Physical Performance Tests for Fall Risk Assessment

Physical Performance Tests for Fall Risk Assessment

By: Anthony Augliera, SPT

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Background:

Over the course of my Doctor of Physical Therapy education at UNC Chapel Hill, I have developed an interest in treating balance, gait, and mobility deficits in older adults. While on clinical in a retirement community setting, and through volunteer work with community-based fall prevention programs, I have had the opportunity to participate in numerous fall screenings. During each of these experiences, physical performance tests have been employed to assess fall risk and determine appropriate intervention. However, on many occasions, I have witnessed varying administration of commonly used physical performance tests. Poor adherence to testing protocols and differences in interpretation of results can misguide interventions or result in a failure to detect high fall risk individuals. It is my hope that this capstone project will address the visible need for a standardized and consistent approach to physical performance testing.

Statement of Need:

Falls in the older adult population are a major public health concern. Approximately 30% of adults over 65-years-old experience a fall annually^{1, 2}. Additionally, the incidence of falls and fall-related injuries increases with age². Injuries resulting from falls not only cause disability and loss of function, but may also lead to serious complications and even death¹. Efforts in the clinic have been made to predict and prevent falls and fall-related injuries, and research shows physical performance tests are useful predictors of fall risk¹. Additionally, evidence-based interventions have been shown to prevent falls in older adults, but are reliant on determining modifiable risk factors associated with falls¹. However, fall risk assessment is not standardized within or across settings³. Inconsistent protocols, errors in delivery, and misinterpretation of results affect precision and reproducibility, and contribute to the failure of fall prevention strategies^{3, 4}.

Project:

The purpose of this capstone project is to provide clinicians with an online educational resource detailing the proper implementation and interpretation of common physical performance tests used for fall risk assessment. The narrated module will be available for healthcare providers to view prior to incorporating physical performance tests into community-based fall prevention programs. A post-module evaluation will measure knowledge gained from the module, with results from the evaluation collected for continuing education purposes. Lastly, an annotated bibliography of primary sources was created to provide clinicians with additional resources and information about common physical performance tests, clinical effectiveness, and feasibility.

Products:

Physical Performance Tests for Fall Risk Assessment- Online Training Module

Post-module Evaluation (PDF Version)

Annotated Bibliography of Primary Sources

Associated Work:

For comprehensive training and education regarding fall risk assessment and intervention, my Physical Performance module can be viewed in conjunction with my classmates’ modules: Carly Bernadotte’s “Falls Risk Assessment and Intervention in Community-Dwelling Older Adults” and Kristin Wright’s “Demographic and Self-Report Measures and Cognitive Screening for Falls Risk Assessment.”

After proper fall risk assessment has been conducted, it is important for clinicians to select appropriate and effective interventions specific to individual needs. For my Evidence Based Practice II course, I investigated fall prevention interventions through the PICO question:

“In an 87-year-old male with a history of falls, is eccentric resistance exercise more effective than traditional resistance exercise for increasing strength and preventing falls?”

Though limited by available evidence in this topic area, I was able to conclude that lower extremity strengthening is a proven method to counteract age-related atrophy and reduce falls. Additionally, eccentric resistance exercise has the same effects on strength, balance, and fall reduction as traditional resistance exercise, suggesting this form of strength training is useful for older adults unable to tolerate traditional strength training. A more in depth review of the research can be found in my Critically Appraised Topic.

Self-Reflection:

Developing this module provided me with valuable opportunities to collaborate with peers and physical therapy professionals across the state of North Carolina. I had the opportunity to attend CHAMP, a comprehensive community-based fall prevention program in western North Carolina, where I was able to administer physical performance tests and discuss with other healthcare providers ways to improve training for physical performance testing. Overall, I am pleased with the online educational module that I have created, and feel that I was able to incorporate suggestions from healthcare providers at CHAMP into the presentation. One main goal that I had for this project was to film realistic videos of physical performance tests being delivered to participants. I am thankful that I was able to concisely and accurately explain testing protocols in these videos, and feel that they are a great visual learning aid that supplements the written information in the presentation.

This module will be accessible online at any healthcare providers convenience, however, I do wish that I could have presented the training module at a CHAMP event. While I typically do not jump at the opportunity for public speaking, presenting this material would have allowed me to determine in real time its effectiveness for training providers. However, after having such a positive experience working with CHAMP volunteers and participants, I certainly plan to volunteer at future screenings, where I will be able to speak with providers who have viewed the training module.

Acknowledgements:

I would like to especially thank Vicki Mercer, PT, PhD for providing me with the opportunity to join her project of creating online educational training modules for healthcare providers. This project could not have been completed without her vision, patience, thoughtful suggestions, and continuous feedback.

I would like to thank Ann Chamberlin, PT for providing me with reassurance and suggestions for improvement. As my clinical instructor at Carol Woods Retirement Community, Ann facilitated my interest and passion for working with the geriatric population. I am thankful for the opportunities I was provided to practice fall risk assessment and intervention.

I would also like to thank Dale Hamilton, PT, DPT, Cert. Aging, for his constructive feedback and the time he devoted to helping me refine this project into what it is today.

Thank you to my fellow classmates, Carly Bernadotte and Kristin Wright, for countless meetings, phone calls, and e-mails filled with valuable suggestions to ensure our modules were an accurate and unified training tool. Additionally, thank you to Martha Zimmerman, MEd, PT, and all of the healthcare providers at CHAMP for welcoming me into your facilities and providing me with suggestions to incorporate into my training module. Finally, I would like to thank Erica Rothman, her team at Night Light Video, and the video participants for their dedication, patience, and enthusiasm throughout the filming process.

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References:

1. Chun, S. H. (2017). Performance on physical function tests and the risk of fractures and admissions: Findings from a national health screening of 557,648 community-dwelling older adults. Archives of Gerontology and Geriatrics, 68, 174-180. doi:10.1016/j.archger.2016.10.008
2. Rosengren, B. E., et al (2012). Inferior physical performance test results of 10,998 men in the MrOS Study is associated with high fracture risk. Age and Ageing, 41(3), 339–344. http://doi.org/10.1093/ageing/afs010.
3. Perell, K., et al (2001). Fall Risk Assessment Measures: An Analytic Review. The Journals of Gerontology, 56(12): 761–766. https://doi.org/10.1093/gerona/56.12.M761.
4. Roberts, H., et al (2011). A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and Ageing, 40(4): 423–429.
5. Image: https://www.swimoutlet.com/p/accusplit-pro-survivor-a601x-stopwatch-2813/