Department of Geriatrics, Centre d'Etudes et de Formation sur le Vieillissement, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
Phys Ther. 2010 Apr;90(4):550-60. doi: 10.2522/ptj.20090158. Epub 2010 Mar 4.
Correct identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults.
The purposes of this study were: (1) to develop and validate a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and (2) to evaluate the added value of 3 clinical balance tests in predicting this risk.
This was a prospective measurement study.
A population of 1,618 community-dwelling people over 65 years of age underwent a health checkup, including performance of 3 clinical balance tests: the One-Leg-Balance Test, the Timed "Up & Go" Test, and the Five-Times-Sit-to-Stand Test. Falls were recorded using a self-administered questionnaire that was completed a mean (SD) of 25+/-5 months after the visit. Participants were randomly divided into either group A (n=999), which was used to develop the scale, or group B (n=619), which was used to prospectively validate the scale.
Logistic regression analysis identified 4 variables that independently predicted recurrent falls in group A: history of falls, living alone, taking >or=4 medications per day, and female sex. Thereafter, 3 risk categories of recurrent falls (low, moderate, and high) were determined. Predicted probability of recurrent falls increased from 4.1% to 30.1% between the first and third categories. This scale subsequently was validated with great accuracy in group B. Only the Five-Times-Sit-to-Stand Test provided added value in the estimation of risk for recurrent falls, especially for the participants who were at moderate risk, in whom failure on the test (duration of >15 seconds) doubled the risk.
Falls were assessed only once, and length of follow-up was heterogeneous (18-36 months).
Clinicians could easily classify older patients in low-, moderate-, or high-risk groups of recurrent falls by using 4 easy-to-obtain items. The Five-Times-Sit-to-Stand Test provides added value to stratify risk for falls in people at moderate risk.
正确识别有复发性跌倒风险的人群有助于为老年人制定预防和康复策略。
本研究旨在：(1) 基于易于获得的社会和临床项目，开发和验证一种简单的临床量表，以分层社区居住的老年人复发性跌倒的风险；(2) 评估 3 项临床平衡测试在预测该风险方面的附加价值。
这是一项前瞻性测量研究。
对 1618 名 65 岁以上的社区居民进行了健康检查，包括进行 3 项临床平衡测试：单腿平衡测试、计时“站起-坐下”测试和 5 次坐立测试。使用自我管理问卷记录跌倒情况，在就诊后平均(SD)25+/-5 个月完成。参与者被随机分为 A 组(n=999)和 B 组(n=619)，A 组用于开发量表，B 组用于前瞻性验证量表。
逻辑回归分析确定了 4 个变量可独立预测 A 组的复发性跌倒：跌倒史、独居、每天服用>4 种药物和女性。此后，确定了 3 个复发性跌倒风险类别(低、中、高)。预测的复发性跌倒概率从第一类到第三类从 4.1%增加到 30.1%。该量表在 B 组中的验证具有很高的准确性。只有 5 次坐立测试在估计复发性跌倒风险方面提供了附加价值，特别是对处于中度风险的参与者，测试失败(持续时间>15 秒)会使风险增加一倍。
仅评估了一次跌倒，随访时间长短不一(18-36 个月)。
临床医生可以通过使用 4 个易于获取的项目，轻松地将老年患者分为低、中、高复发性跌倒风险组。5 次坐立测试为评估处于中度风险的人群的跌倒风险提供了附加价值。
