for Geriatric Fall/Balance Assessment

1 outcome Measure Toolkitfor Geriatric Fall/Balance Assessment1 Table of Contents Introduction ---------------------------------------- ---------------------------------------- ---------------------------------------- - 2 Background of the outcome Measure Toolkit Project ---------------------------------------- ---------------------------------------- -- 3 Taskforce Members ---------------------------------------- ---------------------------------------- ---------------------------------------- - 5 outcome Measure Toolkit Project Searching Key Words and Database ---------------------------------------- ------------------- 6 outcome Measure Toolkit Project Search/Review Flow Chart ---------------------------------------- ---------------------------------- 8 Master List of outcome Measures Assessing Balance/Fall Risk Being Reviewed ---------------------------------------- --- 9 outcome Measures with Evidence of Psychometric Properties and Fall Risk Predictability ---------------------------------- 12 outcome Measures Not Supported in Relation to Balance/Fall Assessment in the Older Adult Population and Rationales ----- 13 outcome Measures Related to Balance/Fall Risk Assessment but Warranting Additional Research for Further Validation ---- 15 outcome Measures Widely Used, but With Limited Recent Evidence Related to Fall Risks ---------------------------------- 18 outcome Measures Divided by Setting ---------------------------------------- ---------------------------------------- --------------- 20 Summary Tables of Each Individual outcome Measure (in alphabetic order) ---------------------------------------- ---------- 26 Discussion ---------------------------------------- ---------------------------------------- ---------------------------------------- ------ 121 Appendix a.

2 Compiled List of outcome Measures Found During Phase 1 Search ---------------------------------------- -------- 122 b. outcome Measure Toolkit Project Article Review Instructions ---------------------------------------- ---------------- 126 c. outcome Measure Summary Table Template ---------------------------------------- ------------------------------- 127 2 Introduction November 2019 Dear fellow therapists: Welcome to the outcome Measure Toolkit. I am excited to present this document to you. The outcome Measure Toolkit project is a product of the Balance & Falls Special Interest Group (BFSIG) of APTA Geriatrics, an Academy of the American Physical Therapy Association (APTA). Falls are the most common cause of injuries and hospital admissions in older adults, and balance is a potentially modifiable factor known to contribute to falls choosing proper tests and measures is a critical component of balance and fall risk Assessment .

3 Evidence-based interventions can then be implemented to improve participation, activity limitations, and impairments of body structure and function for people with balance deficits and risks of falling. In recent decades, an enormous amount of outcome measures have been developed to evaluate balance and to predict fall risk. As fall risks and balance assessments are multidimensional and multifaceted, selecting the optimal outcome measure is challenging. The BFSIG decided to take on the challenge to create the outcome Measures Toolkit, providing our members with an updated summary of current outcome measures related to balance and fall risk Assessment . As the BFSIG Research Liaison, I am humbled and honored to lead the project. The outcome Measure Toolkit took over two years to ready itself; fourteen taskforce members volunteered their time, effort, and knowledge to make this project possible. We started using keywords to search related outcome measures.

4 The original compiled list had over 245 outcome measures! After multiple conferences, discussions, and endless hours of hard working, we now present you with the final list of 107 outcome measures. We hope you find this Toolkit helpful, clinically and academically. For this Toolkit to remain current, the list needs to be updated every three to five years. We hope to see more volunteers devote themselves to updating this project in the future. Your participation and contribution help the BFSIG grow and expand! Sincerely, Elizabeth Wang-Hsu, PT, PhD Elizabeth Wang-Hsu, PT, PhD Chair, the outcome Measure Toolkit Project Research Liaison, Balance and Fall Special Interest Group University of Pennsylvania Health System 3 Background of the outcome Measure Toolkit Project Purposes: 1. Create an updated summary in the form of an outcome Measure Toolkit for balance and fall Assessment , including the psychometric properties, fall predictability, population validated, and references of each outcome measure in a simple, easy to understand table format.

5 2. Provide all APTA Geriatrics members a toolkit to easily access current and existing BF outcome measures, with their psychometric properties and fall predictability in the Geriatric population at various settings or with different diagnosis. Process and Phases of the Project: The project was initiated immediately after CSM 2017. Originally, 8 members from BFSIG volunteered to form the taskforce for this project. A few members withdrew from the project due to various personal reasons, but new members joined the project. The taskforce members in various stages are acknowledged in the following page. The project was conducted in five phases: Phase 1 was finding combinations of key words used to thoroughly search for any existing outcome measures that are appropriate for balance and fall Assessment . From this search, 260 outcome measures were identified. The results were then streamlined to make a consensus master list of 107 outcome measures.

6 Phase 2 was the literature review process. The master list of outcome measures was assigned to taskforce members to review. Each member in each timeline was assigned 3 to 5 outcome measures. Phone conferences were held between each timeline to discuss issues and concerns from taskforce members. Phase 3 was cross-validation and recommendations. Phase 4 was updating of literature from 2018-2019. Phase 5 was formatting of the BFSIG outcome Measure Toolkit and dissemination. 4 The outcome Measure Toolkit is a toolkit based on consensus opinion of experts from the BFSIG. It is a resource/toolkit for members but should not be confused or mistaken for peer-reviewed evidence-based document. The BFSIG outcome Measure Toolkit seeks to offer a quick summary with generalizability, as well as various practice settings, in addition to community-dwelling. Furthermore, the emphasis of this project was placed on current literature in the past 5 or so years.

7 This allows us to make recommendations on outcome measures which may no longer be valid with the changing features of the human population including the prevalence rate of medical comorbidities, life expectancy, and medical advances. 5 Taskforce Members The APTA Geriatrics Balance & Fall Special Interest Group would like to recognize and extend its gratitude to the taskforce members, who volunteered their time, effort, and knowledge to this project. Elizabeth Wang-Hsu, PT, PhD (Chair) Research Liaison for APTA Geriatrics Balance and Falls SIG 2016-2019 Heidi Moyer* , PT, DPT (Co-Chair for the initial phases) Secretary, APTA Geriatrics Balance and Falls SIG Eastern Regional Coordinator, APTA Geriatrics State Advocate Program Carmen Casanova Abbott, PT, PhD (Co-Chair for the final phases) Core Taskforce Members Anne Reilley*, PT, DPT, MS Susan Glenney * , PT, DPT Mariana Wingood* , PT, DPT Adjunct Taskforce Members Ryan Allison, PT, DPT Harsha Dhingra , PT, MS Emma Phillips, PT, DPT Haim Nesser , PT, DPT Paula Graul* , PT, MS Shweta Subramani , PT, MHS Ashley Bell, PTA Jennifer Vincenzo*, PT, MPH, PhD (Chair, BFSIG) * Board Certified Clinical Specialist in Geriatric Physical Therapy (GCS) Certified Exercise Expert for Aging Adults (CEEAA)

8 6 outcome Measure Toolkit Project Searching Key Words and Database Combination of Words: Falls, Fall Risk, Balance, Functional Mobility, Strength, Older Adults, Aged, Geriatric , Elderly, Frail, Community-Dwelling, Independent Living, Nursing Home, Institutionalized, Skilled Nursing Facility, Residential Care, Long Term Care, outcome Measure, Assessment . Database Searched: PubMed, CINAHL, Google Scholar, PsychInfo Falls Word Definition Falls Any event that leads to an unplanned, unexpected contact with a supporting surface. This does NOT include falls that are the result of an outside force such as a push or shove or falls that are the result of a medical event such as a MI, syncope or fainting. Population Examined Word Definition Older Adults According to Medicare, a person over the age of 65 years. Elderly Older adults or aged individuals. Aged A person 65 through 79 years of age.

9 For a person older than 79 years, AGED, 80 and over is available Aged, 80 and over A person 80 years of age and older. Frail elderly (Elderly, Frail) Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. 7 Frail Older Adults A person 65 or older who are lacking in general strength and are unusually susceptible to disease or to other infirmity. Community-Dwelling Adults According to SoG CPG Committee: a person over age of 65 residing in the community or assisted living without distinction about health/frailty status. Independent Living A housing and community arrangement that maximizes independence and self-determination. Item Examined Word Definition outcome Assessment Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome . Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).

10 outcome Measure Evaluations of the efficacy/effectiveness of an intervention on the premise of gauges taken prior to, during, and following the intervention. 8 outcome Measure Toolkit Project Search/Review Flow Chart Presentation of the Purpose/Mission of outcome Measure Project to BFSIG executives; Recruit Taskforce Members via BFSIG emailsDecember 2016 February 2017 First Conference Call; DiscussSearch Strategies, Keywords, Database, Delegation; Key Words Search Balance/Fall-Related outcome MeasureMarch 2017 Compile List From All Members : 245 outcome Measures Identified(By HeidiMoyer & Elizabeth Wang-Hsu)April 2017 Master List of outcome Measures: 107 outcome Measures (By Taskforce Consensus)Not Related to Balance, Falls, Functional Mobility, or Stength( , MiniCog, MMSE)May 2017 outcome measures critically reviewedOutcomemeasure tables developedFirst recommendations made(By Taskforce Members)June 2017 Cross validation of outcome measuresOutcome measure recommendation finalizedDecember 2018 Update outcome measures literature reviewMay 2019 Format BFSIG outcome Measure Toolkit (By Carmen Abbott & Elizabeth Wang-Hsu)BFSIF Executives Internal ReviewAGPT review of outcome Measure ToolkitOctober 2019 DisseminationExcluded9 Master List of outcome Measures Assessing Balance/Fall Risk Being Reviewed 1.