Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury

• Published in: The journal of spinal cord medicine Vol. 38; no. 4; pp. 439 - 445
• Main Authors: Srisim, Kitiyawadee, Saengsuwan, Jiamjit, Amatachaya, Sugalya
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.07.2015; Maney Publishing
• Subjects: Accidental Falls; Adult; Aged; Ambulatory Care; Balance; Falls; Female; Humans; Male; Measurement; Middle Aged; Paraplegia; Risk; Spinal Cord Injuries - complications; Spinal Cord Injuries - diagnosis; Tetraplegia; Trauma Severity Indices; Falls; Measurement; Tetraplegia; Paraplegia; Balance
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1179/2045772313Y.0000000186

Background/objectives Many ambulatory patients with spinal cord injury (SCI) encountered multiple falls and serious consequences after falls, but there was no quantitative practical measure for early identification of individuals at a risk of multiple falls. This study compared the utility of the Berg Balance Scale, Timed "Up & Go" Test, 10-Meter Walk Test, Functional Reach Test (FRT), Step Test, and Five Times Sit-to-Stand Test to predict risk of multiple falls (fall ≥2 times) in these individuals. Methods Eighty-three independent ambulatory subjects with SCI were assessed for their functional abilities using the six tests. Then, their fall data were monitored prospectively every 2 weeks for 6 months in total. The first 25 subjects were also involved in the reliability tests. Results The FRT showed the best predictive ability for the risk of multiple falls (cut-off score ≥20 cm, sensitivity = 73%, specificity = 55%, area under the receiver characteristic curve = 0.64, and adjusted odd ratio = 3.18, P < 0.05), excellent inter-tester reliability, and good feasibility. Conclusions The FRT may be used as a screening tool to predict risk of multiple falls in independent ambulatory individuals with SCI. However, with a moderate level of specificity, a further comprehensive test may be needed to clearly indicate individuals at a risk of falls. In addition, the findings suggest that a higher level of ability increases the risk of multiple falls. Thus, programs for functional integration in an actual environment may be needed to reduce the risk of falls for these individuals.