Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents
Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents
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DOI：
10.1093/gerona/51a.5.m239
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发表时间：
1996-09-01
影响因子：
5.1
通讯作者：
Ray, WA
中科院分区：
文献类型：
--
作者：
Thapa, PB;Gideon, P;Ray, WA
背景。我们评估了田纳西州 12 家社区疗养院的一组体弱老年流动居民的生物力学和临床平衡测量预测未来复发性跌倒风险的能力。方法。对 303 名流动疗养院居民进行了平衡和其他潜在跌倒危险因素的基线测量。平衡测量包括姿势摇摆的生物力学力平台测量（面积椭圆和平均速度）和临床测量，其中包括功能范围、Tinetti 平衡子量表（改编自 Tinetti 的性能导向活动指数）、定时椅子站立和 10 英尺步行。根据疗养院事件报告和护理记录，确定了在随访期间（平均 11 个月）跌倒两次或两次以上的居民。平衡措施的预测价值通过比例风险模型估计的发生密度比（IDR）进行评估。结果。反复跌倒者 118 人（每 100 人年 54.2 人）。反复跌倒的发生率随着平衡生物力学和临床测量五分位数的增加而增加，面积椭圆每五分位数变化的未调整 IDR (95% CI) 为 1.22 (1.07-1.39)，姿势摇摆平均速度为 1.12 (0.98-1.27)，Tinetti 平衡子量表为 1.29 (1.13-1.47)，定时步行为 1.24 (1.08-1.41)，定时椅子站立为 1.24 (1.09-1.42)，功能性伸展为 1.12 (0.98-1.28)。控制年龄、性别、身高和体重并不会显着影响平衡测量五分位数与随后反复跌倒之间的线性关系。然而，在控制其他跌倒风险因素后，只有姿势摇摆面积椭圆和 Tinetti 平衡子量表仍然独立预测随后的复发性跌倒率，IDR 分别为 1.16 (1.02-1.36) 和 1.17 (1.01-1.34)。在一项分析中，受试者按这两项指标的三分位数进行分层，每项指标似乎都能独立预测未来的复发性跌倒率。在多变量分析中控制其他跌倒风险因素后，每项措施的独立预测能力仍然存在，面积椭圆的 IDR 为 1.15 (1.00-1.32)，Tinetti 平衡子量表的 IDR 为 1.15 (1.00-1.32)。将两种平衡措施与其他跌倒风险因素纳入模型中以评估它们的关系，并没有实质性改变这些风险因素的 IDR 点估计。结论。在这群身体虚弱的疗养院居民中，姿势摇摆面积椭圆和蒂内蒂平衡分量表都独立预测了未来反复跌倒的风险。然而，其他独立跌倒风险因素对未来反复跌倒风险的预测价值仍然存在，并且不能用这两项指标来解释。因此，无论是研究还是临床实践，基于替代终点的患者跌倒风险评估可能需要包括多种测量。
Background. We evaluated the capacity of biomechanical and clinical measures of balance to predict future risk of recurrent falls in a cohort of frail, elderly ambulatory residents of 12 Tennessee community nursing homes.Methods. Baseline measurements of balance and other potential fall risk factors were obtained in 303 ambulatory nursing home residents. Balance measures included biomechanics force platform measurements of postural sway (area ellipse and mean velocity) and clinical measures, which included functional reach, Tinetti balance subscale (adapted from Tinetti's Performance Oriented Mobility Index), timed chair stands, and 10-foot walk. Residents who fell two or more times during follow-up (mean of 11 months) were identified from nursing home incident reports and nursing notes. The predictive value of the balance measures was evaluated by the incidence density ratio (IDR) estimated from proportional hazards models.Results. There were 118 recurrent fallers (54.2 per 100 person-years). Rates of recurrent falls increased with increasing quintiles of both the biomechanical and clinical measures of balance, with unadjusted IDRs (95% CI) per quintile change of 1.22 (1.07-1.39) for area ellipse, 1.12 (0.98-1.27) for mean velocity of postural sway, 1.29 (1.13-1.47) for the Tinetti balance subscale, 1.24 (1.08-1.41) for timed walk, 1.24 (1.09-1.42) for timed chair stands, and 1.12 (0.98-1.28) for functional reach. Controlling for age, gender, height, and weight did not materially affect the linear relationship between the balance measure quintiles and subsequent recurrent falls. However, after controlling for additional fall risk factors, only area ellipse of postural sway and the Tinetti balance subscale remained independently predictive of subsequent recurrent fall rates, with IDRs of 1.16 (1.02-1.36) and 1.17 (1.01-1.34), respectively. In an analysis where subjects were stratified by tertiles of each of these two measures, each measure appeared to independently predict future rates of recurrent falls. The independent predictive capacity of each measure persisted after controlling for other fall risk factors in a multivariate analysis with IDRs of 1.15 (1.00-1.32) for area ellipse and 1.15 (1.00-1.32) for the Tinetti balance subscale. Inclusion of both balance measures in a model with other fall risk factors to evaluate their relationship did not materially alter IDR point estimates of these risk factors.Conclusions. In this cohort of frail, nursing home residents, both area ellipse of postural sway and the Tinetti balance subscale independently predicted risk of future recurrent falls. However, the predictive value of other independent fall risk factors on risk of future recurrent falls persisted and was not explained by these two measures. Thus, assessment of patient fall risk based on surrogate endpoints, for either research or clinical practice, may need to include multiple measurements.