Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests

Yoshiro Okubo; Daniel Schoene; Maria Jd Caetano; Erika M Pliner; Yosuke Osuka; Barbara Toson; Stephen R Lord

doi:10.1016/j.arr.2020.101238

Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests

Ageing Res Rev. 2021 Mar:66:101238. doi: 10.1016/j.arr.2020.101238. Epub 2020 Dec 24.

Authors

Yoshiro Okubo¹, Daniel Schoene², Maria Jd Caetano³, Erika M Pliner⁴, Yosuke Osuka⁵, Barbara Toson⁶, Stephen R Lord³

Affiliations

¹ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia. Electronic address: y.okubo@neura.edu.au.
² Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany; Robert-Bosch Hospital, Department of Geriatric Rehabilitation, Stuttgart, Germany.
³ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia.
⁴ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
⁵ Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
⁶ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Flinders Centre for Epidemiology and Biostatistics (FCEB), College of Medicine & Public Health, Flinders University, Adelaide, Australia.

PMID: 33352293
DOI: 10.1016/j.arr.2020.101238

Abstract

Objective: To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.

Data source: PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.

Study selection: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).

Results: A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I² 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.

Conclusions: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.

Keywords: Accidental falls; Aged; Meta-analysis; Stepping; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Exercise Test*
Humans
Postural Balance*
Risk Factors