Middleton Addie, Fulk George D, Herter Troy M, Beets Michael W, Donley Jonathan, Fritz Stacy L
From the Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas (AM); Department of Physical Therapy, Clarkson University, Potsdam, New York (GDF); Department of Exercise Science, Division of Rehabilitation Sciences, University of South Carolina, Columbia, South Carolina (TMH, SLF); Department of Exercise Science, Division of Health Aspects of Physical Activity, University of South Carolina, Columbia, South Carolina (MWB); and Palmetto Health, Research Physical Therapy Specialists, Columbia, South Carolina (JD).
Am J Phys Med Rehabil. 2016 Jul;95(7):475-82. doi: 10.1097/PHM.0000000000000488.
To determine the degree to which self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) are associated with fall status among community-dwelling older adults.
WS and 1-year falls history data were collected on 217 community-dwelling older adults (median age = 82, range 65-93 years) at a local outpatient PT clinic and local retirement communities and senior centers. WSR was calculated as a difference (WSRdiff = MWS - SSWS) and ratio (WSRratio = MWS/SSWS).
SSWS (P < 0.001), MWS (P < 0.001), and WSRdiff (P < 0.01) were associated with fall status. The cutpoints identified were 0.76 m/s for SSWS (65.4% sensitivity, 70.9% specificity), 1.13 m/s for MWS (76.6% sensitivity, 60.0% specificity), and 0.24 m/s for WSRdiff (56.1% sensitivity, 70.9% specificity). SSWS and MWS better discriminated between fallers and non-fallers (SSWS: AUC = 0.69, MWS: AUC = 0.71) than WSRdiff (AUC = 0.64).
SSWS and MWS seem to be equally informative measures for assessing fall status in community-dwelling older adults. Older adults with SSWSs less than 0.76 m/s and those with MWSs less than 1.13 m/s may benefit from further fall risk assessment. Combining SSWS and MWS to calculate an individual's WSR does not provide additional insight into fall status in this population.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the different methods for calculating walking speed reserve and discuss the potential of the metric as an outcome measure; (2) Explain the degree to which self-selected walking speed, maximal walking speed, and walking speed reserve are associated with fall status among community-dwelling older adults; and (3) Discuss potential limitations to using walking speed reserve to identify fall status in populations without mobility restrictions.
Advanced
: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.
确定自我选择步行速度（SSWS）、最大步行速度（MWS）和步行速度储备（WSR）与社区居住的老年人跌倒状态之间的关联程度。
在当地一家门诊物理治疗诊所、当地退休社区和老年中心，收集了217名社区居住老年人（年龄中位数 = 82岁，范围65 - 93岁）的步行速度和1年跌倒史数据。WSR通过差值（WSRdiff = MWS - SSWS）和比值（WSRratio = MWS/SSWS）来计算。
SSWS（P < 0.001）、MWS（P < 0.001）和WSRdiff（P < 0.01）与跌倒状态相关。确定的切点分别为：SSWS为0.76 m/s（灵敏度65.4%，特异度70.9%），MWS为1.13 m/s（灵敏度76.6%，特异度60.0%），WSRdiff为0.24 m/s（灵敏度56.1%，特异度70.9%）。与WSRdiff（曲线下面积[AUC] = 0.64）相比，SSWS和MWS在区分跌倒者和非跌倒者方面表现更好（SSWS：AUC = 0.69，MWS：AUC = 0.71）。
SSWS和MWS似乎是评估社区居住老年人跌倒状态的同等有效指标。自我选择步行速度低于0.76 m/s以及最大步行速度低于1.13 m/s的老年人可能会从进一步的跌倒风险评估中受益。将SSWS和MWS结合起来计算个体的WSR并不能为该人群的跌倒状态提供更多有价值的信息。
高级
学术物理治疗师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理治疗师协会将此活动指定为最多1.5个美国医学协会（AMA）1类学分。医生应仅根据其参与活动的程度申请相应学分。
