Marta Novaes Oliveira 1,2, Jacob Thomas 1, Kelsey Weitzel 1,2, Trent Guess 1, Steve Ball 1,2

1University of Missouri – College of Health Sciences, Columbia, Missouri; 2MU Extension, Columbia, Missouri

Between 30-60% of adults 65+ fall at least once every year, with billions spent annually on related medical costs. Traditionally, static balance has been used in fall risk assessment and can allow for timely interventions to reduce fall incidence. However, available low-cost field-based balance assessments may not be sensitive enough alone to detect balance deficits and predict fall risk. The CDC’s 4 Stage Balance Assessment (CDC4) identifies those not passing the tandem stance as high fall risk, but limited evidence exists about the relationship between holding a tandem stance and falls. PURPOSE: To determine if the CDC4 is a reliable and valid tool to identify those at high fall risk. METHODS: 29 participants, 50+ years old and free of recent injuries, completed the CDC4 test on two occasions consisting of the mountain, semi-tandem, tandem, and one-legged stances. Each stance was held for up to 10 seconds. Self-reported fall frequency in the previous 12 months was collected. Logistic regression was used to determine fall predictability. ICC was calculated to determine reliability. RESULTS: 77.78% of fallers passed the CDC4. There were significant differences (p < .05) in total balance CDC4 scores between fallers (M = 36.14, SD = 4.58) (n=9) and non-fallers (M = 39.12, SD = 2.14) (n=20). Model estimates suggested that, for every additional second held, the odds of having experienced a fall are approximately 0.76 times lower (95% CI 0.59 to 0.99). Test reliability was moderate (ICC = 0.58). CONCLUSION: The CDC4 guidelines should be used with caution for fall risk assessment. Current guidelines for passing the tandem stance may not suffice to distinguish between fallers and non-fallers. This type II error might result in people not taking appropriate steps to prevent falls. Additionally, one leg balance has been shown to be a predictor of injurious falls and could be considered in the determination of fall risk among other dynamic fall risk assessments by using the total score.

ACKNOWLEDGMENTS: The University of Missouri Extension funded the project.

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Figure 1

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