Mobility Assessment: Sensitivity and Specificity of Measurement Sets in Older Adults

• Published in: Archives of physical medicine and rehabilitation Vol. 92; no. 6; pp. 905 - 912
• Main Authors: Panzer, Victoria P., PhD, Wakefield, Dorothy B., MS, Hall, Charles B., PhD, Wolfson, Leslie I., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2011; Elsevier
• Subjects: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Biomechanical Phenomena; Diseases of the osteoarticular system; Elderly; Female; Geriatric Assessment; Humans; Male; Medical sciences; Miscellaneous; Mobility limitations; Movement; Outcome measures; Physical Medicine and Rehabilitation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Sensitivity and Specificity; Task Performance and Analysis; community-dwelling elders; Timed Up & Go; CDE; COP; Mobility limitations; ROC; TUG; Outcome measures; ICC; ADL; SPPB; Sensory Organization Test; Geriatric assessment; Performance Oriented Mobility Assessment; activities of daily living; POMA; intraclass correlation coefficient; SOT; Rehabilitation; center of pressure; receiver operating characteristic; Elderly; Short Physical Performance Battery; Human; Performance evaluation; Prognosis; Mobility; Reeducation; Limitation; Orthopedics; Adult
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2011.01.004

Abstract Panzer VP, Wakefield DB, Hall CB, Wolfson LI. Mobility assessment: sensitivity and specificity of measurement sets in older adults. Objective To identify quantitative measurement variables that characterize mobility in older adults, meet reliability and validity criteria, distinguish fall risk, and predict future falls. Design Observational study with 1-year weekly falls follow-up. Setting Mobility laboratory. Participants Community-dwelling volunteers (N=74; age, 65–94y) categorized at entry as 27 nonfallers or 47 fallers by using Medicare criteria (1 injury fall or >1 noninjury fall in the previous year). Interventions None. Main Outcome Measures Test-retest and within-subject reliability, criterion and concurrent validity; predictive ability indicated by observed sensitivity and specificity to entry fall-risk group (falls status), Tinetti Performance Oriented Mobility Assessment (POMA), computerized dynamic posturography Sensory Organization Test (SOT), and subsequent falls reported weekly. Results Measurement variables were selected that met reliability (intraclass coefficient of correlation >.6) and/or discrimination ( P <.01) criteria (clinical variables: turn steps and time, gait velocity, step-in-tub time, downstairs time; forceplate variables: quiet standing Romberg ratio sway area, maximal lean anterior-posterior excursion, sit-to-stand medial-lateral excursion, sway area). Sets were created (3 clinical, 2 forceplate) using combinations of variables appropriate for older adults with different functional activity levels, and composite scores were calculated. Scores identified entry falls status and concurred with POMA and SOT scores. The full clinical set (5 measurement variables) produced sensitivity of 80% and specificity of 74% to falls status. Composite scores were more sensitive and specific overall in predicting subsequent injury falls and multiple falls compared with falls status and POMA or SOT score. Conclusions Sets of quantitative measurement variables obtained with this mobility battery provided sensitive prediction of future injury falls and screening for multiple subsequent falls by using tasks that should be appropriate to diverse participants.