[The German version of the Falls Efficacy Scale-International Version (FES-I)]

Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements

Objective: The aim is to examine the validity and reliability of the Timed Up and Go Test with dual task for predicting the risk of falls. Standard values for the TUG with dual task were determined, taking account of age and gender.

Design: Validation study

Setting: Data was recorded for 120 volunteers in an outpatient physiotherapy centre.

Subjects: The sample comprised 120 healthy men and women aged 60 to 87 years living at home. Twenty-three subjects selected at random were tested again, after one day and after one week, in order to ascertain the retest reliability.

Main measures: Berg Balance Scale, times for Timed Up and Go Test with manual dual task (TUGman) and with cognitive dual task (TUGcog).

Results: Strong correlations between the TUGman and the BBS (r = -0.72) and between the TUGcog and the BBS (r = -0.66) indicate high criterion validity. The retest reliability of the TUGman (rT1-T2 = 0.97 and rT1-T3 = 0.98) and TUGcog (rT1-T2 = 0.98 and rT1-T3 = 0.98) is very good. The intra-rater reliability is very high with an ICC = 0.99 for the TUGman and an ICC = 0.94 for the TUGcog. The mean time needed to perform the TUGman is 11.6 s (95% CI 11.2—11.9); the mean time needed to perform the TUGcog is 9.8 s (95% CI 9.5—10.2).

Conclusions: The tests with dual task can be recommended because they possess high criterion validity and very good retest reliability. Faster and simpler performance of the TUG-DT is another factor in its favour.

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]

Background

Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted.

Methods

The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs.

Conclusion

A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme.

Trial registration

Current Controlled Trials ISRCTN58562962.

Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale

BACKGROUND

Persons with spinal cord injury who are able to walk are at risk for falls.

OBJECTIVE

The objectives were to investigate if the Berg Balance Scale (BBS) can discriminate those with a propensity to fall; to determine whether the BBS is associated with mobility measures, fear of falling, and muscle strength; and to assess interobserver reliability.

METHODS

The measurement tools used were the BBS, the Spinal Cord Independence Measure, the Falls Efficacy Scale (FES-I), the Walking Index for Spinal Cord Injury, the 10-m walk test, and the standard neurological classification including motor scores (MS). Falls were recorded retrospectively for the previous month and prospectively for the subsequent 4 months. To determine interobserver reliability, BBS performance was videotaped and analyzed by additional physical therapists. Associations between BBS and the number of falls, measures of mobility, FES-I, and MS were calculated using Spearman correlations. The interobserver reliability was quantified using Kendall's coefficient of concordance and intraclass correlation coefficients (ICCs).

RESULTS

Forty-two participants were included of whom 26 sustained 1 or more falls. BBS performance correlated with measures of mobility, FES-I, and MS (r(s) = -.83 to .93; P < .001) but not with the number of falls (r(s) = -.17; P = .28). The interobserver reliability was excellent, both for single items (.84-.98, P < .001) and for the total score (ICC = .95; 95% confidence interval = 0.910-0.975).

CONCLUSIONS

The BBS proved to be reliable and to relate well with other mobility measures, fear of falling, and muscle strength. However, it was unable discriminate between people who did fall and people who did not fall.

[German adaptation of the "Activities-Specific Balance Confidence (ABC) scale" for the assessment of falls-related self-efficacy]

The present study investigates the psychometric properties and the factorial structure of the German adaptation of the Activities-Specific Balance Confidence (ABC) scale (Powell & Myers, 1995) for the evaluation of falls-related self-efficacy in community-dwelling older adults. The German adaptation of the ABC using a forward-backward procedure was administered to 113 older adults (age 68.9+/-8.5 years). The following internationally accepted instruments were used for validation: The Short Form Health Survey SF 36, the Geriatric Depression Scale (GDS), the Trail Making Test and the Letter Number Sequencing Test, and motor tests (balance, strength, mobility). The internal consistency (0.91-0.95) as well as the test-retest reliability of the subscales was excellent (0.94-0.98). The correlation coefficients with the validation instruments ranged between 0.33 and 0.58. Significant differences in the ABC-D scores were found in older adults with and without falls. Older adults with a recent fall history scored lower on the ABC-D than older adults without a recent fall history. To conclude, the German version of the ABC has properties analogous to the original English version and is apparently useful in assessing falls-related self-efficacy.