Center of pressure characteristics from quiet standing measures to predict the risk of falling in older adults: a protocol for a systematic review and meta-analysis

Abstract

Background Falling is the most common accident of daily living and the second most prevalent cause of accidental death in the world. The complex nature of risk factors associated with falling makes those at risk amongst the elderly population difficult to identify. Commonly used clinical tests have limitations when it comes to reliably detecting the risk of falling, but existing laboratory tests, such as force platform measurements, represent one method of overcoming this lack of a test. Despite their widespread use, however, Center of Pressure (COP) signal analysis techniques vary and there is currently no consensus on which features should be used diagnostically. Our objective is to identify, through a systematic review and meta-analysis, the COP characteristics of older adults (≥ 60 years old) during quiet bipedal stance which will allow fallers to be distinguished from non-fallers. Methods The systematic review will include both prospective and retrospective articles. Five databases will be searched: PubMed, Cochrane CENTRAL, EMBASE, and ScienceDirect. In addition, a search of gray literature will be performed using Google Scholar and ClinicalTrials.gov. Searches will be circumscribed to include only older adults (aged over 60 years) who underwent a bipedal quiet standing measure of their balance and for whom the number of falls was reported. Two authors will independently assess the risk of bias for each included article using a 26-item checklist. Funnel plots will be drawn to attest of possible publication biases for each COP parameters. The results will be synthesized descriptively and a meta-analysis will be undertaken. When trial methodological heterogeneity is too great for pooling of the data into a meta-analysis, evidence strength will be evaluated using best evidence analysis. Discussion Despite the numerous advantages of posturography, the diversity of studies exploring balance in older fallers has led to uncertainty regarding the method’s ability to reliably identify fall-prone older adults. It is expected that the findings from this systematic review will help clinicians use bipedal quiet standing measures as a diagnostic test and allow researchers to explore COP characteristics to create better models for fall prevention care. Systematic review registration PROSPERO CRD42018098671 Electronic supplementary material The online version of this article (10.1186/s13643-019-1147-9) contains supplementary material, which is available to authorized users.

A new perspective on transient characteristics of quiet stance postural control

“…Consistent with previous research that has established that older adults often exhibit diminished postural control and are at an elevated risk for falling compared to younger adults [ 3 , 12 , 13 ], these two transient characteristics (DIF_ovr for EA and DIF_ovr for RMS_ml) may also provide clinically-relevant information when assessing an individual’s fall risk. While previous research has identified numerous and sometimes contradictory CoP-based measures that are predictors of falls in older adults, there is no consensus on which CoP measures provide the best predictive ability for falls [ 4 , 27 , 28 ]. However, most of these studies used whole-trial CoP estimates and as established in this study, the transient characteristics of epoch-based CoP estimates exhibit negligible correlations with whole-trial estimates.…”

A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open‐access code*

“…English, French, Italian, Spanish, or German). The choice was made to include a wide range of study types and not to limit the study to RCT in order to have a broad view of the COP analysis methods used to differentiate between fallers and non-fallers of 60 years and older (Quijoux et al, 2019).…”

Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis

“…The search strategy can be found in (Quijoux et al, 2019) and is described in the registration on PROSPERO (International Prospective Register of Systematic Reviews) (Registration: CRD42018098671 on June 19, 2018; last edited on January 17, 2020). The methods for the meta-analysis were specified prior to the completion of the inclusion of studies and the full method has been previously published (Quijoux et al, 2019). Between March 2017 and July 2019, a systematic literature review was conducted to identify COP characteristics that best distinguish older fallers from older non-fallers.…”

“…The overall quality of the evidence per outcome was evaluated by a rating system (Quijoux et al, 2019) adapted from the GRADE system (Ryan and Hill, 2016) for longitudinal follow-up studies. This assessment estimated the overall risk of bias for each variable by rating (i) the number of studies using this variable, (ii) their average risk of bias score, (iii) data heterogeneity, as measured by I² (Higgins et al, 2003) and (iv) the cumulative sample size.…”