Welch SA, Ward RE, Kurlinski LA, Kiely DK, Goldstein R, VanSwearingen J, Brach JS, Bean JF. PM R 2015; 8(8): 754-760.
Affiliation
Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of PM&R, Harvard Medical School, Boston, MA, USA. Electronic address: jfbean@partners.org.
BACKGROUND: Most falls among community-dwelling older adults occur while walking. Simple walking tests that require little resources, and can be interpreted quickly are advocated as useful screening tools for fall prone patients.
OBJECTIVE: To investigate two clinically feasible walking tests, consisting of straight- and curved-path walking and examine their associations with history of prior falls and fall-related outcomes among community-living older adults.
DESIGN: A cross-sectional analysis was performed on baseline data from a longitudinal cohort study. SETTING: Participants were recruited through primary care practices. PARTICIPANTS: Participants included 428 primary care patients ≥65 years of age at risk for mobility decline. Participants had a median age of 76.5 years, 67.8% were women, and 82.5% were white.
METHODS: Straight-path walking performance was measured as the time needed to walk a 4 meter straight path at usual pace from standstill using a stopwatch (timed to 0.1 second). Curved-path walking performance was timed while participants walked from standstill in a figure-of-8 pattern around two cones placed 5 feet apart. MAIN OUTCOME MEASUREMENTS: Multivariable negative binomial regression analyses were performed to assess the relationship between straight-path walking or curved-path walking and self-reported history of number of falls. For fall-related injuries, and fall-related hospitalizations, logistic regression models were used.
RESULTS: In the fully adjusted model, an increase of 1 second in straight path walking time was associated with 26% greater rate of falls (RR=1.26, 95% CI: 1.10-1.45). An increase in curved-path walking time was associated with 8% greater rate of falls (RR=1.08, CI: 1.03-1.14). Neither walk test was associated with history of fall-related injuries or hospitalizations.
CONCLUSIONS: Poor performance on straight- and curved-path walking performance was associated with a history of greater fall rates in the prior year, but not with a history of fall-related injuries or hospitalizations. This information helps inform how prior fall history is related to performance on walking tests in the primary care setting.