Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests |
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| Affiliation: | 1. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia;2. School of Population Health, University of New South Wales, Sydney, Australia;3. Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany;4. Robert-Bosch Hospital, Department of Geriatric Rehabilitation, Stuttgart, Germany;5. Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA;6. Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan;7. Flinders Centre for Epidemiology and Biostatistics (FCEB), College of Medicine & Public Health, Flinders University, Adelaide, Australia;1. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;2. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada;3. Graduate Department of Rehabilitation Science, University of Toronto, Toronto, ON, Canada;4. Institute of Medical Science, University of Toronto, Toronto, ON, Canada;5. Heart & Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada;6. Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada;1. Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan;2. The Japan Society for the Promotion of Science, 8 Ichiban, Chiyoda, Tokyo, 102-8472, Japan;3. Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan;4. Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan;1. Human Health and Nutritional Sciences, University of Guelph, Canada;2. Schlegel-UW Research Institute for Aging, Kitchener, ON, Canada;1. College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan;2. Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA;1. Arizona State University, College of Health Solutions, USA;2. University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, USA;3. Phoenix VA Veterans Affairs Medical Center, USA;1. Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany;2. Department of Training and Movement Sciences, Humboldt-University of Berlin, Germany;3. Faculty of Mathematics and Technology, University of Applied Sciences Koblenz, RheinAhrCampus Remagen, Germany |
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| Abstract: | ![]()
ObjectiveTo systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.Data sourcePubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.Study selection: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).ResultsA meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen’sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.Conclusions: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy. |
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| Keywords: | Accidental falls Aged Stepping Systematic review Meta-analysis |
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