Biodex Fall Risk Assessment in the Elderly With Ataxia: A New Age-Dependent Derived Index in Rehabilitation: An Observational Study

Paola Prometti, Adriana Olivares, Giuseppina Gaia, Giampietro Bonometti, Laura Comini, Simonetta Scalvini, Paola Prometti, Adriana Olivares, Giuseppina Gaia, Giampietro Bonometti, Laura Comini, Simonetta Scalvini

Abstract

The aim of this study was to evaluate if the Biodex Fall Risk Assessment could provide an age-adjusted index useful for classifying patients at "risk of fall."This was a cohort study conducted on 61 chronic patients, in stable conditions, having a history of ataxia, difficulty in walking or loss of balance, and aged >64 years. These patients were coming from home to our Institute undergoing a period of in-hospital standard rehabilitation. Assessment of clinical parameters was performed at entry. Functional scales (Functional Independence Measure [FIM] for motor and cognitive function, Barthel G, Tinetti POMA), and the Biodex Fall Risk Index (FRI) were performed at entry and discharge. The Normalized FRI, obtained adjusting FRI to the reported maximum predictive FRI for the relevant age, identified 2 types of patients: those with a greater risk of fall than expected for that age, labeled Case 1 (Normalized FRI>1); and those with an equal or even lesser risk of fall than expected for that age, labeled Case 0 (Normalized FRI≤1).FRI, Normalized FRI as well as independent variables as age, sex, pathology group, FIM, BarthelG, were considered in a multiple regression analysis to predict the functional improvement (i.e., delta Tinetti Total score) after rehabilitation.Normalized FRI is useful in assessing patients at risk of falls both before and after rehabilitation. At admission, the Normalized FRI evidenced high fall risk in 46% of patients (Case 1) which decreased to 12% after rehabilitation, being greater than age-predicted in 7 patients (Case 1-1) despite the functional improvement observed after the rehabilitation treatment. Normalized FRI evidenced Case 1-1 patients as neurological, "very old" (86% in age-group 75-84 years), and with serious events at 18 to 24 months' follow-up. Normalized FRI, but not FRI, at admission was a predictor of improvement in Tinetti Total scores.The normalized FRI effectively indicated patients at higher risk of fall, in whom health deterioration, falls, or cognitive decline was later documented at follow-up. The normalized FRI could be a standardized measure for identifying frailer patients becoming a further criterium of discharge home and marker of fall risk at home.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Design and flow of participants through the study.
FIGURE 2
FIGURE 2
Comparison between pathology groups for normalized Fall Risk Index.∗∗∗P ≤ 0.001, ∗P = 0.04, ^P = 0.06.
FIGURE 3
FIGURE 3
Comparison between cases at admission and discharge for 2 relevant parameters. ∗∗∗P ≤ 0.001, ∗∗P = 0.003, ∗P = 0.03.

References

    1. Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. J Clin Epidemiol 1990; 43:1415–1420.
    1. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18:141–158.
    1. Singh MA. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci 2002; 57:M262–M282.
    1. Brown AP. Reducing falls in elderly people: a review of exercise interventions. Physiother Theory Pract 1999; 15:59–68.
    1. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47:30–39.
    1. Moreland J, Richardson J, Chan D, et al. Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology 2003; 49:93–116.
    1. Skelton DA, Beyer N. Exercise and injury prevention in older people. Scand J Med Sci Sports 2003; 13:77–85.
    1. Feder G, Cryer C, Donovan S, et al. Guidelines for the prevention of falls in people over 65. The guidelines’ development group. BMJ 2000; 321:1007–1011.
    1. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009; 3:CD002759.
    1. Panel on Prevention of Falls in Older Persons, American Geriatrics Society, British Geriatrics Society. Summary of the updated American geriatrics Society/British geriatrics society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011; 59:148–157.
    1. Cyarto EV, Moorhead GE, Brown WJ. Updating the evidence relating to physical activity intervention studies in older people. J Sci Med Sport 2004; 7 (1 Suppl):30–38.
    1. Robertson MC, Campbell AJ, Gardner MM, et al. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002; 50:905–911.
    1. Sherrington C, Lord SR, Finch CF. Physical activity interventions to prevent falls among older people: update of the evidence. J Sci Med Sport 2004; 7 (1 Suppl):43–51.
    1. Tiedemann A, Sherrington C, Close JC, et al. Exercise and Sports Science Australia. Exercise and sports science Australia position statement on exercise and falls prevention in older people. J Sci Med Sport 2011; 14:489–495.
    1. Granacher U, Muehlbauer T, Zahner L, et al. Comparison of traditional and recent approaches in the promotion of balance and strength in older adults. Sports Med 2011; 41:377–400.
    1. Cho SI, An DH. Effects of a fall prevention exercise program on muscle strength and balance of the old-old elderly. J Phys Ther Sci 2014; 26:1771–1774.
    1. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004; 291:1999–2006.
    1. Balance System Operation and Service Manual. Shirley, NY: Biodex Medical Systems; 1995. Accessed February 29, 2016.
    1. Parmelee PA, Thuras PD, Katz IR, et al. Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 1995; 43:130–137.
    1. Granger CV, Cotter AC, Hamilton BB, et al. Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil 1993; 74:133–138.
    1. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34:119–126.
    1. Collin C, Wade DT, Davies S, et al. The Barthel ADL index: a reliability study. Int Disabil Stud 1988; 10:61–63.
    1. Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system. J Athl Train 1998; 33:323–327.
    1. Cachupe WJ, Shifflett B, Kahanov L, et al. Reliability of biodex balance system measures. Meas Physical Educ Exercise Sci 2001; 5:97–108.
    1. R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. Available at: 2015. Accessed February 29, 2016.
    1. Hauer K, Rost B, Rutschle K, et al. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc 2001; 49:10–20.
    1. Quigley PA, Bulat T, Schulz B, et al. Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: a three-group randomized clinical trial. Am J Phys Med Rehabil 2014; 93:1–12.
    1. Cadore EL, Rodriguez-Manas L, Sinclair A, et al. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16:105–114.
    1. Coppola L, Guidolin L, Frigo A, et al. Balance evaluation by a dynamic system before and after exercise therapy in elderly patients. Eur Med Phys 2008; 44 (suppl 1 no. 3):1–5.
    1. Aydog E, Bal A, Aydog ST, et al. Evaluation of dynamic postural balance using the biodex stability system in rheumatoid arthritis patients. Clin Rheumatol 2006; 25:462–467.
    1. Gusi N, Carmelo Adsuar J, Corzo H, et al. Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalised older people: a randomised trial. J Physiother 2012; 58:97–104.
    1. Pickerill ML, Harter RA. Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices. J Athl Train 2011; 46:600–606.
    1. Kegelmeyer DA, Kloos AD, Thomas KM, et al. Reliability and validity of the Tinetti mobility test for individuals with parkinson disease. Phys Ther 2007; 87:1369–1378.
    1. An S, Lee Y, Lee G. Validity of the performance-oriented mobility assessment in predicting fall of stroke survivors: a retrospective cohort study. Tohoku J Exp Med 2014; 233:79–87.
    1. Marventano S, Ayala A, Gonzalez N, et al. Multimorbidity and functional status in community-dwelling older adults. Eur J Intern Med 2014; 25:610–616.

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