Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville.
Department of Physical Therapy Education, Elon University, Elon, North Carolina.
J Geriatr Phys Ther. 2021;44(4):189-197. doi: 10.1519/JPT.0000000000000290.
Older adults who live independently in the community are higher functioning and routinely ambulate in the community. Unrestricted community ambulation increases the likelihood of encountering precarious situations challenging balance. Sufficient dynamic balance is necessary to avoid falls. Currently used balance and mobility assessments may not sufficiently challenge dynamic balance to uncover mobility deficits in independent community-dwelling older adults. The purpose of this study was to investigate whether backward walking speed (BWS) can serve as an outcome measure to screen dynamic balance and mobility deficits in independent community-dwelling older adults.
A convenience sample of 30 older adults (73.68 ± 6.54 years) participated in this cross-sectional study. Participants walked backward on an instrumented walkway to record BWS. Other outcomes included forward walking speed (FWS), Community Balance and Mobility (CB&M) Scale, Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG) test, and 7-day average step count (ASC). A multivariate analysis of variance investigated the overall group differences between older adults at fall risk and those not at risk and was followed up by univariate tests. Pearson and spearman coefficients investigated associations between study outcomes. Youden's index assessed diagnostic accuracy.
Backward walking speed, CB&M, FES-I, ASC discriminated older adults at fall risk from those not at risk (P < .01) whereas FWS and TUG did not. Backward walking speed strongly correlated with challenging assessments of balance and mobility (CB&M, FES-I, and ASC) but only moderately correlated with the TUG. The CB&M Scale independently explained 53% variance in the BWS performance (P < .01). Youden's index was highest (Y = 0.6, sensitivity = 93%, and specificity = 67%) for BWS (0.73 m/s) compared with other study outcomes.
Preliminary results suggest that BWS can screen for dynamic balance and mobility deficits in independent community-dwelling older adults. Accurate screening is the first step to capture early decline in function for independent community-dwelling older adults. Longitudinal follow-up studies are warranted to validate BWS as a screening tool.
独立生活在社区中的老年人功能更高，通常在社区中走动。不受限制的社区活动增加了遇到不稳定情况挑战平衡的可能性。充足的动态平衡是避免跌倒的必要条件。目前使用的平衡和移动能力评估可能无法充分挑战动态平衡，无法发现独立生活在社区中的老年人的移动能力缺陷。本研究的目的是探讨后退行走速度（BWS）是否可以作为一种筛查工具，用于筛查独立生活在社区中的老年人的动态平衡和移动能力缺陷。
一项便利的横断面研究纳入了 30 名老年人（73.68±6.54 岁）。参与者在仪器化步道上向后行走以记录 BWS。其他结果包括向前行走速度（FWS）、社区平衡和移动能力量表（CB&M）、国际跌倒效能量表（FES-I）、计时起立行走测试（TUG）和 7 天平均步数（ASC）。采用多变量方差分析比较处于跌倒风险的老年人和无跌倒风险的老年人之间的总体组间差异，随后进行单变量检验。Pearson 和 spearman 系数用于评估研究结果之间的相关性。Youden 指数评估了诊断准确性。
后退行走速度、CB&M、FES-I、ASC 区分了处于跌倒风险的老年人和无跌倒风险的老年人（P＜0.01），而 FWS 和 TUG 则没有。后退行走速度与平衡和移动能力的挑战性评估（CB&M、FES-I 和 ASC）高度相关，但与 TUG 仅中度相关。CB&M 量表独立解释了 BWS 表现的 53%的方差（P＜0.01）。与其他研究结果相比，BWS（0.73m/s）的 Youden 指数最高（Y=0.6，灵敏度=93%，特异性=67%）。
初步结果表明，BWS 可用于筛查独立生活在社区中的老年人的动态平衡和移动能力缺陷。准确的筛查是捕捉独立生活在社区中的老年人功能早期下降的第一步。需要进行纵向随访研究来验证 BWS 作为筛查工具的有效性。
