A comparison of four mobility assessment tools in discriminating elderly fallers and non-fallers

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A comparison of four mobility assessment tools in discriminating elderly fallers and non-fallers

 

Author: Chiu, Yuen-yee Alice
Title: A comparison of four mobility assessment tools in discriminating elderly fallers and non-fallers
Degree: M.Sc.
Year: 2000
Subject: Falls (Accidents) in old age
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xiii, 109 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1541801
URI: http://theses.lib.polyu.edu.hk/handle/200/133
Abstract: Fall is a common problem in elders which have great health and social consequences. Fall prevention in this target population would reduce the need for medical and hospital resources. One major component of fall prevention is the identification of elders at risk of falls. Mobility problem is a known risk for falls. The Geriatric Assessment Teams in Hong Kong adopt a number of performance based mobility assessment tools in their service to the elders - the Berg Balance Scale, the Tinetti Mobility Score, the Elderly Mobility Scale and the Timed Up and Go. There has been no consensus on which tool is the best in discriminating elderly fallers from non-fallers. This study aimed to compare the mobility performance of elders who were known to be single fallers, multiple fallers and non-fallers. The sensitivity and specificity of the four mobility assessment tools were also investigated in order to identify an optimal cut-off score for the purpose of discriminating the three groups of elders. Over the nine-month period from December 1998 to September 1999, 17 single fallers and 22 multiple fallers were recruited from a Falls Clinic. Thirty nine healthy elders matched in age, sex and Body Mass Index with the fallers were recruited from a community center. All subjects underwent an assessment session with the four tools. The mobility performance of the single fallers and non-fallers was found to be different when measured by the Berg Balance Scale and the Tinetti Mobility Score. Multiple fallers performed significantly worse than non-fallers on all of the four tests. Analysis of variance with age, sex and Body Mass Index as covariates showed the mobility performance on all the four tools was different between single and multiple fallers. In discriminating single fallers from non-fallers, the Berg Balance Scale demonstrated the highest sensitivity with 47 as the cut off score (sensitivity 88.2% and specificity 76.5%), while the Tinetti Mobility Score ranked second in sensitivity (82.4%). The area under the Receiver Operating Characteristic curve was largest for the Berg Balance Scale (ROC=0.84) followed by the Tinetti Mobility Score (ROC=0.72) between single fallers and non-fallers indicating that Berg Balance Scale was a more powerful tool in discrimination. The area under the Receiver Operating Characteristic curve between multiple fallers and non-fallers were larger than 0.90 for all four tools. The areas were also larger than 0.87 for all four tools between single fallers and multiple fallers. Items nine (pick up object from the floor) and fourteen (standing on single leg) of the Berg Balance Scale were the two items identified by logistic regression analysis to distinguish single fallers from non-falters (odds ratios were 0.27 and 0.21 respectively), while items nine and twelve (placing alternate foot on stool) significantly discriminated single fallers from multiple fallers (odds ratios were 38.45 and 45.66 respectively). Results of this study supported the Berg Balance Scale as the most optimal amongst the four mobility assessment tools in screening fallers from non-fallers in elders.

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