESSMENT TOOLS

KW - COMMUNITY

KW - ADULTS

KW - PEOPLE

U2 - 10.2147/CIA.S322506

DO - 10.2147/CIA.S322506

M3 - (Systematic) Review article

C2 - 34483656

SN - 1178-1998

VL - 16

SP - 1591

EP - 1616

JO - Clinical Interventions in Aging

JF - Clinical Interventions in Aging

ER -

Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

Abstract

Keywords

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