Impaired ankle inversion proprioception during walking is associated with fear of falling in older adults

Abstract

BackgroundAnkle proprioception plays a critical role in lower limb movement control. However, the relationship between ankle proprioception and fear of falling (FOF) in older people is still unclear.Objective(1) This study aims to develop a new device for measuring ankle inversion proprioceptive discrimination sensitivity during walking, i.e., the Ankle Inversion Discrimination Apparatus–Walking (AIDAW), and assess the test–retest reliability of the AIDAW in both young and older adults; (2) to evaluate the discriminant validity of the measure by comparing ankle proprioception during walking between the two groups; and (3) to explore convergent validity by determining to what extent the AIDAW proprioceptive scores correlate with Fall Efficacy Scale-International (FES-I) scores.Materials and methodsThe AIDAW was purpose-built to test ankle inversion proprioceptive discrimination sensitivity during walking. The area under the receiver operating curve (AUC) was calculated as the proprioceptive discrimination score. In total, 54 adults volunteered. Test–retest reliability was evaluated in 12 young and 12 older adults, and another 15 young and 15 older adults completed the comparison study. FOF was assessed by using the FES-I.ResultsThe test–retest reliability intraclass correlation coefficient ICC (3,1) value for the whole group was 0.76 (95% CI: 0.52–0.89). The ICC values of the young and older groups were 0.81 (95% CI: 0.46–0.94) and 0.71 (95% CI: 0.26–0.91), respectively. The Minimal Detectable Change with 90% confidence (MDC90) values for the young and older groups were 0.03 and 0.11, respectively. There was a significant difference between the AIDAW proprioceptive sensitivity scores for the young and older groups (0.78 ± 0.04 vs. 0.72 ± 0.08, F = 5.06, p = 0.033). Spearman’s correlation analysis showed that the FES-I scores were significantly and negatively correlated with the AIDAW scores (rho = −0.61, p = 0.015), with higher FOF associated with worse ankle proprioception.ConclusionThe AIDAW is a reliable and valid device for measuring ankle proprioception during walking in both young and older adults. Ankle inversion proprioceptive discrimination sensitivity during walking was found to be impaired in the elderly compared to young adults. This impairment was found to be strongly associated with FOF, suggesting that assessment and intervention for ankle proprioception in this population are needed to reduce the risk of falls.

Association between falls and musculoskeletal pain among middle-aged and older adults: Findings from the China health and retirement longitudinal study

“…Our ndings con rmed that musculoskeletal pain was signi cantly associated with risk of falls, aligning with similar reports in studies of other populations involving different pain sites [21,23,24,[31][32][33]. A number of speci c pain sites can increase the risk of falls particularly in older people.…”

“…For example, people experiencing waist pain often have impaired central proprioceptive processing and decreased ankle proprioception, which can result in underestimating the extent of ankle inversion and a fall [31,32]. Pain in the waist and lower limbs including leg, knee, and ankle can also in uence lower limb proprioception, muscle strength, joint stability, reactive balance, and fear of falling, all of which may increase falls risk [21,23,24,33]. Interestingly and different to other studies, we found a signi cant relationship between nger pain and the incidence of falls in our study population.…”

Risk factors analysis of falls due to musculoskeletal pain in Chinese middle-aged and elderly people based on 2018 CHARLS data

“…Musculoskeletal pain in uencing risk of falls Our ndings con rmed that musculoskeletal pain was signi cantly associated with risk of falls, aligning with similar reports in studies of other populations involving different pain sites [20,22,23,[30][31][32]. A number of speci c pain sites can increase the risk of falls particularly in older people.…”

“…For example, people experiencing waist pain often have impaired central proprioceptive processing and decreased ankle proprioception, which can result in underestimating the extent of ankle inversion and a fall [30,31]. Pain in the waist and lower limbs including leg, knee, and ankle can also in uence lower limb proprioception, muscle strength, joint stability, reactive balance, and fear of falling, all of which may increase falls risk [20,22,23,32]. Interestingly and different to other studies, we found a signi cant relationship between nger pain and the incidence of falls in our study population.…”

Reliability and validity of the ankle inversion discrimination apparatus during walking in individuals with chronic ankle instability

“…In order to calculate the AIDAW proprioceptive discrimination sensitivity score, the raw data of the 40 randomly assigned ankle inversion positions and their associated participant responses were entered into a 4 4 matrix representing the frequency with each response was made to each stimulus. Then the true positive rate (sensitivity) and the false positive rate (1-specificity) were calculated ( Shao et al, 2022 ). The ROC curve is the plot of sensitivity against specificity.…”