My Grandma is one of my most favorite people. Over the past few years she has been in physical therapy a handful of times due to falls and I always ask her about what she does in physical therapy. After peppering her with questions each time, trying to make sure she is getting excellent care, I have learned no therapist has ever administered a falls risk or balance outcome measure. It makes me think that maybe that’s part of the problem. No one is evaluating if her balance is improving! Each time she begins a new round of therapy I am always shocked. Falls risk and balance outcome measures are readily available, easy to administer, and well researched. How come more therapists don’t use them?
Of the many reasons why outcome measures are not more commonly used, I chose four reasons to address within the scope of this project.
1. Therapists do not remember all of the cut points for falls risk measures or really how to interpret what the scores mean.
2. Therapists do not have the tests and score sheets readily available.
3. The longer tests are just more paper to deal with.
4. They did not develop the habit of using outcome measures early on in their career.
For my Capstone project, I decided to try and help lessen some of these reasons. Because habits begin early in practice, I decided to target students in my project. The material is meant to be supplemental material for PHYT 724 Measurement and Functional Assessment during the ‘ADL, Gait, and Functional Mobility Tools for Rehab’ lecture.
We are all taught about these outcome measures while in school. Personally, I had trouble remembering all of the details, so I created a booklet with the basics of each test that students can use while on clinical rotations or even when practicing. By keeping the booklet handy, students will have the basics of each test as well as information on how to interpret scores for each test easily available. Instructions for using the score sheets created for this project are also included. Click here to see the booklet. I would recommend printing the booklet on 2 pages per sheet and double sided to make the booklet easier to keep with you. There is also a corresponding PowerPoint that can be used for presentation purposes.
I’ve also created score sheets for each of the selected tests. The first group of tests below are the longer outcome measures that I have condensed. Each test score sheet is reduced down to one page to provide an easy way to administer and score each test without having to flip through multiple pages. In general, the therapist has the patient complete each task and mark the appropriate box. Each column on the score sheet is worth a certain point value. After the patient completes all of the tasks, simply total the points in each column and sum the column totals for the final score. The links to the score sheets are below.
Berg Balance Scale
Tinetti POMA
Tinetti Falls Efficacy Scale
Functional Gait Assessment
Dynamic Gait Index
The second group of score sheets are not as complex as the group of score sheets above and may not always be needed. However, I wanted to offer students a score sheet for each test discussed in the booklet. The links to these score sheets are below.
Timed Up and Go
Activities-Specific Balance Confidence Scale
10 Meter Walk
Six Minute Walk
Single Leg Stance
I’ve also included the handout that is now given in PHYT 724 that I used as an evidence table for my project. The handout was originally created by Karen McCulloch, PT, Ph.D., NCS, I simply added to it as I did my literature review. So a big thank you to Kmac for sending me the document to work with!
Thanks for visiting my Capstone project website! I’d also like to give a special thanks to my capstone adviser Mike Gross and committee members Karen McCulloch and Judy Blasko for their help! Because PHYT 724 is taken in the fall, I was unable to ask students to evaluate my project. Instead, I asked faculty to look at my project and provide any feedback they might have, so thank you to the faculty that provided feedback on my project!
23 Responses to “A Physical Therapy Student’s Toolbox For Assessing Falls Risk in Seniors”
llashley
Mike,
I have updated the tests and equipment to the best of my knowledge. Thank you for your help this semester!
-Lindsey
Mike Gross
Lindsey- very nice job on this. You might go through all of your tests to make certain that the instructions are complete for someone who is not that familiar with the test. Also do the same for the equipment needed. For example, I think there is a specific height needed for the step stoll that is used in the alternate stepping task. Mike
llashley
I just wanted to say thank you to everyone for viewing my project! Thanks for offering such great suggestions as to how to improve/expand this project and offering such encouraging feedback. I’m glad everyone found my project to be helpful! Thanks again!
-Lindsey
llashley
Susan,
Thanks for the complement! Fall prevention in seniors is a passion of mine as I’ve had multiple grandparents and great-grandparents fall. It’s crazy to me that something so simple like using an outcome measure to make sure a seniors balance is improving is so rarely used. My hopes is if all of the information is handy, balance measures will be used more often.
I hope your Grandmother’s balance improves with PT and stays safe!
-Lindsey
SusanR
Lindsey,
I love your project! Your booklet is an awesome idea and I can see it being used on clinical rotations. I have honestly administrated tests not remembering the cut offs and then have had to go and look them up once I was not with the patient. This did require more of my time but I thought it would be helpful to have the measurement. I really appreciate the MDC for different diseases! I know that next year’s students will appreciate having this handy!
On a side note, my grandmother has gone to PT multiple times for mainly upper extremity issues (due to falls) and no one has ever administered an outcome measure. I wish that her PTs would since they do not always listen to family when it comes to trying to reduce their risk of falls (removing area rugs or stop using ladders). I hope that your project encourages new graduates to use these measures because it would not only help you with treatment but can show a patient when/if things are changing and how to address the issue of safety.
Brittany
You did a great job on this project Lindsey. I love how you put it in a book almost like “Falls Assessments for Dummies”. I really think it is also important that you included which aspect of the ICF the function addresses. This is especially helpful if a patient asks why we are doing a test. Although PTs probably find it easy to relate to real life, it is also good to think about the reasoning a global way. This tool will also be very important as we become PTs and start our career. As Carol pointed out, falls risk assessments are used at an alarmingly low rate. If we, as students on our clinical rotations or new employes have a way to show the importance of screens and provide them with information at least we have eliminated one barrier to providing screens.
You did a fantastic job on this project and I really appreciate that you gave us this toolbox.
Brittany
Katie Ollendick
Nice work Lindsey. I just did the older adult movement lab with the first years so these measures are fresh in my mind and I think you have offered an easy way for future clinicians to access these tools. Well done.
aishaj
Lindsey,
This is such a great project. It one of those obvious needs for students, but it takes someone with initiative to make it. The booklet is a great way to keep the information handy during rotations and easy enough to introduce and pass off to CIs who may be interested. Great job!
Aisha
llashley
Thanks Ashley! I’m glad it will be helpful for you in your future practice!
-Lindsey
atortori
WOW!!! Lindsey!
I love your project! After our functional assessment class when I went on our 2 second year rotations I was so surprised to see how seldom outpatient clinics used balance measures. Plus, if they did i was the same one over and over regardless of the patient population. When I asked about this they usually did not know how to perform it correctly, didnt have a copy, didnt know the norms and/or didnt know about it at all. I think your capstone easily solves all of these issues! have already saved a copy of your booklet for future use and look forward to sharing it in the future! thanks and GREAT JOB!
Ashley
llashley
**would be very beneficial.
Sorry about the typo
llashley
Carol,
Thanks for the feedback. Adding test instructions to the booklet you be very beneficial and a great way to improve the project. Although they are on some of the score sheets and in the PowerPoint, I should’ve included instructions in the booklet as well since that is what people would keep. Thanks again!
-Lindsey
Carol Giuliani
Lindsey
Excellent job putting together all this information so it is easily accessible. I certainly agree with you about the lack of standardized falls screening and assessments used by clinicians. Hopefully your efforts will help in this regard. My only suggestion would be to include the instructions for conducting the test. For example, the TUG must have at least 6 variations for instructions and how it is timed. That concerns me about reliability and the appropriate cut off value. A great start and I think, as Vicki suggested, a document we could keep up as new information is available. Again a valuable tool for students and clinicians.
llashley
Vicki,
Yes, only the average norms were provided. It’s a great idea to include standard deviations, I’ll have to look into that. Thanks for the tip!
-Lindsey
Judy Blasko
Nice job Lindsey- You are so organized and detail oriented, that this project was a perfect fit for you. I will print this off and offer this to all our therapists here. It is so helpful to have the interpretations of our findings clearly defined, at our fingertips. A big help on busy days of treating multiple patients with multiple diagnoses.
kevolker
Lindsey, this is fantastic! The booklet you put together will be so useful in the clinic. I wish I had had something like this on my previous rotations, but I will definitely be printing it out for future use. It is really nice that you included some score interpretation along with MCID information regarding the tests because that is helpful when writing goals for patients. And your score sheets for tests will be useful too. Thanks, well done!
Katie V.
akinsey
Wow Lindsey, great job! With so much material and evidence existing for outcome measures for falls, every single PT should be using them. And now with this handout, there is no excuse!! This booklet is a fantastic resource for students and clinicians. You did a nice job putting things together in a sensible, easy-to-read way. I will definitely be taking a copy of this into clinic. Nice work!!
Alicia
jkschult
Lindsey,
This is great! I have been wanting to have all this information organized as well. I think this will help me to more easily implement outcome measures when working in the clinic.
Thanks!!
Jennifer
kamccall
Thanks Lindsey!! I’m very greatful for this project. I have “intended” to keep track of all these great tools somehow, ever since we started learning about them and of course never got around to it. This will come in very handy down the road as a quick reference!
chhill
Great project! Speaking as a practicing clinician, your products could definitely improve the ease in administering and interpreting the outcome measures. I concur with the barriers you listed for using outcome measures and this toolbox helps to overcome them. I agree with Vicki that normative data by age group and standard deviations would be helpful where available. I really like the condensed scoring sheets you made and plan to put them to use!
Carla
Vicki Mercer
Really nice project! Seems like something that could be updated and expanded (with additional instruments) from year to year. In the booklet, I’m wondering whether it might be helpful to add a little more explanation about odds ratios (how to interpret) and normative data for the different age groups (for the instruments for which this is available). For the norms, are only the mean values provided? If standard deviations are published, I think it would be helpful to include those as well. Great work Lindsey!
ssites
Great capstone lindsey!! Thank you so much for creating such a convenient handbook for students and clinicians to use in the clinical setting! I’m with you, it’s hard to keep track of the many outcome measures that we learn about in school. What a great idea for putting them all in one convenient location. I think it’s going to be something highly used and will help future students to better learn the material. Great job including research to support each outcome measure too. Very organized and well thought out project.
Katie
mcculloc
This looks great, Lindsey. I absolutely love your picture with your grandmother. Its easy to see where your passion for working with older adults comes from. I am so appreciative to you for improving the materials that we’ll use in the 724 course…I’m not sure if I’ll be teaching it in the fall or not, but depending on where you are – who knows, maybe you could make a guest appearance? Great job!!!!