Citation

Jernigan SD, Pohl PS, Mahnken JD, Kluding PM. Phys. Ther. 2012; 92(11): 1461-1470.

Affiliation

S.D. Jernigan, PT, PhD, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Mail Stop 2002, 3901 Rainbow Blvd, Kansas City, KS 66160 (USA).

Copyright

(Copyright © 2012, American Physical Therapy Association)

DOI

10.2522/ptj.20120070

PMID

22836004

Abstract

BackgroundDiabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking.ObjectiveThe purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent fallers and those who are not recurrent fallers.DesignA cross-sectional study.SettingA medical research university setting.ParticipantsA convenience sample of 36 participants between 40 and 65 years old with diabetic peripheral neuropathy.MeasurementsFall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, Timed Up and Go, Berg Balance Scale and Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cut-off scores for each fall risk assessment tool; indices were then recalculated. RESULTS: /b>Ten of the 36 participants were classified as recurrent fallers. When traditional cut-off scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cut-off scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests but the Functional Reach Test; the Timed Up and Go demonstrated the highest diagnostic accuracy at 88.9%.LimitationsSmall sample size and retrospective fall history assessment. CONCLUSIONS:/b>Modified cut-off scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy.

Language: en