Lateral Balance Factors Predict Future Falls in Community-Living Older Adults
Abstract
Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults.
Objective
To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people.
Design
Cross-sectional study.
Setting
A balance and falls research laboratory.
Participants
Medically screened and functionally independent community-living older adult volunteers (N=51).
Interventions
Not applicable.
Main Outcome Measures
Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status.
Results
The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status.
Conclusions
The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.
aDepartment of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
bDepartment of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
cDepartment of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
dDepartment of Preventive Medicine, Rush University Medical School, Chicago, IL
Reprint requests to Mark W. Rogers, PhD, PT, Dept of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, 645 N Michigan Ave, Ste 1100, Chicago, IL 60611
Supported by the National Institutes of Health (grant no. R01 AG16780).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT