Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data

BACKGROUND

The unipedal balance test (UBT) is widely used with older adults, but interpreting performance on the test requires the availability of normative values.

OBJECTIVE

To use meta-analysis to provide normative values for the UBT for adults ≥60years.

DATA SOURCES

Electronic searches of PubMed, CINAHL, and Scopus as well as hand searches.

STUDY SELECTION

Inclusion required that articles provided means and standard deviations for UBT time for strata including at least 30 participants without pathology.

STUDY APPRAISAL AND SYNTHESIS

The two authors independently abstracted information on UBT procedures and performance. The Comprehensive Meta Analysis (3.0) program (random effects model) was used to consolidate UBT data from 23 articles. A custom six component (14 point) checklist was used to rate article quality.

RESULTS

Meta-analysis showed the mean UBT time for 13,454 tested individuals to be 26.9 seconds. Times were longer for individuals who were younger, male, and allowed longer test durations (e.g. ≥120seconds vs 30seconds).

LIMITATIONS

Although the UBT norms presented herein provide a better estimate of normal performance than individual studies, differences between studies in age and gender strata and test durations limit the generalizability of some of the normative values generated using meta-analysis.

Longitudinal change in the physical performance of older adults in the community

The primary purposes of this study were 1) to confirm age-related deterioration of physical performance in older adults longitudinally, and 2) to predict future functional status and mortality by initial level of physical performances. The subjects were 517 older adults examined both in 1992 and 1996 in the Tokyo Metropolitan Institute of Gerontology, Longitudinal Interdisciplinary Study on Aging. The same battery consisting of muscle strength, balance, walking, and manual speed was administered to the subjects in the baseline and follow-up examinations. A significant longitudinal decline was observed in all physical performances except for grip strength. The age-related decline accelerated with aging for preferred walking velocity. Inter-subject variability in walking velocity significantly increased for 4 years period. Maximum walking velocity was a common predictor for functional status and mortality. The results suggest that physical performance measures, especially maximum walking velocity, is a valid means for physical therapy to evaluate physical functioning of community-living older persons.

Normative values for the unipedal stance test with eyes open and closed

PURPOSE

Limited normative data are available for the unipedal stance test (UPST), making it difficult for clinicians to use it confidently to detect subtle balance impairments. The purpose of this study was to generate normative values for repeated trials of the UPST with eyes opened and eyes closed across age groups and gender.

METHODS

This prospective, mixed-model design was set in a tertiary care medical center. Healthy subjects (n= 549), 18 years or older, performed the UPST with eyes open and closed. Mean and best of 3 UPST times for males and females of 6 age groups (18-39, 40-49, 50-59, 60-69, 70-79, and 80+) were documented and inter-rater reliability was tested.

RESULTS

There was a significant age dependent decrease in UPST time during both conditions. Inter-rater reliability for the best of 3 trials was determined to be excellent with an intra-class correlation coefficient of 0.994 (95% confidence interval 0.989-0.996) for eyes open and 0.998 (95% confidence interval 0.996-0.999) for eyes closed.

CONCLUSIONS

This study adds to the understanding of typical performance on the UPST. Performance is age-specific and not related to gender. Clinicians now have more extensive normative values to which individuals can be compared.

One-leg standing test for elderly populations

BACKGROUND

The one-leg standing (OLS) test is one of the balance tests used to diagnose musculoskeletal ambulation disability symptom complex (MARS), a condition newly defined by three professional Japanese medical societies in 2006 to help identify the symptoms of motor organ deterioration and establish preventive strategies. Although many studies have used the OLS test, none has shown conclusively that the test can be used as a practical marker of frailty among elderly people, especially in community settings. Based on the type of epidemiological study -- i.e., descriptive epidemiology and analytical epidemiology (observational and intervention studies) -- we reviewed evidence on three fundamental issues related to the OLS test: (1) testing procedures and reference values; (2) the associations between the OLS time and negative events; (3) improvement of the OLS time by intervention. These issues are key to any discussion of whether the OLS test can be used as a practical marker for predicting frailty in community-dwelling elderly populations.

METHODS

Articles were collected from MEDLINE databases using the search terms "one- leg standing" and the other names included in the same category.

RESULTS

Because various procedures are used to carry out the OLS test, the measured values for the OLS time varied widely from study to study. Some observational studies showed that the OLS time is related to negative events such as falls, declines in activity of daily living, and other morbidity. OLS times could be improved by several interventions.

CONCLUSIONS

This review suggests that the OLS test can be a tool for predicting frailty in community-dwelling elderly populations. However, our review should be interpreted with caution because we did not confirm the evidence level of each of the studies we selected. Further research on this topic is needed.

Reproducibility and relationship of single-joint strength vs multi-joint strength and power in aging individuals

INTRODUCTION

Reliable and sensitive muscle strength/power assessments are essential when evaluating age-related and/or training-induced changes in maximal strength and power.

AIM

To investigate the reproducibility and inter-relationship of single-joint isokinetic/isometric leg muscle strength vs multi-joint mechanical muscle function during counter-movement jump (CMJ) in moderately trained aging individuals (age 72.3+/-6.6).

RESULTS

The within-subject coefficient of variation (CV(w-s)) for the single-joint test showed good reproducibility (<10%) for quadriceps and hamstring strength (except for hamstring isometric). Plantar flexion demonstrated good to moderate reproducibility (CV(w-s) range: 10.4-17.2%). Excellent to good CV(w-s) (<10%) was observed for all concentric CMJ parameters, except for plantar flexor mean work (CV(w-s)=13%). Eccentric CMJ parameters demonstrated good to moderate reproducibility (CV(w-s) range: 8.1-18.2%). Isokinetic and isometric quadriceps, hamstring and plantar flexor single-joint strength measurements were found to correlate with several CMJ parameters.

CONCLUSION

Single-joint and multi-joint strength and power assessment tests of the lower limbs appear to be reproducible in aging individuals. Furthermore, associations between single-joint strength and multi-joint CMJ power and force variables exist. To evaluate functional capacity in elderly people further investigations must be carried out to identify specific power/strength parameters that are most tightly linked to functional performance.

Physical-Fitness Declines in Older Japanese Adults

This cross-sectional study determined physical-fitness levels of more than 1,000 Japanese older men and women, including 338 participants who were 75 years of age and older. Each participant performed 11 tests representing 4 domains of functioning (muscular, joint, neural, and respiratory). Two-way ANOVA was used to examine gender and age differences for each variable. Performance on every test decreased with advancing age, but the declines did not occur at a uniform rate. In addition, men and women did not decline at the same rate for each variable. Although leg strength, balance ability, and reaction time did not decline until after the age of 65, they exhibited the steepest decline of all the variables after age 75. These findings suggest that significant declines in physical fitness occur with advancing age, especially those that are related to mobility and risk for falls.

Reliability and validity of the Motor Fitness Scale for older adults in the community

Responses to 14 items of a questionnaire on motor fitness were collected from 990 subjects, all 65 years of age or older, living in a community. The Motor Fitness Scale was created by totalling the score for each item on the questionnaire. A second-order covariance structure analysis revealed that the Scale has a unidimensional structure with three subscales, Mobility, Strength, and Balance. The Scale appeared highly reliable with alpha = 0.92 and test-retest = 0.92. The Scale correlated with the summary physical performance score (r = 0.59). High discriminant validity, using the age and sex of the subjects, and construct validity, using their health status and level of sports participation, were confirmed for both the Scale and the summary physical performance score. The Scale can also discriminate among older persons who are at the high end of the functional spectrum that determines their level of competence in daily life. The results suggest that the Motor Fitness Scale is a feasible substitute for the application of physical performance measures in assessing the physical function of older adults in the community.