Purpose: It has been accepted that walking ability is a good predictor of falling in the elderly. An assessment of walking ability is regularly conducted with 10-m forward walking time (10mFWT), which is the most popular test used by physical therapists and other medical professionals. However, 10mFWT may not be sensitive enough to be a single predictor for falling incidence. In our clinical observation, we sometimes found elderly people who did not have gait disorders or fall experiences encountered difficulties in performing backward walking. Although backward walking time may be a better predictor of falling than 10mFWT based on our clinical experience, the validity of a backward walking test as an assessment tool of fall risks is unknown. Therefore, the purpose of this study was to demonstrate whether the backward walking test was able to assess walking ability and other physical variables associated with the risk of falling in elderly people.
Method: Fifty elderly outpatients from local hospitals volunteered to attend the study (16 male, 34 female). Mean (± SD) values of age, height, and weight were 76.6 ± 4.3 year, 154.8 ± 9.0 cm, 53.9 ± 9.8 kg, respectively. Although subjects were diagnosed with knee or spinal osteoarthritis and/or periarthritis scapulohumeralis by their orthopedic physician, they all were independent and were capable of walking without any walking aid. Those who complained of any pain during gait due to musculoskeletal problems were excluded from the study. In our test, 10-m backward walking time (10mBWT), 10mFWT, opened and closed-eyes single leg standing time, grip strength, isometric knee extension strength and 30-s chair stand test (CS-30) were measured. Pearson’s correlation coefficient or Spearman’s rank correlation coefficient was used to demonstrate the relationships between the measured variables. In addition, multiple regression analysis (stepwise) was performed to identify the contributing factors of 10mBWT and 10mFWT in the measured physical performance. Statistical significance was defined at the alpha level of .05 in this study. This study was approved by Hiroshima University’s ethics committee.
Result: Significant correlation was found between 10mBWT and 10mFWT (r = .75, p < .01), opened-eyes single leg standing time (r = -.56, p < .01) and closed-eyes leg standing time (r = -.44, p < .01). The correlations between 10mFWT and opened-eyes leg standing time (r = -.49, p < .01), closed-eyes leg standing time (r = -.31, p < .05), grip strength (r = -.49, p < .01) and CS-30 (r = -.45, p < .01) were also statistically significant. The result of stepwise regression analysis showed that CS-30 and opened-eyes single leg standing time were significantly correlated to 10mBWT and 10mFWT. In addition, grip strength was also a predictor of 10mFWT.
Discussion: The current result showed that 10mBWT may be able to assess walking ability in active-independent elderly people. In addition, the result of stepwise regression analysis demonstrated that strength and balance ability were significantly correlated to 10mBWT. Therefore, however, 10mFWT showed similar correlation with balance and strength. The result suggests that both 10mBWT and 10mFWT have similar qualities as assessment tools of the fall risk in active-independent elderly. We are currently conducting the same type of research with elderly people who need nursing care.