Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study

Abstract

IntroductionThe one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk.MethodsData from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60–64. Number of falls in the past year was self-reported at ages 53, 60–64 and 68; recurrent falls (0–1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60–64; age 53 → 68; age 60–64 → 68; age 53 & 60–64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points.ResultsMedian eyes open balance time was 30 s at ages 53 and 60–64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577–0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604–0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using “optimal” cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42–0.47), poor sensitivity (0.38–0.61) and poor specificity (0.23–0.56).DiscussionDespite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.

Ambulosono-Enhanced Ankle Rotation Training Leads to Significant Gains in Balance Among Healthy Adults

“…Second, poor balance can adversely affect one’s ability to carry out daily tasks, like walking, climbing stairs, or rising from a chair, thereby limiting functional mobility 10,11. Third, those with poor balance may find it challenging to engage in physical activities and sports, impacting both their overall fitness and social interaction 12,13. Additionally, poor balance has been linked to a decrease in self-confidence and an increased fear of falling, which can lead to a sedentary lifestyle 14.…”

“…This measure has also been deemed a useful predictor for the risk of lower limb injuries 20,21, 22. Consequently, the development of effective exercise methods targeting ankle ROM and balance is of great importance, especially for older adults concerned with preventing falls and injuries.…”

“…Evaluating lower extremity ROM is therefore integral for assessing joint health and its impact on an individual's ability to maintain balance, which is of particular concern for the elderly. 19 This measure has also been deemed a useful predictor for the risk of lower limb injuries.20,21, 22 Consequently, the development of effective exercise methods targeting ankle ROM and balance is of great importance, especially for older adults concerned with preventing falls and injuries.…”

“…Limited ankle ROM has been associated with an increased risk of balance-related challenges, including instability during daily movements and activities. Evaluating lower extremity ROM is therefore integral for assessing joint health and its impact on an individual’s ability to maintain balance, which is of particular concern for the elderly 19…”

“…First, individuals with poor balance face a heightened risk of falls, leading to severe injuries such as fractures, head trauma, and soft tissue damage 6, 7. This risk is especially acute for older adults, for whom falls can result in a loss of independence, diminished quality of life, and escalating healthcare costs.8,9 Second, poor balance can adversely affect one’s ability to carry out daily tasks, like walking, climbing stairs, or rising from a chair, thereby limiting functional mobility.10,11 Third, those with poor balance may find it challenging to engage in physical activities and sports, impacting both their overall fitness and social interaction 12,13. Additionally, poor balance has been linked to a decrease in self-confidence and an increased fear of falling, which can lead to a sedentary lifestyle.14 Lastly, studies indicate that poor balance correlates with cognitive impairments, affecting attention, memory, and executive function 15, 16.…”