This study aimed to examine trial-to-trial reliability of a new clinical test, rapid reaction step cued on a screen test, and its relationship with fall risk score, independence in activity of daily living score, and various leg muscle function tests. One-hundred fifty seven older women participated in this study. Nine square plates (32 × 32 cm) were lined up with three plates. Participants stood on a center plate and were instructed to step, using one leg, to one of the other eight plates, as quickly as possible, when that plate changed in color from white to red. The mean total time and the mean total error time of rapid reaction step cued on a screen and, fall risk score, activity of daily living score, lower muscle function (isometric muscle strength: toe flexion, plantar flexion, knee extension, hip flexion; balance: one leg standing time with eye open, functional reach test; gait: 10 m walk time with maximal speed). Results: trial-to-trial reliabilities of step parameters were high (intraclass correlation coefficient [ICC] = 0.75 - 0.85). The step parameters correlated significantly with the other parameters except for toe flexion and hip flexion strengths. In conclusion, the present step test was found to evaluate physical function related to prevention of falls in older people.
In most countries with an aging society, the primaryprevention of bedridden and other elderly persons unable to care for themselves was critical issue. To achieve successful aging, emphasis should be placed on improving independence in daily living rather than seeking perfect health. Falls in older people produce physical and psychological trauma, loss of independence, or even death, and is a serious problem in terms of decreasing quality of life [
Falls occur due to a complex combination of factors such as physiological function level, visual acuity and hearing, disease and disorder, cognitive function, medication, home environment, and age [2,3]. On the other hand, fall prevention intervention for the older living in self-reliant attach importance to improve physical fitness related fall prevention.
Physical function is a modifiable risk factor in every older individual and contributes greatly to falls. Particularly, it was reported that a decrease in leg muscle strength, gait and balance ability all have a higher relative risk ratio (RR = 4.4, 2.9, and 2.9, respectively) [
However, falls occur when a stable body posture cannot be maintained due to accidental disturbance [
The stepping strategy of avoiding a fall requires rapid postural control and quick step. From this view point, previous studies proposed several voluntary stepping tests, such as repeated stepping on the spot with maximal effort [10-12] and stepping to forward, backward, left and right directions (Four square stepping) [19,20]. However, they are also insufficient for assessing the stepping strategy since they are limited to a single task. Melzer et al. [
However, the tempo step test is not enough of a disturbance stimulus for assessing stepping strategy, because the step patterns are determined in advance. In addition, avoiding a fall depends not only on a person’s sensory motor function and balance ability, but also on a perception of dangerous signs of falling and the proper responses to keep body posture [
Based the above, we developed a new step test which requires participants to rapid step in random directions along with a fixed tempo (rapid reaction step cueing by a screen), as a balance task combined with a visuospatial secondary task would properly evaluate the ability to avoid falls.
It is hypothesized that the reliability of the step test are good, and can evaluate both the fall risk scores and independence in activity of daily living scores, rather than various other leg muscle functions. Thus, the step test may be useful to evaluate the ability of fall avoidance in a clinical setting.
This study aimed to examine the trial-to-trial reliability of this test and its relationship with the fall risk score, independence in activity of daily living score, and various leg muscle function tests in older women.
One-hundred fifty seven older women aged 65 - 87 years (Age: 72.0 ± 6.7 years, Height: 148.3 ± 6.3 cm, Body mass: 51.9 ± 6.3 kg) living independently in a community dwelling participated in this study. The participants were selected based on the following criteria: ambulatory without walking aid and no visual problem in visible colors. The participants have taken part in a weekly light exercise program (stretch exercise for 15 minutes) for over a year. Informed consent was obtained from each participant after a full explanation of the experimental project and its procedure. This study received approval from the Kanazawa University ethical committee.