Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults Evaluation of Falls Risk in Community-Dwelling Older Adults Using Body-Worn Sensors Which Neuromuscular or Cognitive Test Is the Optimal Screening Tool to Predict Falls in Frail Community-Dwelling Older People? Adaptability to Perturbation as a Predictor of Future Falls: A Preliminary Prospective Study The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. Validation of the Timed Up and Go Test for Assessing Balance Variables in Adults Aged 65 and Older. Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Tai Chi Chuan can improve balance and reduce fear of falling in community dwelling older adults: a randomized control trial Predicting the probability of falls in community-dwelling elderly individuals using the trail-walking test The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye [Prediction of falls with performance on Timed "Up-and-Go" and one-leg-balance tests and additional cognitive tasks]. Multitarget stepping program in combination with a standardized multicomponent exercise program can prevent falls in community-dwelling older adults: a randomized, controlled trial. A Simple Clinical Scale to Stratify Risk of Recurrent Falls in Community-Dwelling Adults Aged 65 Years and Older Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. 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. "Timed Up & Go": A Screening Tool for Predicting 30-Day Morbidity in Onco-Geriatric Surgical Patients? A Multicenter Cohort Study A comparison of four functional tests in discriminating fallers from non-fallers in older people Is timed up and go better than gait speed in predicting health, function, and falls in older adults? Efficacy of a whole-body vibration intervention on functional performance of community-dwelling older adults. Influence of Whole Body Vibration Platform Frequency on Neuromuscular Performance of Community-Dwelling Older Adults Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Fall Prevention in a Primary Care Setting. Are interventions effective in improving the ability of older adults to rise from the floor independently? A mixed method systematic review
Background The Functional Gait Assessment ( FGA ) is a reliable and valid measure of gait-related activities . Objective The purpose of this study was to determine the concurrent , discriminative , and predictive validity of the FGA in community-dwelling older adults . Design This was a prospect i ve cohort study . Methods Thirty-five older adults aged 60 to 90 years completed the Activities-specific Balance Confidence Scale ( ABC ) , Berg Balance Scale ( BBS ) , Dynamic Gait Index ( DGI ) , Timed “ Up & Go ” Test ( TUG ) , and Functional Gait Assessment ( FGA ) during one session . Falls were tracked by having participants complete a monthly fall calendar for 6 months . Spearman correlation coefficients were used to determine concurrent validity among the ABC , BBS , TUG , DGI , and FGA . To determine the optimum scores to classify fall risk , sensitivity ( Sn ) , specificity ( Sp ) , and positive and negative likelihood ratios ( LR+ and LR− ) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA , TUG , and DGI in identifying prospect i ve falls . Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI , TUG , and FGA in identifying prospect i ve falls . Results The FGA correlated with the ABC ( r=.053 , P<.001 ) , BBS ( r=.84 , P<.001 ) , and TUG ( r=−.84 , P<.001 ) . An  FGA  score of ≤22/30 provides both discriminative and predictive validity . The FGA ( scores ≤22/30 ) provided 100 % Sn , 72 % Sp , LR+ of 3.6 , and LR− of 0 to predict prospect i ve falls . Limitations The study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade . Conclusions The FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults Background : Falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide . This study aim ed to determine if a method based on body-worn sensor data can prospect ively predict falls in community-dwelling older adults , and to compare its falls prediction performance to two st and ard methods on the same data set . Methods : Data were acquired using body-worn sensors , mounted on the left and right shanks , from 226 community-dwelling older adults ( mean age 71.5 ± 6.7 years , 164 female ) to quantify gait and lower limb movement while performing the ‘ Timed Up and Go ’ ( TUG ) test in a geriatric research clinic . Participants were contacted by telephone 2 years following their initial assessment to determine if they had fallen . These outcome data were used to create statistical models to predict falls . Results : Results obtained through cross-validation yielded a mean classification accuracy of 79.69 % ( mean 95 % CI : 77.09–82.34 ) in prospect ively identifying participants that fell during the follow-up period . Results were significantly ( p < 0.0001 ) more accurate than those obtained for falls risk estimation using two st and ard measures of falls risk ( manually timed TUG and the Berg balance score , which yielded mean classification accuracies of 59.43 % ( 95 % CI : 58.07–60.84 ) and 64.30 % ( 95 % CI : 62.56–66.09 ) , respectively ) . Conclusion : Results suggest that the quantification of movement during the TUG test using body-worn sensors could lead to a robust method for assessing future falls risk Background : The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit . Objective : To determine the optimal physical or cognitive test to screen for falls risk in frail older people . Methods : This prospect i ve cohort study involved recruitment from 213 day-care centers in Japan . The feasibility study included 3,340 ambulatory individuals aged 65 years or older enrolled in the Tsukui Ordered Useful Care for Health ( TOUCH ) program . The external validation study included a sub sample of 455 individuals who completed all tests . Physical tests included  grip strength ( GS ) , chair st and test ( CST ) , one-leg st and ing test ( OLS ) , functional reach test ( FRT ) , t and em walking test ( TWT ) , 6-meter walking speed at a comfortable pace ( CWS ) and at maximum pace ( MWS )  , and timed up- and -go test ( TUG ) . The  mental status question naire ( MSQ )  was used to measure  cognitive function . The incidence of falls during 1 year was investigated by self-report or an interview with the participant ’s family and care staff . Results : The most practicable tests were the GS and MSQ , which could be administered to more than 90 % of the participants regardless of the activities of daily living status . The FRT and TWT had lower feasibility than other lower limb function tests . During the 1-year retrospective analysis of falls , 99 ( 21.8 % ) of the 455 validation study participants had fallen at least once . Fallers showed significantly poorer performance than non-fallers in the OLS ( p = 0.003 ) , TWT ( p = 0.001 ) , CWS ( p = 0.013 ) , MWS ( p = 0.007 ) , and TUG ( p = 0.011 ) . The OLS , CWS , and MWS remained significantly associated with falls when performance cut-points were determined . Logistic regression analysis revealed that the TWT was a significant and independent , yet weak predictor of falls . A weighting system which considered feasibility and validity scored the CWS ( at a cut-point of 0.7 m/s ) as the best test to predict risk of falls . Conclusion : Clinical tests of neuromuscular function can predict risk of falls in frail older people . When feasibility and validity were considered , the CWS was the best test for use as a screening tool in frail older people , however , these preliminary results require confirmation in further research Background Falls often result from failed responses to unexpected , externally applied perturbations . Whether performance-based , reaction-based , and /or adaptation-based assessment tools can predict future falls among community-dwelling older adults is unknown . Purpose This preliminary prospect i ve study examined the relationship between older adults ' future fall risk and their reactive responses and adaptations to repeated slips , and their functional status . Methods Thirteen community-dwelling adults ( > 64 years ) were exposed initially to a session of repeated slips . About 30 months later , self-reported falls experience data were collected for the preceding year from these participants . Slip outcome ( fall , loss of balance , or recovery ) , slip score ( weighted sum of slip outcomes ) , Timed Up and Go scores , and future fall incidence were recorded . Results Four participants who reported at least 1 fall had significantly higher slip scores than the rest . In contrast , neither failed recovery on the first slip nor a higher TUG score predicted greater odds of future falls . Conclusion Community-dwelling older adults ' adaptability to externally imposed perturbations may reveal their future fall risk BACKGROUND the Falls Risk for Older People in the Community assessment ( FROP-Com ) tool was design ed for use in targeted multi-factorial falls prevention programmes . It fills the gap between the short screening tools and the longer assessment tools , e.g. the physiological profile assessment ( PPA ) . The aim of this study was to determine the reliability and predictive accuracy of the FROP-Com . METHODS the intra-rater and inter-rater reliability studies were performed with 20 participants each . The prospect i ve study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home . Following a home-based assessment , including the FROP-Com , Timed Up and Go ( TUG ) and functional Reach ( FR )  , participants were monitored for falls for 12 months . RESULTS the intra-class correlation coefficient ( ICC ) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 ( 95 % CI 0.84 - 0.97 ) and 0.81 ( 95 % CI 0.59 - 0.92 ) respectively . The AUC for the  FROP-Com  was 0.68 ( 95 % CI 0.63 - 0.74 ) . At the cut-off 18/19 , sensitivity was 71.3 % ( 95 % CI 64.4 - 78.3 ) and specificity was 56.1 % ( 95 % CI 48.9 - 63.4 ) . The AUC for the TUG was 0.63 ( 95 % CI 0.57 - 0.69 ) and for the FR was 0.60 ( 95 % CI 0.54 - 0.66 ) . CONCLUSION the FROP-Com demonstrated good reliability and a moderate capacity to predict falls OBJECTIVES To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living ( ADLs ) . DESIGN A prospect i ve cohort study ; home visits every 6 months for 18 months . SETTING Community-based . PARTICIPANTS Community-dwelling older adults , n=110 , ( mean age 80.3+/-7.0 ; range 67 - 98 ) who reported no difficulty in basic ADLs .  MEASUREMENTS The  Short Physical Performance Battery ( SPPB ) , gait speed , Berg Balance Scale ( BBS ) , grip strength , and Timed Up and Go Test ( TUG ) were evaluated at baseline . Seven ADL items  were assessed at baseline and 6 , 12 , and 18 months . The onset of ADL disability was self-report of difficulty in any of the seven ADL items . Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6 , 12 , and 18 months . RESULTS After controlling for age , comorbid conditions , and sex , the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period ( 6 months , c-statistic=0.725 , ( 95 % confidence interval (CI)=0.60 - 0.85 ; 12 months , c-statistic=0.840 95 % CI=0.75 , 0.93 ; 18 months , c-statistic=0.821 , 95 % CI=0.71 , 0.93 ) . The SPPB showed excellent predictive value for the onset of difficulty at 12 months . Ninety-five , 89 , and 75 older adults completed the 6 , 12 , and 18-month follow-up visits , respectively . CONCLUSION BBS , followed by SPPB , TUG , gait speed , and grip strength , were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults . Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline The Timed Up and Go ( TUG ) test is recommended by the U.S. Centers for Disease Control and Prevention as an easy to administer clinical test to evaluate a senior citizen 's fall risk . Limited evidence has been presented in the literature validating the TUG test . In this study , the authors sought to assess correlations between the TUG test and various balance markers utilizing the OptoGait system .  A total of 51 healthy seniors completed r and omized trials of the TUG test and a gait test utilizing  OptoGait photoelectric technology .  Correlations among mean and SD values for these variables and TUG performance were calculated . Utilizing a Bonferroni adjustment and an alpha level of .05 , eight significant correlations of a moderately strong degree ( absolute r scores between .51 and .78 ) emerged . Correlation results indicate that the TUG test is a valid tool for screening balance deficits that lead to increased fall risk in senior citizens OBJECTIVE To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults . DESIGN Multicenter r and omized controlled trial . SETTING Three medical centers and adjacent community health centers . PARTICIPANTS Community-dwelling older adults ( N=616 ) who have fallen in the previous year or are at risk of falling . INTERVENTIONS After baseline assessment , eligible subjects were r and omly allocated into the intervention group ( IG ) or the control group ( CG ) , stratified by the Physiological Profile Assessment ( PPA ) fall risk level . The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training , health education , home hazards evaluation/modification , along with medication review and ophthalmology/other specialty consults . The CG received health education brochures , referrals , and recommendations without direct exercise intervention . MAIN OUTCOME MEASURES Primary outcome was fall incidence within 1 year . Secondary outcomes were PPA battery ( overall fall risk index , vision , muscular strength , reaction time , balance , and proprioception ) , Timed Up & Go ( TUG ) test , Taiwan version of the International Physical Activity Question naire , EuroQol-5D , Geriatric Depression Scale ( GDS ) , and the Falls Efficacy Scale-International at 3 months after r and omization . RESULTS Participants were 76±7 years old and included low risk 25.6 % , moderate risk 25.6 % , and marked risk 48.7 % .  The cumulative 1-year fall incidence was 25.2 % in the IG and 27.6 % in the CG ( hazard ratio=.90 ; 95 % confidence interval , .66 - 1.23 ) . The IG improved more favorably than the CG on overall PPA fall risk index , reaction time , postural sway with eyes open , TUG test , and GDS , especially for those with marked fall risk . CONCLUSIONS The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls , but did not reduce falls at 1-year follow-up . Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessment s , education , referrals , and recommendations Fear of falling and balance impairment are prevalent in older adults and cause major morbidities for this population . The aim of this study was to evaluate the effect of Tai Chi Chuan on balance and fear of falling in community-dwelling older adults . This study was a single-blind r and omized control trial . Sixty older adults were r and omly allocated into two groups using a 4-cell r and om block design . The participants of intervention group were trained in Tai Chi Chuan for eight weeks , twice a week , and 55 min in each session . Balance and fear of falling were assessed by Timed Up and Go ( TUG ) test , Tinetti test and Falls Efficacy Scale International in baseline and after 8 weeks . After eight weeks of intervention , the mean scores of the TUG and Tinetti scales in the intervention group were improved significantly compared to the baseline and the control group ( P<0.001 ) . Moreover , the intervention group showed a significant reduction in fear of falling scores ( P<0.001 ) , while those in the control group remained unchanged . Tai Chi Chuan effectively improves the balance and fear of falling and could be considered as a practical and useful method for fall prevention in community-dwelling older adults Background Falling is a common problem in the fast-growing elderly population .  Multitasking or engaging in two or more activities at the same time is common in daily living . Objective To determine the usefulness of the  trail-walking test ( TWT ) for predicting a fall in community-dwelling elderly individuals . Methods This was a prospect i ve study in which the TWT was used to evaluate the risk of falling among a group of community-dwelling elderly individuals ( n = 171 ) with a mean age of 80.5 ± 5.6 years . The following tests were conducted :  TWT , trail-making test ( TMT ) , timed-up- and -go test ( TUG ) , functional reach ( FR ) test , one-leg st and ing ( OLS ) test , and 10-m walking time test . Test – retest reliability was assessed by repeating the TWT within 2 weeks of the first trial , and there was a 1-year follow-up . Stepwise logistic regression analysis was used to analyze whether the TWT , TMT , TUG , FR , OLS , or 10-m walking tests predicted falling . Results The test – retest reliability  of TWT was high ( intraclass correlation coefficient 0.945 , p < 0.001 ) . Fifty-nine participants ( 34.5 % ) had reported a fall during the year preceding the 1-year follow-up . The stepwise logistic regression analysis revealed that only the TWT was significantly related to falling ( odds ratio 1.160 , 95 % confidence interval 1.107–1.214 ; p < 0.001 ) . In total , 77.8 % of cases were correctly classified . Conclusion When reliability and validity were considered , the TWT was most useful test of those evaluated for assessing the risk of fall among our elderly cohort Decline in dual-task walking performance is associated with increased risk of falls among older adults . The objective of this study is to determine whether 18 hr of participation in EnhanceFitness ( EF ) , an evidence -based group exercise program , improves dual-task walking performance among community-dwelling older adults . Twenty-eight healthy , community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation . Gait speed was evaluated under single task and dual tasks using the TUG ( Timed Up and Go ) and 1-min walk tests . Dual-task costs ( DTC ) , the relative cost of dual-task performance compared to single-task performance , were calculated for both cognitive and motor tasks . Postural control and executive functions were evaluated as well . After 18 hr of EF , dual-task walking performance improved . Single-task performance improved as well as postural control and executive function . There was no significant change in DTC across all measurements , except for the cognitive task of the TUG PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling Background : The  ‘ timed up and go ’ test ( TUG ) is a simple , quick and widely used clinical performance-based measure of lower extremity function , mobility and fall risk . We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults . Objective : To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test ( BBT ) and the Dynamic Gait Index ( DGI ) . Methods : The  TUG , DGI and BBT  were assessed in 265 healthy older adults ( 76.4 ± 4.3 years ; 58.3 % women ) who participated in a 3-year prospect i ve study . The  Mini-Mental State Examination , digit span and verbal fluency measured cognitive function . The one- sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson ’s correlation coefficients quantified associations . Results : The mean scores of the BBT , DGI and TUG were : 54.0 ± 2.4 , 22.8 ± 1.5 , 9.5 ± 1.7 s , respectively . The BBT and the DGI were not normally distributed ( p < 0.001 ) , but the TUG was ( p = 0.713 ) . The TUG times were mildly associated ( p < 0.01 ) with digit span and verbal fluency and were related to future falls , while the BBT and the DGI were not . Conclusions : The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults . It does not suffer from ceiling effect limitations , is normally distributed and is apparently related to executive function . The BBT and the DGI do not share these beneficial properties . Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive re sources OBJECTIVE This study aim ed to determine whether ordinary clinical performance on the timed " up- and -go " and one-leg-balance tests varied with additional cognitive tasks and the predictive value of this combination for future falls . METHODOLOGY The sample comprised 95 women with osteoporosis who lived independently in the community and were older than 70 years ( mean 73.4+/-1.7 years ) who were r and omized to perform the timed " up- and -go " ( TUG ) and one-leg-balance ( OLB ) tests . The tests were performed with or without an additional cognitive task ( math task involving subtraction by 2 s or 5 s or addition by 3 s ) . RESULTS For both TUG and OLB , performance decreased in the dual-task condition ( P<0.05 ) but did not differ in older women with and without a history of falling , whatever the test , and with or without an additional cognitive load . CONCLUSION Performance on the  TUG and OLB tests  was less efficient when patients simultaneously performed a cognitive task . Performance on these tests , without or with cognitive tasks , did not predict falls in a sample of women who lived independently OBJECTIVES To investigate the effects of a twice-weekly multitarget stepping ( MTS ) task combined with a multicomponent exercise program on stepping accuracy , gaze behavior , fall risk factors , and fall rates . DESIGN R and omized controlled trial . SETTING Community . PARTICIPANTS Community-dwelling adults aged 65 and older in Japan ( N = 264 ) were r and omized into an MTS group ( n = 132 ) and a control group ( n = 132 ) . INTERVENTION Twenty-four weeks of a twice-weekly community-based MTS program in combination with a st and ardized multicomponent exercise program . MEASUREMENTS Number of falls and fall-related fractures during a 12-month follow-up period after completion of the intervention , stepping accuracy , gaze behavior while performing the MTS test , and results of four clinical tests relevant to assessment of risk of falls ( Timed Up and Go ( TUG ) , functional reach ( FR ) , 10-m walking , and Five Chair St and ( 5CS ) ) were measured . RESULTS Thirteen participants ( 11.6 % ) in the MTS group and 39 ( 33.0 % ) in the control group fell during the 12-month follow-up period ( incidence rate ratio = 0.35 , 95 % confidence interval ( CI ) = 0.19 - 0.66 ) . Three participants in the MTS group and 13 in the control group experienced fall-related fractures during the 12-month follow-up period ( relative risk = 0.22 , 95 % CI = 0.06 - 0.80 ) . After the intervention , a subset of participants in the MTS group had significantly greater improvement in stepping accuracy and gaze behavior during the MTS test , and all participants in the MTS group had significantly greater improvement in performing the TUG and 10-m walking ( P < .001 ) . CONCLUSION Participants who performed MTS tests combined with a multicomponent exercise program showed greater improvements in stepping accuracy , gaze behavior , and physical performance in a virtually complex environment . Considering the less-frequent fall rate in the follow-up assessment , these improvements could contribute to preventing falls in community-dwelling older adults Background Correct identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults . Objective The purpose s of this study were : ( 1 ) to develop and vali date a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and ( 2 ) to evaluate the added value of 3 clinical balance tests in predicting this risk . Design This was a prospect i ve measurement study . Methods A population of 1,618 community-dwelling people over 65 years of age underwent a health checkup , including performance of 3 clinical balance tests : the One-Leg-Balance Test , the Timed “ Up & Go ” Test , and the Five-Times-Sit-to-St and Test . Falls were recorded using a self-administered question naire that was completed a mean ( SD ) of 25±5 months after the visit . Participants were r and omly divided into either group A ( n=999 ) , which was used to develop the scale , or group B ( n=619 ) , which was used to prospect ively vali date the scale . Results Logistic regression analysis identified 4 variables that independently predicted recurrent falls in group A : history of falls , living alone , taking ≥4 medications per day , and female sex . Thereafter , 3 risk categories of recurrent falls ( low , moderate , and high ) were determined . Predicted probability of recurrent falls increased from 4.1 % to 30.1 % between the first and third categories . This scale subsequently was vali date d with great accuracy in group B. Only the Five-Times-Sit-to-St and Test provided added value in the estimation of risk for recurrent falls , especially for the participants who were at moderate risk , in whom failure on the test ( duration of > 15 seconds ) doubled the risk . Limitations Falls were assessed only once , and length of follow-up was heterogeneous ( 18–36 months ) . Conclusions Clinicians could easily classify older patients in low- , moderate- , or high-risk groups of recurrent falls by using 4 easy-to-obtain items . The Five-Times-Sit-to-St and Test provides added value to stratify risk for falls in people at moderate risk OBJECTIVES To compare the practicality , reliability , validity , and responsiveness of the timed up and go ( TUG ) , one-leg st and ( OLS ) , functional reach ( FR ) , and Tinetti balance ( TB ) performance measures in people aged 65 and older . DESIGN A prospect i ve study . SETTING Shin-Sher Township of Taichung County , west- central Taiwan . PARTICIPANTS Twelve hundred community-dwelling older people . MEASUREMENTS During an initial assessment at their residences , participants were interviewed for demographics , cognition , fall history , use of a walking aid , and activities of daily living ( ADLs )  , in addition to completing the four balance tests . Falls were ascertained by telephone every 3 months for a 1-year follow-up ; the four balance measures and ADLs were also reassessed at the end of the follow-up year . RESULTS Of the four balance measures , the OLS had the lowest participation rate , and participation of people who were cognitively impaired had fallen in the previous year , used a walking aid , or suffered from an ADL disability was lower than for their counterparts . The time to complete the tests ranged from 58 seconds for OLS , to 160 seconds for the TB . All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status . The TB showed better discriminant , convergent , and predictive validities and responsiveness to ADL changes than the other three tests . CONCLUSION According to psychometric properties , the most suitable performance measure for evaluating balance in community-dwelling older people was the TB , followed by the TUG BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons OBJECTIVES to evaluate and compare the prognostic validity relative to falls of the Timed Up- and -Go test ( TUG ) , a modified Get-Up- and -Go test ( GUG-m ) , staff 's judgement of global rating of fall risk ( GLORF ) and fall history among frail older people . DESIGN cohort study , 6-month prospect i ve follow-up for falls . PARTICIPANTS 183 frail persons living in residential care facilities in Sweden , mean age 84 years , 73 % women . METHODS the occurrence of falls during the follow-up period were compared to the following assessment s at baseline : the TUG at normal speed ; the  GUG-m , a rating of fall risk scored from 1 ( no risk ) to 5 ( very high risk ) ; the  GLORF  ,  staff 's rating of fall risk as ' high ' or ' low ' ; a history of falls in the previous 6 months . These assessment tools were evaluated using sensitivity , specificity and positive and negative likelihood ratios ( LR(+ ) to rule in and LR(- ) to rule out a high fall risk ) . RESULTS 53 % of the participants fell at least once . Various cut-off values of the TUG ( 12 , 15 , 20 , 25 , 30 , 35 , 40 s ) and the GUG-m showed LR(+ ) between 0.9 and 2.6 and LR(- ) between 0.1 and 1.0 . The GLORF showed an LR(+ ) of 2.8 and an LR(- ) of 0.6 and fall history showed an LR(+ ) of 2.4 and an LR(- ) of 0.6 . CONCLUSIONS in this population of frail older people , staff judgement of their residents ' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk . A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk . The grading of fall risk by GUG-m appears of very limited value Objective To determine the predictive value of the “ Timed Up & Go ” ( TUG ) , a vali date d assessment tool , on a prospect i ve cohort study and to compare these findings to the ASA classification , an instrument commonly used for quantifying patients ’ physical status and anesthetic risk . Background In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population . Methods 263 patients ≥70 years undergoing elective surgery for solid tumors were prospect ively recruited . Primary endpoint was 30-day morbidity . Pre-operatively TUG was administered and ASA-classification was registered . Data were analyzed using multivariable logistic regression analyses to estimate odds ratios ( OR ) and 95 % confidence intervals ( 95%-CI ) . Absolute risks and area under the receiver operating characteristic curves ( AUC ’s ) were calculated . Results 164 ( 62.4 % ) patients ( median age : 76 ) underwent major surgery . 50 ( 19.5 % ) patients experienced major complications . 50.0 % of patients with high TUG and 24.8 % of patients with ASA≥3 experienced major complications ( absolute risks ) . TUG and ASA were independent predictors of the occurrence of major complications ( TUG : OR 3.43 ; 95%-CI = 1.13–10.36 . ASA1 vs. 2:OR 5.67 ; 95%-CI = 0.86–37.32 . ASA1 vs. 3&4:OR 11.75 ; 95%-CI = 1.62–85.11 ) . AUCTUG was 0.66 ( 95%-CI = 0.57–0.75 , p<0.001 ) and AUCASA was 0.58 ( 95%-CI = 0.49–0.67 , p = 0.09 ) . Conclusions Twice as many onco-geriatric patients at risk of post-operative complications , who might benefit from pre-operative interventions , are identified using TUG than when using ASA Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear . This study aims to compare the  Berg Balance Scale ( BBS ) , Tinetti Mobility Score ( TMS ) , Elderly Mobility Scale ( EMS ) and Timed Up and Go test ( TUG )  in discriminating fallers from non-fallers in older people . Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in r and om sequence .  Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic , and 39 community-dwellers without fall history and whose age , sex and BMI matched those of the fallers . All subjects underwent the mobility and balance assessment within one day . Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS , TMS and TUG . The BBS demonstrated the best discriminating ability , with high sensitivity and specificity . The BBS item ` pick up an object from the floor ' was the best at screening fallers . Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller OBJECTIVES To assess whether the Timed Up and Go ( TUG ) is superior to gait speed in predicting multiple geriatric outcomes . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care clinics . PARTICIPANTS Adults aged 65 and older ( N=457 ) . MEASUREMENTS Baseline gait speed and TUG  were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) global health ; functional decline according to National Health Interview Survey ( NHIS ) activities of daily living ( ADLs ) score and SF-36 physical function index ; hospitalization ; and any falls and multiple falls over 1 year . RESULTS Mean age was 74 , and 44 % of participants were female . Odds ratios for all outcomes were equivalent for gait speed and TUG . Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability , gait speed and TUG each alone predicted decline in global health , new ADL difficulty , and falls , with no difference in predictive ability between performance measures . Neither performance measure predicted hospitalization , EuroQol decline , or physical function decline . As a continuous variable , TUG did not add predictive ability to gait speed for any outcome . CONCLUSION Gait speed predicts most geriatric outcomes , including falls , as does TUG . The time taken to complete TUG may not add to information provided by gait speed , although its qualitative elements may have other utility OBJECTIVE The objective of this study was to investigate efficacy of a whole-body vibration ( WBV ) intervention on functional performance of community-dwelling older adults . DESIGN The study was design ed as a r and omized controlled trial . SETTING The setting was in community centers . SUBJECTS There were 37 total subjects ( 21 women and 16 men ) ( age 69 + /- 8 years ; mean + /- st and ard deviation ) . INTERVENTION Participants were r and omized to a WBV intervention ( INT ) group and control ( CON ) group . Whole-body vibration was administered for five 1-minute bouts per session , 3 days per week , for 6 weeks . The CON group was asked not to commence any form of physical training . OUTCOME MEASURES Functional performance was measured with the timed-up- and -go-test ( TUG ) and sit-to-st and -test ( STS ) . RESULTS After WBV , TUG and STS time was less for INT than CON ( INT , TUG 7.6 + /- 0.3 seconds , STS 11.9 + /- 2.0 seconds ; CON , TUG 8.6 + /- 0.9 , STS 13.5 + /- 1.1 seconds ; p < 0.05 ) . Within INT , TUG improved 0.9 + /- 0.4 seconds ; p = 0.01 and STS improved 3.0 + /- 0.9 seconds ; p = 0.05 ) . CONCLUSIONS The efficacy of this WBV intervention was established . Functional performance improvement after WBV may be attributed to a number of biological mechanisms that remain speculative . Further research is required to mechanistically underst and the effects of WBV on older adults Furness , TP and Maschette , WE . Influence of whole body vibration platform frequency on neuromuscular performance of community-dwelling older adults . J Strength Cond Res 23(5 ) : 1508 - 1513 , 2009-The purpose of this study was to progressively overload vibration platform frequency to describe sea-saw whole body vibration influence on neuromuscular performance of community-dwelling older adults . Seventy-three community-dwelling older adults ( aged 72 ± 8 years ) were r and omly assigned to 4 groups ( zero , one , 2 , and 3 whole body vibration sessions per week ) . Quantifiers of neuromuscular performance such as the 5-Chair St and s test , the Timed Up and Go ( TUG ) test , and the Tinetti test were recorded . Furthermore , Health-related quality of life was qualified with the SF-36 Health Survey . A 6-week whole body vibration intervention significantly improved the quantifiers of neuromuscular performance in a community-dwelling older adult sample . Whole body vibration was shown to significantly reduce time taken to complete the 5-Chair St and s test ( p < 0.05 ) and the TUG test ( p < 0.05 ) . Tinetti test scores significantly improved ( p < 0.05 ) . as did all components of health-related quality of life ( p < 0.05 ) . Overall , progressively overloaded frequency elicited more beneficial improvement for the 3 whole body vibration sessions per week group . It was concluded that progressively overloaded frequency was effective in improving quantifiable measures of neuromuscular performance in the sample and that practitioners may confidently prescribe 3 whole body vibration sessions per week with more precise knowledge of the effects of whole body vibration on neuromuscular performance and health-related quality -of-life effects Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment BACKGROUND Falls and fall-related injuries are common in community-dwelling elderly people . Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls . METHODS In a cluster r and omized trial in 33 general practice s 378 people living independently and at high risk of falling ( 65 to 94 years old ; 285 women ) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises , combined with a 12 week home-based exercise program ( 222 participants ) , or to usual care ( 156 participants ) . The main outcome was number of falls over a period of 12 months . Secondary outcomes were the number of fall-related injuries , physical function ( Timed-Up- and -Go-Test , TUG , Chair-St and -Test , CST , modified Romberg Test ) , and fear of falling . RESULTS In the intervention group ( n=222 patients in 17 general practice s ) 291 falls occurred , compared to 367 falls in the usual care group ( n=156 patients in 16 general practice s ) . We observed a lower incidence rate for falls in the intervention group ( incidence rate ratio/IRR : 0.54 ; 95 % confidence interval ( CI ) : [ 0.35 ; 0.84 ] , p=0.007 ) and for fall-related injuries ( IRR : 0.66 ; [ 0.42 ; 0.94 ] , p=0.033 ) . Additionally , patients in the intervention group showed significant improvements in secondary endpoints ( TUG : -2.39 s , [ -3.91 ; -0.87 ] , p=0.014 ; mRomberg : 1.70 s , [ 0.35 ; 3.04 ] , p=0.037 ; fear of falling : -2.28 points , [ -3.87 ; -0.69 ] , p=0.022 ) compared to usual care . CONCLUSION A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries  in community dwelling older adults at risk Abstract Purpose : To review available evidence on older people ’s ability to get up off the floor independently and determine the effectiveness of interventions to improve older adults ’ ability to rise from the floor . Material s and methods : Seven data bases were search ed between January 1975 and June 2018 . Eligibility criteria included : people aged ≥60 ; interventions to improve strength/function including ability to get up off the floor  ( for intervention studies ) ; comparison groups ( for r and omized and nonr and omized controlled trials ) ; outcome : quantitative or qualitative evaluation of ability to get up off the floor . Selection of the studies was undertaken in three stages : ( 1 ) titles and abstract s were scanned by one review er , ( 2 ) full abstract screening by one review er , and ( 3 ) articles read in full by two review ers . Results of all articles are summarized and r and omized controlled trials ( RCT ) ( where possible ) were analyzed by meta- analysis to determine intervention effectiveness . Results : Forty-one studies met inclusion criteria . For each of the RCTs that utilized resistance training and /or teaching the skill , a reduction in time to get up off the floor were reported . However , meta-analyses of all RCT interventions indicated no significant change in time for older people to get up off the floor independently with intervention ( MD : –0.43[–1.38 , 0.51 ] ) . Sub-analyses of interventions utilizing resistance training showed an improvement trending towards significance ( MD : –0.81[–1.72 , 0.09 ] ) . Heterogeneity between studies was high , therefore results should be viewed with some caution . Conclusions : Resistance training interventions may improve  older people ’s ability to rise from the floor unassisted . However , knowledge of specific techniques to get up and the effect of simply practicing the task of getting off the floor need to be further explored . Implication for rehabilitation One in three older people living in the community fall each year One aspect of falling that is often overlooked is whether the older person can get themselves up off the floor independently or do they have to wait for assistance . Interventions that include resistance training may help the older person to be able to get up by themselves
Conclusion The Timed Up and Go test has limited ability to predict  falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting
Background The Timed Up and Go test ( TUG ) is a commonly used screening tool to assist clinicians to identify patients at risk of falling .
The purpose of this systematic review and meta- analysis is to determine the overall predictive value of the TUG in community-dwelling older adults .