A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: A cohort study

Abstract

Background: People with vertebral fractures are at high risk of developing hip fractures. Falls risk is important in the pathogenesis of hip fractures. Aim: To investigate if balance tests, in conjunction witha falls history, can predict falls in older women with vertebral fractures. Methods: A cohort study of community-dwelling women aged over 60 years, with vertebral fractures. Balance tests investigated were: 5 m-timed-up-and-go-test (5 m-TUG), timed 10 m walk, TURN180 test (number of steps to turn 180°), tandem walk, ability to stand from chair with arms folded. Leg extensor power was also measured. Outcome measure: fallers (at least one fall in a 12 month follow-up period) versus non-fallers. Results: One hundred and four women aged 63-91 years [mean = 78 ± 7], were recruited. Eighty-six (83%) completed the study. Four variables were significantly associated with fallers: previous recurrent faller (2+ falls) [OR = 6.52; 95% CI = 1.69-25.22], 5 m-TUG test [OR = 1.03; 1.00-1.06], timed 10 m walk [OR = 1.07; 1.01-1.13] and the TURN180 test [OR = 1.22; 1.00-1.49] [P<0.05]. Multi-variable analysis showed that only two variables, previous recurrent faller [OR = 5.60; 1.40-22.45] and the 5 m-TUG test [OR = 1.04; 1.00-1.08], were independently significantly associated with fallers. The optimal cut-off time for performing the 5 m-TUG test in predicting fallers was 30 s (area under ROC = 60%). Combining previous recurrent faller with the 5 m-TUG improved prediction of fallers [OR = 16.79, specificity = 100%, sensitivity = 13%]. Conclusions: A previous history of recurrent falls and the inability to perform the 5 m-TUG test within 30 s predicted falls in older women with vertebral fractures. Combining these two measures can predict fallers with a high degree of specificity (although a low sensitivity), allowing the identification of a group of patients suitable for fall and fracture prevention measures. © The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society.