Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 74

J Rehabil Med 2019: 51: 71–76 ORIGINAL REPORT USEFULNESS OF AN UNSTABLE BOARD BALANCE TEST TO ACCURATELY IDENTIFY COMMUNITY-DWELLING ELDERLY INDIVIDUALS WITH A HISTORY OF FALLS Kazunori AKIZUKI, PhD, PT 1 , Yuki ECHIZENYA, MS, PT 2 , Tatsuya KANENO, MS, OT 3 and Yukari OHASHI, PhD, PT 4 From the 1 Department of Physical Therapy, Mejiro University; present address: Department of Physical Therapy, Kobe International University, Kobe, 2 Saitama Rehabilitation Center, 3 Department of Occupational Therapy, Mejiro University, and 4 Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan Objective: To determine the usefulness of an un­ stable board balance test in identifying a fall history among high-functioning community-dwelling elderly individuals. Design: Case-control study. Subjects: Sixty-one community-dwelling elderly aged ≥ 65 years and having the capacity to walk in- dependently without an assistive device. Methods: Subjects completed 3 balance performance tests: the Unstable Board Balance Test, Functional Reach Test, and Timed Up and Go. For analysis, sub- jects were classified as fallers or non-fallers based on the history of falls over the previous year, and performance outcomes were compared between the 2 groups. Subjects classified as fallers were then matched 1:1 with non-fallers (for sex, age, body weight and height), and the optimal cut-off score and area under the receiver operating characteristic curve (AUC) for each test were calculated. Results: Functional reach test and Timed Up and Go did not reliably discriminate between fallers and non-fallers. In contrast, the score on the unstable board balance test was significantly different bet- ween the 2 groups (p  = 0.040). Among all 3 tests, AUC was largest for the unstable board balance test (0.78), with superior sensitivity (0.67) and specifi- city (0.87). Conclusion: For high-functioning elderly subjects, the unstable board balance test was useful in discri- minating between fallers and non-fallers. Key words: dynamic balance; assessment of falls; history of falls; elderly people. Accepted Oct 8, 2018; Epub ahead of print Nov 8, 2018 J Rehabil Med 2019: 51: 71–76 Correspondence address: Kazunori Akizuki, Department of Physical Therapy, Kobe International University, 9-1-6 Koyouchou, Higasinada- ku, Kobe-shi, Hyogo 658-0032, Japan. E-mail: [email protected] I t is estimated that one out of every 3 elderly indivi- duals over the age of 65 years will experience one or more falls per year (1), resulting in health impairment of varying degrees of severity (2). In Japan, fall-related injuries are the fourth leading cause for elderly indi- viduals requiring nursing care (3). As we consider the ageing of the general population globally (4), preven- LAY ABSTRACT The aim of this study was to determine the ability of an Unstable Board Balance Test to discriminate fall history in high-functioning community-dwelling elderly people. Subjects underwent an Unstable Board Balance Test, a Functional Reach Test (FRT), Timed Up and Go (TUG) measurement, and body height and body weight mea- surement. The age of subjects was determined and they were asked whether they had fallen within the past year. FRT and TUG did not differ significantly between fallers and non-fallers, but the Unstable Board Balance Test did show a significant difference between groups. We found that, in high-functioning elderly subjects, the Unstable Board Balance Test was able to detect elderly people with a fall history more accurately than either FRT or TUG. tion of falls and fall-related injuries among the elderly population has become increasingly important. Early identification of individuals at high risk of falls has been shown to be an effective strategy to reduce the occurrence of falls (5). Various clinical tools have been developed to identify individuals at high risk of falling (6). Of these, the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Functional Reach Test (FRT) are widely used for their convenience and availability of cut-off values to identify those at risk of falling (7–10). The cut-off values (to differentiate fallers from non-fallers) for these tests, however, vary depending on individuals’ characteristics and the length of follow-up (11, 12). Moreover, the use of these tests in healthy, active, elderly individuals is limited due to a ceiling effect. In fact, both the BBS and TUG lack the specificity to identify a decrease in balance capacity predictive of a risk of falls among healthy, high-functioning, elderly individuals (13, 14). There- fore, there is a need for an assessment tool to detect changes in balance capacity that are predictive of falls in healthy, active elderly individuals. Previous studies have shown that dynamic balance tests could be more appropriate than the BBS and TUG to differentiate the risk of falls among healthy, active, elderly individuals (15, 16). Thus, we developed the Unstable Board Balance Test for this purpose, antici- pating that it would not be limited by the same ceiling This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2504