Date of Award

2017

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Meridee Danks

Keywords

Aged -- psychology; Accidental Falls -- prevention & control; Postural Balance; Risk Assessment; Risk Factors

Abstract

Introduction: Falls are a leading cause of injury for older adults. Stepping On is one of many fall prevention programs in which individuals who have a fear of falling can participate. Stepping On is a 7 week multifactorial fall prevention program for community-dwelling adults age 65 and older. The program implements an exercise program and addresses education on mobility safety in the community and home. The program addresses how different fall risk factors impact function including diet, medication, vision, balance, and strength.

Purpose: The purpose of this study is to measure pre- and post-program fall risk with the Four Stage Balance Test (FSBT) and examine whether static balance improves Week 1 to Week 7. The study will assess whether identified fall risk by the CDC Fall Risk Checklist and past medical history correlates with fall risk identified by the FSBT. The study will also assess whether self-perceived balance, confidence, and physical activity level improve after the completion of Stepping On.

Methods: There were 3 participants in this study (2 female and 1 male) with a mean age of 87 years that were enrolled in the Stepping On program. Two participants completed the program. The FSBT was used to assess fall risk based on standing balance performance Week 1 and Week 7. The CDC Fall Risk Checklist and Week 1 Stepping On Baseline Questionnaire were used to identify fall risk based on past medical history and to identify self-perceived balance, confidence, and physical activity level. Other surveys and assessments used in conjunction to this study were the 30-second Sit to Stand (30secSTS), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC), and the Stepping On Exit Survey.

Results: From Week 1 to Week 7, Subject 1 increased tandem stance time by 22% and single leg stance time by 40%. Subject 2 had a 45% decrease in tandem stance time and 100% decrease in single leg stance time. Fall risk was identified for Subject 1 with single leg stance Week 1 and Week 7 and for Subject 2 with Week 1 and Week 7 single leg stance and Week 7 tandem stance. Fall risk identified by the CDC Fall Risk Checklist and past medical history inconsistently correlated with fall risk identified by tandem stance but consistently correlated with single leg stance when using age and gender normative data. Self-perceived balance improved in Subject 1, confidence remained the same in both Subjects, and physical activity level improved in both Subjects.

Conclusion: After the first 7 weeks, an increase in static balance measured by the FSBT occurred in 1 of the 2 participants. A longer duration between pre- and post-assessments may show greater improvement in balance. The FSBT as a whole does not consistently identify fall risk based on the CDC Fall Risk Checklist and past medical history. The clinical significance of this study suggests that the FSBT may not be the best to use in identifying fall risk with, the current test procedure and normative data. The small sample size (n=2), older participant age (mean age = 87 years), and participant past medical history may have influenced the results of this study. A 3 month follow up is planned to check in on the Subjects' reported progress.

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