老年人的步态障碍和跌倒：意向性和反应性步测的系统评价和荟萃分析。

Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests.

机构信息

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany; Robert-Bosch Hospital, Department of Geriatric Rehabilitation, Stuttgart, Germany.

出版信息

Ageing Res Rev. 2021 Mar;66:101238. doi: 10.1016/j.arr.2020.101238. Epub 2020 Dec 24.

DOI:10.1016/j.arr.2020.101238

PMID:33352293

Abstract

OBJECTIVE

To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.

DATA SOURCE

PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.

STUDY SELECTION

Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).

RESULTS

A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.

CONCLUSIONS

This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.

摘要

目的

系统地考察步态表现作为跌倒风险因素。更具体地说，我们检查了：(i) 步测是否可以区分跌倒者和非跌倒者；以及 (ii) 区分跌倒者和非跌倒者所需的步测类型（例如自主与反应性步测）。

资料来源

PubMed、EMBASE、CINAHL、Cochrane 系统评价数据库和纳入文章的参考文献列表。

研究选择

评估至少一种步测与老年人跌倒之间关联的横断面和队列研究（年龄≥60 岁和/或平均年龄为 65 岁）。

结果

对 61 项研究（n=9536）的荟萃分析表明，与非跌倒者相比，跌倒者的步态表现明显更差（Cohen's d 0.56，95%CI 0.48 至 0.64，p<0.001，I 66%）。这适用于自主和反应性步测。23 项研究（n=3615）纳入了诊断性荟萃分析，结果表明步测具有中等的敏感性（0.70，95%CI 0.62 至 0.77）、特异性（0.68，95%CI 0.58 至 0.77）和受试者工作特征曲线下面积（AUC）（0.75，95%CI 0.59 至 0.86），可区分跌倒者和非跌倒者。