One-Legged Balance Performance and Fall Risk in Mid and Later Life: Longitudinal Evidence From a British Birth Cohort

Blodgett, Joanna M.; Hardy, Rebecca; Davis, Daniel; Peeters, Geeske; Kuh, Diana; Cooper, Rachel

doi:10.1016/j.amepre.2022.07.002

Cited by 12 publications

(23 citation statements)

References 62 publications

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“…Additionally, evidence consistently shows that interventions targeting balance exercises effectively reduce fall risk confirming a clear role of balance ability in fall mechanisms ( 3 , 4 ). Previous investigation in this cohort has identified relatively strong and consistent population level associations between poorer one-legged balance performance and increased odds of recurrent falls, which were sustained after adjustment for socioeconomic, health, behavioural or cognitive factors ( 23 ). However, these new findings demonstrate that this does not translate to prediction of falls at an individual level.…”

Section: Discussionmentioning

confidence: 63%

“…Analyses were conducted in two stages: (1) Given no previous evidence of sex differences in association between one-legged balance performance and falls in this study population (23), males and females were included in the same model, with sex included as a covariate.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals who responded affirmatively were subsequently asked how many times they had fallen; this was recorded on a continuous scale at ages 60–64 and 68 and categorically at age 53 (0,1–2, 3+). Given stronger associations between one-legged balance performance and recurrent rather than single falls in this cohort ( 23 ), we focused on recurrent falls (0–1 vs. 2+ falls) as the main outcome. Results for any fall (0 vs. 1+ falls) are presented in Supplementary material .…”

Section: Methodsmentioning

confidence: 99%

“…Results for any fall (0 vs. 1+ falls) are presented in Supplementary material . Up to 2,508 participants with data on at least one measure of balance time and reported falls at a follow-up wave were included; detailed information on sample size including those who completed balance assessments and fall questionnaires at each age is documented elsewhere ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…Note that the fourth combination included two repeated assessments of balance (at ages 53 and 60–64) to assess if change in balance performance over time was informative for fall risk. Given no previous evidence of sex differences in association between one-legged balance performance and falls in this study population ( 23 ), males and females were included in the same model, with sex included as a covariate.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study

Blodgett

Hardy²,

Davis³

et al. 2023

Front. Sports Act. Living

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IntroductionThe one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk.MethodsData from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60–64. Number of falls in the past year was self-reported at ages 53, 60–64 and 68; recurrent falls (0–1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60–64; age 53 → 68; age 60–64 → 68; age 53 & 60–64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points.ResultsMedian eyes open balance time was 30 s at ages 53 and 60–64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577–0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604–0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using “optimal” cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42–0.47), poor sensitivity (0.38–0.61) and poor specificity (0.23–0.56).DiscussionDespite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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