PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2010

Clinical Scenario

In the rehabilitation hospital where my clinical was we performed many functional assessment tests on patients to determine their fall risk and to justify what assistive device they might need. Also they were used to detect meaningful changes after therapy for insurance purposes. I wanted to find a functional assessment test that could be used on any population and predict falls in the elderly population that I was working with.

Clinical Question

Can gait speed predict falls in the elderly?

Clinical Bottom Line

Based on the results of the outcomes from Verghese et al and Beauchet et al I might be more inclined to add gait speed testing into my evaluations of a patient but only because it is so quick, easy and inexpensive to perform. Most likely it would only be a minor factor in the decision making of any of my treatments. I feel gait speed would be more useful as an objective measure to determine whether my treatments had an effect on the patient.

Based on article evidence, decreased gait speed is an indicator of increased risk for falls in an elderly population. Verghese et al even went so far as to quantify it saying that a gait speed less than 100 cm/s has a 28% increase in risk of falling which increases to 54% with a gait speed slower than 70 cm/s. However neither study reported data in such a manner that I was able to statistically analyze myself, so all results are based on author’s calculations.

Both studies had a subject population over 200. The population Verghese et al used was much more representative of the patients one might see in an outpatient clinic, as they included anyone over the age of 70 in Bronx County that lived in the community and could walk. The subject population in the Beauchet et al study were not generalizable to any population one would see in clinic since they used only healthy elderly subjects from 13 senior housing facilities in France.

Verghese et al only had minor threats to internal validity, the biggest being that they could have been more consistent in their follow-up calls with patients, so the number of falls could actually be underreported. The biggest threat to internal validity of the Beauchet et al article was the dissimilarity of their subjects to the majority of physical therapy patients. Also during testing of gait speed researchers walked with patients in order to guard them, but this could have affected the subject’s selected gait speed.

Share

COinS