Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Andrés Soto-Varela, Marcos Rossi-Izquierdo, María Del-Río-Valeiras, Ana Faraldo-García, Isabel Vaamonde-Sánchez-Andrade, Antonio Lirola-Delgado, Sofía Santos-Pérez, Andrés Soto-Varela, Marcos Rossi-Izquierdo, María Del-Río-Valeiras, Ana Faraldo-García, Isabel Vaamonde-Sánchez-Andrade, Antonio Lirola-Delgado, Sofía Santos-Pérez

Abstract

Objective: To compare the results from the modified Timed Up and Go Test (TUG) with posturographic variables, the subjective perception of disability due to gait instability, and the number of falls in a sample of the elderly population with imbalance, to confirm that the TUG Test is a useful clinical instrument to assess the tendency to fall in individuals of this age group. Materials and Methods: Cross-sectional study conducted in a tertiary university hospital, in 174 people aged 65 years or older with gait instability. Modified TUG Test was performed; time, step count and the need for support during the test were the analyzed variables. They were compared with the number of falls, Computerized Dynamic Posturography scores, and questionnaires scores (Dizziness Handicap Inventory and a shortened version of the Falls Efficacy Scale-International). Results: The average time to complete the TUG Test was 21.24 ± 8.18 s, and the average step count was 27.36 ± 7.93. One hundred two patients (58.6%) required no support to complete the test, whereas the other 72 (41.4%) used supports. The time taken to complete the Test was significantly related with having or not having fallen in the previous year, with the scores of the questionnaires, and with various parameters of dynamic posturography. A higher percentage of patients who took more than 15 s had fallen in the previous year than those who took up to 15 s to complete the test [P = 0.012; OR = 2.378; 95% CI (1.183, 4.780)]. No significant correlation was found between the step count and the number of falls in the previous year, with falling during the test or not, or with being a single or a frequent faller. No relation was found between the need for supports and the number of falls, with having or not having fallen in the previous year, or with being a single or frequent faller. Conclusion: The modified TUG Test is in relation with the presence or absence of falls. Time is the essential parameter for analyzing the risk of falling and the 15-s threshold is a good value to differentiate elderly patients at high risk of falling. Unique Identifier: NCT03034655, www.clinicaltrials.gov.

Keywords: Dizziness Handicap Inventory; Timed Up and Go; computerized dynamic posturography; falls in elderly; mobile posturography; short FES-I.

Copyright © 2020 Soto-Varela, Rossi-Izquierdo, del-Río-Valeiras, Faraldo-García, Vaamonde-Sánchez-Andrade, Lirola-Delgado and Santos-Pérez.

References

    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. (2012) 12:9 10.1002/14651858.CD007146.pub3
    1. Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F, et al. . Fall prevention in the elderly. Clin Cases Miner Bone Metab. (2013) 10:91–5.
    1. Public Health England with the National Falls Prevention Coordination Group member organisations Falls and Fracture Consensus Statement. Supporting Commissioning for Prevention (2017). Available online at: (accessed April 16, 2020).
    1. Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons and Recommendations: Prevention of Falls in Older Persons AGS BGS Clinical Practice Guideline 2010. (2010) Available online at: (accessed April 17, 2020)
    1. National Institute for Health and Care Excellence . Surveillance of Falls in Older People: Assessing Risk and Prevention (NICE Guideline CG161). (2019). Available online at: (accessed April 17, 2020).
    1. Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N, et al. . A Comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement. Aging Clin Exp Res. (2016) 28:797–803. 10.1007/s40520-016-0588-4
    1. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. . Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. (2017) 51:1750–8. 10.1136/bjsports-2016-096547
    1. Kristinsdottir EK, Baldursdottir B. Effect of multi-sensory balance training for unsteady elderly people: pilot study of the “Reykjavik model.” Disabil Rehabil. (2014) 36:1211–18. 10.3109/09638288.2013.835452
    1. Kao CL, Chen LK, Chern CM, Hsu LC, Chen CC, Hwang SJ. Rehabilitation outcome in home-based versus supervised exercise programs for chronically dizzy patients. Arch Gerontol Geriatr. (2016) 51:264–7. 10.1016/j.archger.2009.11.014
    1. Zijlstra A, Mancini M, Chiari L, Zijlstra W. Biofeedback for training balance and mobility tasks in older populations: a systematic review. J Neuroeng Rehabil. (2010) 7:58. 10.1186/1743-0003-7-58
    1. Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. . Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial. Eur Arch Oto-Rhino-Laryngol. (2017) 274:2395–403. 10.1007/s00405-017-4472-4
    1. Rossi-Izquierdo M, Gayoso-Diz P, Santos-Pérez S, Del-Río-Valeiras M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. . Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial. Aging Clin Exp Res. (2018) 30:1353–61. 10.1007/s40520-018-1003-0
    1. Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sánchez-Andrade I, Del-Río-Valeiras M, et al. . Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx. (2015) 42:8–14. 10.1016/j.anl.2014.06.005
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. (1991) 39:142–8. 10.1111/j.1532-5415.1991.tb01616.x
    1. Nordin E, Lindelöf N, Rosendahl E, Jensen J, Lundin-Olsson L. Prognostic validity of the timed up-and-go test, a modified get-up-and-go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing. (2008) 37:442–8. 10.1093/ageing/afn101
    1. Rodrigues ARGM, Assef JC, Lima CB. Assessment of risk factors associated with falls among the elderly in a municipality in the state of paraíba, Brazil. A cross-sectional study. Saõ Paulõ Med J. (2019) 137:430–7. 10.1590/1516-3180.2018.0198120619
    1. Soto-Varela A, Gayoso-Diz P, Faraldo-García A, Rossi-Izquierdo M, Vaamonde-Sánchez-Andrade I, Del-Río-Valeiras M, et al. . Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system. BMC Geriatr. (2019) 19:1. 10.1186/s12877-018-1019-5
    1. Vaillant J, Martigné P, Vuillerme N, Caillat-Miousse J-L, Parisot J, Juvin R, et al. . Modification des performances au timed “up and go” test et à l'appui monopodal par l'addition d'une charge cognitive: valeur discriminative des résultats. Ann Réadaptation Méd Phys. (2006) 49:1–7. 10.1016/j.annrmp.2005.07.002
    1. Rossi-Izquierdo M, Soto-Varela A, Santos-Pérez S, Sesar-Ignacio A, Labella-Caballero T. Vestibular rehabilitation with computerised dynamic posturography in patients with Parkinson's disease: improving balance impairment. Disabil Rehabil. (2012) 31:1907–16. 10.1080/09638280902846384
    1. Pérez N, Garmendia I, Martín E, García-Tapia R. [Cultural adaptation of 2 questionnaires for health measurement in patients with vertigo]. Acta Otorrinolaringol Esp. (2000) 51:572–80.
    1. Kempen GIJM, Yardley L, van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K, et al. . The short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. (2008) 37:45–50. 10.1093/ageing/afm157
    1. Boelens C, Hekman EEG, Verkerke GJ. Risk factors for falls of older citizens. Technol Health Care. (2013) 21:521–33. 10.3233/THC-130748
    1. Morris R, Harwood RH, Baker R, Sahota O, Armstrong S, Masud T. A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study. Age Ageing. (2007) 36:78–83. 10.1093/ageing/afl147
    1. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. (2008) 37:430–5. 10.1093/ageing/afn100
    1. Muir SW, Berg K, Chesworth B, Speechley M. Use of the berg balance scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther. (2008) 88:449–59. 10.2522/ptj.20070251
    1. Masuda S, Suganuma K, Kaneko C, Hoshina K, Suzuki T, Serita T, et al. . Prediction of falls using a 3-m zigzag walk test. J Phys Ther Sci. (2013) 25:1051–4. 10.1589/jpts.25.1051
    1. Tuunainen E, Rasku J, Jäntti P, Pyykkö I. Risk factors of falls in community dwelling active elderly. Auris Nasus Larynx. (2014) 41:10–16. 10.1016/j.anl.2013.05.002
    1. Del-Río-Valeiras M, Gayoso-Diz P, Santos-Pérez S, Rossi-Izquierdo M, Faraldo-García A, Vaamonde-Sánchez-Andrade I, et al. . Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability? Arch Gerontol Geriatr. (2016) 62:90–96. 10.1016/j.archger.2015.09.005
    1. Lee JE, Chun H, Kim YS, Jung HW, Jang IY, Cha HM, et al. . Association between timed up and go test and subsequent functional dependency. J Korean Med Sci. (2020) 35:e25. 10.3346/jkms.2020.35.e25
    1. Lee JE, Shin DW, Jeong SM, Son KY, Cho B, Yoon JL, et al. . Association between timed up and go test and future dementia onset. J Gerontol A Biol Sci Med Sci. (2018) 73:1238–43. 10.1093/gerona/glx261
    1. Park JH, Cho H, Shin J-H, Kim T, Park S-B, Choi B-Y, et al. . Relationship among fear of falling, physical performance, and physical characteristics of the rural elderly. Am J Phys Med Rehabil. (2014) 93:379–86. 10.1097/PHM.0000000000000009

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다