A novel model to quantify balance alterations in older adults based on the center of pressure (CoP) measurements with a cross-sectional study

Abstract

Background The timely detection of fall risk or balance impairment in older adults is transcendental because, based on a reliable diagnosis, clinical actions can be taken to prevent accidents. This study presents a statistical model to estimate the fall risk from the center of pressure (CoP) data. Methods This study is a cross-sectional analysis from a cohort of community-dwelling older adults aged 60 and over living in Mexico City. CoP balance assessments were conducted in 414 older adults (72.2% females) with a mean age of 70.23 ± 6.68, using a modified and previously validated Wii Balance Board (MWBB) platform. From this information, 78 CoP indexes were calculated and analyzed. Multiple logistic regression models were fitted in order to estimate the relationship between balance alteration and the CoP indexes and other covariables. Results The CoP velocity index in the Antero-Posterior direction with open eyes (MVELAPOE) had the best value of area under the curve (AUC) to identify a balance alteration (0.714), and in the adjusted model, AUC was increased to 0.827. Older adults with their mean velocity higher than 14.24 mm/s had more risk of presenting a balance alteration than those below this value (OR (Odd Ratio) = 2.94, p<0.001, 95% C.I.(Confidence Interval) 1.68–5.15). Individuals with increased age and BMI were more likely to present a balance alteration (OR 1.17, p<0.001, 95% C.I. 1.12–1.23; OR 1.17, p<0.001, 95% C.I. 1.10–1.25). Contrary to what is reported in the literature, sex was not associated with presenting a balance alteration (p = 0.441, 95% C.I. 0.70–2.27). Significance The proposed model had a discriminatory capacity higher than those estimated by similar means and resources to this research and was implemented in an embedded standalone system which is low-cost, portable, and easy-to-use, ideal for non-laboratory environments. The authors recommend using this technology to support and complement the clinical tools to attend to the serious public health problem represented by falls in older adults.

Reliability and Usability Analysis of an Embedded System Capable of Evaluating Balance in Elderly Populations Based on a Modified Wii Balance Board

“…Our previous research verified the criterion validity of the mWBB and its capability to quantify balance deficits in older adults [ 35 ]. However, evaluating its intra-rater and inter-rater reliability is necessary when assessing static standing balance.…”

“…The rater that performed the test–retest trials also attended as one of the three evaluators in the inter-rater test (Rater 1 in Table 3 and Table 4 ). The two evaluators (Raters 4 and 5) who participated in our previous study [ 35 ] also responded to the SUS questionnaire. The five female raters (age: 25.8 (SD 7.12) years; experience in geriatric care and management: 5.1 (SD 3.69) years) answered the SUS questionnaire at the end of all the experimental balance tests.…”

“…Furthermore, previous research showed that the mWBB is a valid device that identifies balance alterations in independent, active older adults with no acute condition. Seventy-three percent of the CoP indices obtained with the mWBB were able to detect balance alterations, with the mean velocity of the CoP in the antero-posterior direction with open-eyes (MVELAPOE) being the best at discriminating between groups [ 35 ].…”

“…Due to the high variability between methodological variables, there is no universal consensus on which CoP indices are the best to assess balance and risk of falling [ 35 , 55 ]. The majority of studies show AUC values between 0.7 and 0.8, most of them presenting sensitivity or specificity below 0.7 [ 35 , 66 , 67 , 68 , 69 , 70 , 71 ] (comparisons between studies can be found in [ 35 ]).…”

“…Due to the high variability between methodological variables, there is no universal consensus on which CoP indices are the best to assess balance and risk of falling [ 35 , 55 ]. The majority of studies show AUC values between 0.7 and 0.8, most of them presenting sensitivity or specificity below 0.7 [ 35 , 66 , 67 , 68 , 69 , 70 , 71 ] (comparisons between studies can be found in [ 35 ]). Therefore, it is interesting to note that for the classification accuracy, the mean CoP velocity in the anterior-posterior direction with open-eyes (MVELAPOE) and the range of the anterior-posterior CoP with open-eyes (RANGEAPOE) presented: AUC = 0.747, sensitivity = 0.744, and specificity = 0.75 (equality of values for both indices is a coincidence).…”