Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

Figures & data

Figure 1 Fagan Nomogram to calculate the post-test probability for the TUG FAST in the community-dwelling setting, by drawing a line between the fall risk (pre-test probability, 30% in community-dwelling persons) and the likelihood ratio for a positive (green) or a negative test (red).

Figure 2 Relationship between the prevalence (pre-test probability) and the post-test probability for different cut-off values and fall risk prevalence of the TUG FAST. The dotted line indicates the 30%fall risk prevalence for the community-dwelling setting and the related post-test probability (y-axis) of a positive test and the continuous line for a negative test respectively.

Figure 3 PRISMA flow diagram of the literature search of this systematic review.

Figure 4 Results of the assessment of the methodological quality with the Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2). On the left proportion of studies with low, high or unclear risk of bias. On the right the proportion of the studies with low, high, or unclear concerns regarding applicability.

Table 1 Validity; Area Under the Curve (AUC) for the Different Settings, Summary of Findings

Setting	Test	No of Studies	AUC (95% CI)	Overall Rating (+/ ?/-)
Community dwelling	BBS	5	0.68 (0.62 to 0.73)	-
	BEST	2	0.75 (0.69 to 0.81)	+
	MiniBEST	2	0.79 (0.64 to 0.88)	+
	BriefBEST	1	0.76 (0.64 to 0.85)	+
	POMA BALANCE	1	(-)	?
	POMA GAIT	1	(-)	?
	TUG	8	0.63 (0.59 to 0.66)	-
	TUG FAST	1	0.58 (0.47 to 0.70)	-
	TUG-8FT FAST	1	(-)	?
	TUG MAN FAST	1	(-)	?
	TUG COG FAST	1	0.65 (0.55 to 0.76)	-
	FRT	1	(-)	?
	GAIT SPEED	1	0.69 (0.62 to 0.76)	-
	GAIT SPEED FAST	1	0.71 (0.64 to 0.77)	+
	GRIP	1	(-)	?
	OLS	1	(-)	?
Nursing home	BBS	1	0.76 (0.66 to 0.84)	+
	BEST	1	0.75 (0.57 to 0.87)	+
	MINI BEST	1	0.71 (0.53 to 0.84)	+
	BRIEF BEST	1	0.75 (0.57 to 0.87)	+
	POMA	1	(-)	?
	POMA BALANCE	1	(-)	?
	POMA GAIT	1	(-)	?
	TUG	1	0.57 (0.40 to 0.73)	-
Hospital	SIMPLIFIED POMA	1	0.58 (0.52 to 0.64)	-
	TUG	2	0.55 (0.50 to 0.60)	-
	SPPB	1	0.57 (0.52 to 0.62)	-
Hospital and Commnity-dwelling	GRIP	1	0.65 (0.48 to 079) **	-
	HIP STRENGTH ABDUCTORS	1	0.83 (0.71 to 0.94)	+
	HIP STRENGTH ABDUCTORS RFG	1	0.79 (0.67 to 0.91)	+
	HIP STRENGTH ADDUCTORS	1	0.77 (0.65–0.90)**	+
	HIP STRENGTH ADDUCTORS RFG	1	0.71 (0.57–0.84) **	+
	HIP STRENGTH EXTENSORS	1	0.56 (0.40 to 0.71) **	-
	HIP STRENGTH EXTENSORS RFG	1	0.61 (0.46 to 0.76) **	-
	HIP STRENGTH EXTERNAL ROTATOR	1	0.74 (0.61 to 0.87) **	+
	HIP STRENGTH EXTERNAL ROTATORS RFG	1	0.65 (0.51 to 0.80) **	-
	HIP STRENGTH FLEXORS	1	0.76 (0.63 to 0.88) **	+
	HIP STRENGTH FLEXORS RFG	1	0.68 (0.54 to 0.82) **	-
	HIP STRENGTH INTERNAL ROTATORS	1	0.58 (0.42 to 0.73) **	-
	HIP STRENGTH INTERNAL ROTATORS RFG	1	0.62 (0.47 to 0.77) **	-

Notes: **Authors provided additional information (unpublished data). Overall rating, +Sufficient, -Insufficient, ?Indeterminate.

Abbreviations: AUC, Area under the curve; BBS, Berg Balance Scale, BEST, Balance Evaluation System Test, BriefBEST, Brief Balance Evaluation System Test; MiniBEST, Mini Balance Evaluation System Test; CI, 95% confidence interval; (-), confidence interval not reported; FRT, Functional Reach Test; GAIT SPEED, Gait speed at usual speed; GAIT SPEED FAST, Gait speed as fast as possible without running; GRIP, grip strength; OLS, one leg stance; POMA, Performance Oriented Mobility Assessment; POMA Balance, Performance Oriented Mobility Assessment Balance part; POMA GAIT, Performance Oriented Mobility Assessment gait part; RFG, rate of force generation; SPPB, Short Physical Performance Battery; TUG, Timed Up and Go test usual gait speed; TUG FAST, Timed Up and Go test speed as fast as possible without running; TUG 8ft FAST, Timed Up and Go test on 8 feet distance speed as fast as possible; TUG COG FAST, Timed Up and Go test cognitive speed as fast as possible; TUG MAN FAST, Timed Up and Go test manual speed as fast as possible.

Table 2 Inter- Rater and Intra-Rater Reliability for Community-Dwelling Setting, Summary of Findings

	Inter-Rater Reliability			Intra-Rater Reliability
Test	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Overall Rating (+, ?, -)
BBS	Marques 2016^Citation44	28 (1)	0.93 (0.85 to 0.97)	Marques 2016^Citation44	28 (1)	0.82 (0.64 to 0.91)	+
BEST	Marques 2016^Citation44	60 (2)	0.94 (0.79 to 0.98)	Anson 2017^Citation74	165 (4)	0.83 (0.63 to 0.93)	+
				Marques 2016^Citation44
	Wang-Hsu 2018^Citation73
				Wang−Hsun 2018^Citation73
				Yingyongyudha 2016^Citation47
BRIEF BEST	Marques 2016^Citation44	28 (1)	0.71 (0.46 to 0.86)	Marques 2016^Citation44	28 (1)	0.73 (0.49 to 0.87)
MINI BEST	Marques 2016^Citation44	28 (1)	0.77 (0.56 to 0.89)	Anson 2017^Citation74	95 (3)	0.83 (0.73 to 0.90)	+
				Marques 2016^Citation44
				Yingyongyudha 2016^Citation47
TUG	/	/	/	Yingyongyudha 2016^Citation47	12 (1)	0.92 (0.73 to 0.98)	+
TUG FAST	Shumway-Cook 2000^Citation59	30 (1)	0.98 (0.96 to 0.99)	Hofheinz 2010^Citation75	50 (3)	0.93 (0.87 to 0.97)	+
				Lee 2016^Citation76
				Smith 2016^Citation77
TUG FAST 6m	/	/	/	Lee 2016^Citation76	15 (1)	0.95 (0.85 to 0.98)	+
TUG FAST 9m	/	/	/	Lee 2016^Citation76	15 (1)	0.96 (0.88 to 0.99)	+
TUG COG FAST	Marques 2016^Citation44	28 (1)	0.99 (0.98 to 1.0)	Hofheinz 2010^Citation75	35 (2)	0.97 (0.88 to 0.99)	+
				Smith 2016^Citation77
TUG MAN FAST	Marques 2016^Citation44	28 (1)	0.99 (0.98 to 1.0)	Hofheinz 2010^Citation75	35 (2)	0.97 (0.81 to 1.0)	+
				Smith 2016^Citation77
GAIT SPEED	Hartmann 2009^Citation78	23 (1)	0.94 (0.86 to 0.97)	Goldberg 2011^Citation79	113 (3)	0.93 (0.82 to 0.97)	+
				Hars 2013^Citation80
				Hartmann 2009^Citation78
GAIT SPEED FAST	/	/	/	Hars 2013^Citation80	60 (1)	0.9 (0.84 to 0.94)	+
GAIT SPEED DUAL TASK	Hartmann 2009^Citation78	23 (1)	0.97 (0.93 to 0.99)	Hars 2013^Citation80	83 (2)	0.88 (0.78 to 0.94)	+
				Hartmann 2009^Citation78
GAIT SPEED FOAM	Hartmann 2009^Citation78	23 (1)	0.96 (0.91 to 0.98)	Hartmann 2009^Citation78	23 (1)	0.98 (0.95 to 0.99)	+
GAIT SPEED FOAM DUAL TASK	Hartmann 2009^Citation78	23 (1)	0.95 (0.88 to 0.98)	Hartmann 2009^Citation78	23 (1)	0.93 (0.84 to 0.97)	+
DYNAMOMETER HIP FLEX SITTING	Arnold 2010^Citation81	18 (1)	0.84 (0.62 to 0.94)	Arnold 2010^Citation81	43 (2)	0.90 (0.81 to 0.95)	+
				Ford−Smith 2001^Citation82
DYNAMOMETER HIP FLEX STANDING	Arnold 2010^Citation81	18 (1)	0.85 (0.64 to 0.94)	Arnold 2010^Citation81	18 (1)	0.88 (0.69 to 0.95)	+
DYNAMOMETER HIP EXT STANDING	Arnold 2010^Citation81	18 (1)	0.92 (0.81 to 0.97)	Arnold 2010^Citation81	18 (1)	0.83 (0.59 to 0.93)	+
DYNAMOMETER HIP EXT SUPINE	/	/	/	Ford-Smith 2001^Citation82	25 (1)	0.74 (0.49 to 0.88)	+
DYNAMOMETER HIP ABD SUPINE	Arnold 2010^Citation81	18 (1)	0.84 (0.62 to 0.94)	Arnold 2010^Citation81	18 (1)	0.89 (0.72 to 0.96)	+
DYNAMOMETER HIP ABD STANDING	Arnold 2010^Citation81	18 (1)	0.92 (0.78 to 0.97)	Arnold 2010^Citation81	18 (1)	0.94 (0.83 to 0.98)	+
DYNAMOMETER KNEE FLEX				Ford-Smith 2001^Citation82	25 (1)	0.85 (0.68 to 0.93)	+
DYNAMOMETER KNEE EXT 45°	Arnold 2010^Citation81	18 (1)	0.82 (0.58 to 0.93)	Arnold 2010^Citation81	18 (1)	0.86 (0.66 to 0.95)	+
DYNAMOMETER KNEE EXT 90°	/	/	/	Ford-Smith 2001^Citation82	211 (2)	0.94 (0.88 to 0.97)	+
				Katoh 2014^Citation83
DYNAMOMETER PLANTARFLEX	/	/	/	Ford-Smith 2001^Citation82	25 (1)	0.71 (0.44 to 0.86)	+
DYNAMOMETER DORSIFLEX SITTING	Arnold 2010^Citation81	18 (1)	0.55 (0.11 to 0.81)	Arnold 2010^Citation81	18 (1)	0.80 (0.53 to 0.92)	+
DYNAMOMETER DORSIFLEX LYING	/	/	/	Ford-Smith 2001^Citation82	25 (1)	0.84 (0.67 to 0.93)	+
CALF RAISE SENIOR	André 2016^Citation84	12 (1)	0.84 (0.51 to 0.95)	André 2016^Citation84	41 (1)	0.90 (0.82 to 0.95)	+

Notes: Overall rating: +Sufficient, -Insufficient, ?Indeterminate, /No values.

Abbreviations: ABD, abduction; BBS, Berg Balance Scale; BEST, Balance Evaluation System Test; BriefBEST, Brief Balance Evaluation System Test; MiniBEST, Mini Balance Evaluation System Test; 95% CI, 95% confidence interval; DYNAMOMETER, strength measures with dynamometer in the respective position; EXT, Extension; FLEX, Flexion; Gait speed, gait speed at usual speed; Gait Speed FAST, gait speed as fast as possible without running; ICC_agreement, intraclass correlation coefficient agreement; TUG, Timed Up and Go test usual gait speed; TUG FAST, Timed Up and Go test speed as fast as possible without running; TUG FAST 6m, Timed Up and Go test speed as fast as possible without running on 6m distance; TUG FAST 9m, Timed Up and Go test speed as fast as possible without running on 9m distance; TUG COG FAST, Timed Up and Go test cognitive; speed as fast as possible; TUG MAN FAST, Timed Up and Go test manual; speed as fast as possible.

Table 3 Validity for Community-Dwelling Setting, Summary of Findings

Test	Author	No of Participants (n Studies)	Pre-Test Probability	Optimal Cut-Off	Sensitivity (95 CI)	Specificity (95% CI)	LR+	LR-	Post-Test Probability %, +Test	Post-Test Probability %, -Test
BBS	Pooled	949 (5)	30% (2)	≤ 54.13 points	0.65 (0.25–0.91)	0.52 (0.21–0.81)	1.34	0.68	37	23
	Greene 2010^Citation43
	Marques 2016^Citation44
	Muir 2008^Citation45
	Santos 2011^Citation46
	Yingyongyudha 2016^Citation47
BEST	Marques 2016^Citation44	122 (1)	30%	48.5* points	0.74 (-)	0.72 (-)	2.59	0.37	53	13
BEST	Yingyongyudha 2016^Citation47	200 (1)	30%	66* points	0.76 (0.67–0.83)	0.5 (0.40–0.60)	1.52	0.48	39	17
BRIEF BEST	Marques 2016^Citation44	122 (1)	30%	12.5* points	0.74 (-)	0.71 (-)	2.49	0.38	52	14
MINI BEST	Marques 2016^Citation44	122 (1)	30%	19.5* points	0.74 (-)	0.67 (-)	2.23	0.40	49	14
MINI BEST	Yingyongyudha 2016^Citation47	200 (1)	30%	16* points	0.85 (0.77–0.9)	0.75 (0.66–0.83)	3.40	0.20	59	8
POMA BALANCE	Murphy 2003^Citation60	45 (1)	30%	12* points	0.55 (-)	0.97 (-)	18.33	0.46	89	16
POMA BALANCE	Trueblood 2001^Citation56	180 (1)	30%	12* points	0.21 (-)	0.95 (-)	4.20	0.83	64	26
POMA GAIT	Trueblood 2001^Citation56	180 (1)	30%	8* points	0.24 (-)	0.91 (-)	2.67	0.84	53	26
TUG	Pooled	3148 (11)	30%	≥13.20 s	0.39 (0.22–0.59)	0.74 (0.63–0.88)	1.72	0.79	43	25
	Abu Samah 2018^Citation48
	Alexandre 2012^Citation49
	Greene 2010^Citation43
	Trueblood 2001^Citation56
	Chantanachai 2014^Citation50
	Criter 2016^Citation51
	Criter 2017^Citation52
	Ibrahim. 2017^Citation53
	Kojima 2015^Citation54
	Shimada 2009^Citation55
	Yingyongyudha 2016^Citation47
TUG FAST	Pooled	269 (3)	30%	≥5.6s	0.86 (0.49–0.97)	0.76 (0.05–1.00)	3.64	0.19	61	7
	Arnold 2007^Citation57
	Rose 2002^Citation58
	Shumway-Cook 2000^Citation59
TUG 8feet FAST	Rose 2002^Citation58	134 (1)	30%	≥8.5s	0.78 (-)	0.86 (-)	5.57	0.26	70	10
TUG COG FAST	Hofheinz 2016^Citation85	113 (1)	30%	≤ 10.3s **	0.49 (0.33–0.65)	0.77 (0.68–0.86)	2.13	0.66	48	22
TUG COG FAST	Shumway-Cook 2000^Citation59	30 (1)	30%	≥14.5s	0.86 (-)	0.93 (-)	12.90	0.15	84	6
TUG MAN FAST	Shumway-Cook 2000^Citation59	25 (1)	30%	≥15s	0.80	0.93	12.00	0.21	82	9
FRT	Murphy 2003^Citation60	45 (1)	30%	20.32cm*	0.73 (-)	0.88 (-)	6.08	0.31	72	12
FRT	Shimada 2009^Citation55	455 (1)	30%	≤ 18cm	0.47 (-)	0.59 (-)	1.15	0.90	33	28
GAIT SPEED	Middleton 2016^Citation61	217 (1)	30%	< 0.76 m/s	0.65 (-)	0.71 (-)	2.25	0.49	49	17
GAIT SPEED	Shimada 2009^Citation55	455 (1)	30%	≤ 0.7 m/s	0.56 (-)	0.59 (-)	1.37	0.75	37	24
GAIT SPEED FAST	Middleton 2016^Citation61	217 (1)	30%	< 1.13 m/s	0.77 (-)	0.60 (-)	1.92	0.39	45	14
GAIT SPEED FAST	Shimada 2009^Citation55	455 (1)	30%	≤ 1 m/s	0.58 (-)	0.58 (-)	1.38	0.72	37	24
GRIP	Shimada 2009^Citation55	455 (1)	30%	≤17 kg	0.55 (-)	0.55 (-)	1.22	0.82	34	26
OLS	Shimada 2009^Citation55	455 (1)	30%	≤3 s	0.51 (-)	0.61 (-)	1.31	0.80	36	26

Notes: *Not stated if ≥, ≤. **Cut-off closest to the other articles included for the same test. In the original article four other cut-off values are presented (see supplementary Table 2).

Abbreviations: BBS, Berg Balance Scale; BEST, Balance Evaluation System Test; BriefBEST, Brief Balance Evaluation System Test; MiniBEST, Mini Balance Evaluation System Test; CI, 95% confidence interval; FRT, Functional Reach Test; Gait speed, gait speed at usual speed; Gait Speed FAST, gait speed as fast as possible without running; GRIP, grip strength; LR+, Likelihood ratio for a positive test; LR-, Likelihood ratio for a negative test; OLS, one leg stance; POMA Balance, Performance Oriented Mobility Assessment Balance part; POMA GAIT, Performance Oriented Mobility Assessment Gait part; TUG, Timed Up and Go test usual gait speed; TUG FAST, Timed Up and Go test speed as fast as possible without running; TUG 8ft FAST, Timed Up and Go test on 8 feet distance speed as fast as possible; TUG COG FAST, Timed Up and Go test cognitive speed as fast as possible; TUG MAN FAST, Timed Up and Go test manual speed as fast as possible; +test, Positive test; -test, Negative test; (-), confidence interval not reported..

Table 4 Inter-Rater and Intra-Rater Reliability for Nursing-Home Setting, Summary of Findings

	Inter-Rater Reliability			Intra-Rater Reliability
Test	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Author	No of Participants (n Studies)	Relative Reliability I ICCagreement (95% CI)	Overall Rating (+, ?, -)
BBS	Holbein−Jenny 2005^Citation86 Viveiro 2018^Citation62	76 (2)	0.97 (0.61 to 1.00)	Holbein−Jenny 2005^Citation86 Viveiro 2018^Citation62	64 (2)	0.84 (0.69 to 0.92)	+
BEST	Viveiro 2018^Citation62	49 (1)	0.99 (0.99 to 1.00)	Viveiro 2018^Citation62	37 (1)	0.94 (0.89 to 0.97)	+
MiniBEST	Viveiro 2018^Citation62	49 (1)	0.99 (0.99 to 1.00)	Viveiro 2018^Citation62	37 (1)	0.93 (0.87 to 0.97)	+
BriefBEST	Viveiro 2018^Citation62	49 (1)	0.99 (0.99 to 1.00)	Viveiro 2018^Citation62	37 (1)	0.94 (0.88 to 0.97)	+
FRT	Holbein−Jenny 2005^Citation86	27 (1)	0.98 (0.96 to 0.99)	Holbein−Jenny 2005^Citation86	27 (1)	0.75 (0.52 to 0.88)	+

Notes: Overall rating: +Sufficient; -Insufficient; ?Indeterminate.

Abbreviations: BBS, Berg Balance Scale; BEST, Balance Evaluation System Test; BriefBEST, Brief Balance Evaluation System Test; MiniBEST, Mini Balance Evaluation System Test; CI, 95% confidence interval; FRT, Functional Reach Test; ICC, intraclass correlation coefficient agreement.

Table 5 Validity for Nursing Home Setting, Summary of Findings

Test	Author	No of Participants (n Studies)	Pre-Test Probability	Optimal Cut-Off	Sensitivity (95% CI)	Specificity (95% CI)	LR+	LR-	Post-Test Probability %, +Test	Post-Test Probability %, -Test
BBS	Viveiro 2018^Citation62	49 (1)	40% (2)	48* points	0.55 (0.36–0.55)	0.94 (0.73–1.00)	9.87	0.48	87	24
BEST	Viveiro 2018^Citation62	49 (1)	40%	57* points	0.61 (0.42–0.78)	0.83 (0.59–0.96)	3.68	0.46	71	23
BriefBEST	Viveiro 2018^Citation62	49 (1)	40%	10* points	0.58 (0.39–0.75)	0.94 (0.73–1.00)	10.45	0.44	87	23
MiniBEST	Viveiro 2018^Citation62	49 (1)	40%	10* points	0.71 (0.52–0.86)	0.78 0.52–0.94)	3.19	0.37	68	20
TUG	Applebaum 2017^Citation63	53 (1)	40%	14.2s*	0.97 (-)	0.15 (-)	1.14	0.2	43	12

Note: * Not stated if ≥, ≤.

Abbreviations: BBS, Berg Balance Scale; BEST, Balance Evaluation System; BriefBEST, Brief Balance Evaluation System; MiniBEST, Mini Balance Evaluation System; 95% CI, 95% confidence interval; s, second; +test, Positive test; -test, Negative test; TUG, Timed Up and Go; (-), confidence interval not reported.

Table 6 Inter-Rater and Intra-Rater Reliability for Hospital Setting, Summary of Findings

	Inter-Rater Reliability			Intra-Rater Reliability
Test	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Overall Rating (+, ?, -)
GAIT SPEED	/	/	/	Hars 2013^Citation80	60 (1)	0.92 (0.87 to 0.95)	+
GAIT SPEED FAST	/	/	/	Hars 2013^Citation80	170 (2)	0.98 (0.87 to 1.0)	+
				Martinez 2016^Citation87
GAIT SPEED DUAL TASK	/	/	/	Hars 2013^Citation80	60 (1)	0.91 (0.85 to 0.95)	+

Notes: Overall rating: +Sufficient, -Insufficient, ?Indeterminate, /No values.

Abbreviations: 95% CI, 95% confidence interval; GAIT SPEED, gait speed usual walking speed; GAIT SPEED FAST, gait speed as fast as possible without running; GAIT SPEED DUAL TASK, gait speed with dual task conditions; ICC_agreement, intraclass correlation coefficient agreement.

Table 7 Validity for Hospital Setting, Summary of Findings

Test	Author	No of Participants (n studies)	Pre-Test Probability	Optimal Cut-Off	Sensitivity (95% CI)	Specificity (95% CI)	LR+	LR-	Post-Test Probability %, +Test	Post-Test Probability %, -Test
SIMPLIFIED POMA	Hars 2018^Citation32	524 (1)	24%(32,33)	≥ 2 points	0.71 (-) **	0.46 (-)**	1.31	0.64	47	30
SPPB	Hars 2018^Citation32	678 (1)	24%	< 5 points	0.68 (-)**	0.46 (-)**	1.26	0.69	46	32
TUG	Chow 2018^Citation64	192 (1)	24%	≥ 12s	0.71 (-)	0.28 (-)	0.98	1.04	40	41
TUG	Hars 2018^Citation32	525 (1)	24%	> 29.5s	0.41 (-)**	0.69 (-)**	1.34	0.85	47	36

Notes: **Authors provided additional information (unpublished data).

Abbreviations: 95% CI, 95% confidence interval; SimplifiedPOMA, Simplified Performance Oriented Mobility Assessment; SPPB, Short Physical Performance Battery; TUG, Timed Up and Go test; s, seconds; (-), confidence interval not reported.

Table 8 Inter-Rater and Intra-Rater Reliability for Combined Setting of Hospitalized and Community-Dwelling Persons, Summary of Findings

	Inter-Rater Reliability			Intra-Rater Reliability
Test	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Author	No of Participants (n Studies)	Relative Reliability ICCagreement (95% CI)	Overall Rating (+, ?, -)
GAIT SPEED	Bautmans 2011^Citation88	81 (1)	0.94 (0.90 to 0.96)	Bautmans 2011^Citation88	81 (1)	0.96 (0.93 to 0.97)	+
GAIT SPEED MEAN OF TWO	Bautmans 2011^Citation88	81 (1)	0.98 (0.96 to 0.98)	Bautmans 2011^Citation88	81 (1)	0.99 (0.98 to 1.0)	+
DYNAMOMETER HIP ABD STANDING	/	/	/	Bruyneel 2018^Citation89	32 (1)	0.98 (0.96 to 0.99)	+
DYNAMOMETER HIP ABD STANDING RFG	/	/	/	Bruyneel 2018^Citation89	32 (1)	0.93 (0.86 to 0.97)	+
DYNAMOMETER HIP ABD SIDELYING MAX	/	/	/	Gafner 2017^Citation90	76 (1)	0.94 (0.91 to 0.96)	+
DYNAMOMETER HIP ABD SIDELYING RFG	/	/	/	Gafner 2017^Citation90	76 (1)	0.94 (0.91 to 0.96)	+
DYNAMOMETER HIP ADD SIDELYING MAX	/	/	/	Gafner 2017^Citation90	76 (1)	0.90 (0.0.85 to 0.94)	+
DYNAMOMETER HIP ADD SIDELYING RFG	/	/	/	Gafner 2017^Citation90	76 (1)	0.94 (0.91 to 0.96)	+

Notes: Overall rating: + Sufficient, - Insufficient, ? Indeterminate, /No values.

Abbreviations: ABD, abduction; ADD, adduction; 95% CI, 95% confidence interval; GAIT SPEED, gait speed usual walking speed; ICC_agreement, intraclass correlation coefficient agreement; MAX, maximum strength; RFG, rate of force generation.

Table 9 Validity for Combined Setting of Hospitalized and Community-Dwelling Persons, Summary of Findings

Test	Author	No of Participants (n Studies)	Pre-Test Probability	Optimal Cut-Off	Sensitivity (95% CI)	Specificity (95% CI)	LR+	LR-	Post-Test Probability %, +Test	Post-Test Probability %, -Test
Grip	Gafner 2018^Citation65	56 (1)	27% (2,32,33)*	≤70 kPa	0.91 (-)**	0.32 (-)**	1.3**	0.3**	33**	10**
HIP STRENGTH ABDUCTORS	Gafner 2018^Citation65	56 (1)	27%	≤1.1 N/kg	0.91 (-)	0.43 (-)	1.6	0.2	37	8
HIP STRENGTH ABDUCTORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 8.5 N/kg/s	0.91 (-)	0.43 (-)	1.6	0.2	37	8
HIP STRENGTH ADDUCTORS	Gafner 2018^Citation65	56 (1)	27%	≤ 1.3 N/kg	0.90 (-)**	0.19 (-)**	1.1**	0.5**	29**	17**
HIP STRENGTH ADDUCTORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 6.2 N/kg/s	0.90 (-)**	0.15 (-)**	1.1**	0.7**	28**	20**
HIP STRENGTH EXTENSORS	Gafner 2018^Citation65	56 (1)	27%	≤ 1.7 N/kg	0.90 (-)**	0.32 (-)**	1.3**	0.3**	33**	10**
HIP STRENGTH EXTENSORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 10.7 N/kg/s	0.90 (-)**	0.18 (-)**	1.1**	0.6**	29**	17**
HIP STRENGTH EX.ROTATORS	Gafner 2018^Citation65	56 (1)	27%	≤ 0.9 N/kg	0.91 (-)**	0.50 (-)**	1.8**	0.2**	40**	7**
HIP STRENGTH EX. ROTATORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 5.7 N/kg/s	0.91 (-)**	0.32 (-)**	1.3**	0.3**	33**	10**
HIP STRENGTH FLEXORS	Gafner 2018^Citation65	56 (1)	27%	≤ 1.9 N/kg	0.90 (-)**	0.25 (-)**	1.2**	0.4**	31**	13**
HIP STRENGTH FLEXORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 14.5 N/kg/s	0.90 (-)**	0.25 (-)**	1.2**	0.4**	31**	13**
HIP STRENGTH IN. ROTATORS	Gafner 2018^Citation65	56 (1)	27%	≤ 1.4 N/kg	0.91 (-)**	0.43 (-)**	1.6**	0.2**	37**	8**
HIP STRENGTH IN. ROTATORS RFG	Gafner 2018^Citation65	56 (1)	27%	≤ 6.4 N/kg/s	0.91 (-)**	0.43 (-)**	1.6**	0.2**	37**	8**

Notes: * Chosen prevalence between the fall risk prevalence of hospitalized and community-dwelling persons. **Authors provided additional information (unpublished data).

Abbreviations: 95% CI, 95% confidence interval; EX.ROTATORS, external rotators; Grip, grip strength; RFG, rate of force generation; IN.RROTATORS, internal rotators; kPa, kilo pascal; LR+, likelihood ratio for a positive test; LR-, likelihood ratio for a negative test; N/kg, Newton per kilo; (-), confidence interval not reported.

MarquesA, AlmeidaS, CarvalhoJ, CruzJ, OliveiraA, JácomeC. Reliability, validity, and ability to identify fall status of the balance evaluation systems test, mini-balance evaluation systems test, and brief-balance evaluation systems test in older people living in the community. Arch Phys Med Rehabil. 2016;97(12):2166–73.e1.27497826

 PubMed Web of Science ®Google Scholar

AnsonE, ThompsonE, MaL, JekaJ. Reliability and fall risk detection for the BESTest and Mini-BESTest in older adults. J Geriatric Phys Ther. 2019;42(2):81–85.

 PubMed Web of Science ®Google Scholar

Wang-HsuE, SmithSS. Interrater and test-retest reliability and minimal detectable change of the Balance Evaluation Systems Test (BESTest) and subsystems with community-Dwelling older adults. J Geriatric Phys Ther. 2018;41(3):173–179.

 PubMed Web of Science ®Google Scholar

YingyongyudhaA, SaengsirisuwanV, PanichapornW, BoonsinsukhR. The mini-balance evaluation systems test (mini-bestest) demonstrates higher accuracy in identifying older adult participants with history of falls than do the bestest, berg balance scale, or timed up and go test. J Geriatric Phys Ther. 2016;39(2):64–70.

 PubMed Web of Science ®Google Scholar

Shumway-CookA, BrauerS, WoollacottM. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896–903.10960937

 PubMed Web of Science ®Google Scholar

HofheinzM, SchusterschitzC. Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements. Clin Rehabil. 2010;24(9):831–842.20562166

 PubMed Web of Science ®Google Scholar

LeeS-P, DufekJ, HickmanR, SchuermanS. Influence of procedural factors on the reliability and performance of the timed up-and-go test in older adults. Int J Gerontol. 2016;10(1):37–42.

 Web of Science ®Google Scholar

SmithE, WalshL, DoyleJ, GreeneB, BlakeC. The reliability of the quantitative timed up and go test (QTUG) measured over five consecutive days under single and dual-task conditions in community dwelling older adults. Gait Posture. 2016;43:239–244.26526223

 PubMed Web of Science ®Google Scholar

HartmannA, MurerK, de BieRA, de BruinED. Reproducibility of spatio-temporal gait parameters under different conditions in older adults using a trunk tri-axial accelerometer system. Gait Posture. 2009;30(3):351–355.19628391

 PubMed Web of Science ®Google Scholar

GoldbergA, SchepensS. Measurement error and minimum detectable change in 4-meter gait speed in older adults. Aging Clin Exp Res. 2011;23(5–6):406–412.22526072

 PubMed Web of Science ®Google Scholar

HarsM, HerrmannFR, TrombettiA. Reliability and minimal detectable change of gait variables in community-dwelling and hospitalized older fallers. Gait Posture. 2013;38(4):1010–1014.23790571

 PubMed Web of Science ®Google Scholar

ArnoldCM, WarkentinKD, ChilibeckPD, MagnusCR. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res. 2010;24(3):815–824.19661831

 PubMed Web of Science ®Google Scholar

Ford-SmithCD, WymanJF, ElswickRKJr, FernandezT. Reliability of stationary dynamometer muscle strength testing in community-dwelling older adults. Arch Phys Med Rehabil. 2001;82(8):1128–1132.11494194

 PubMed Web of Science ®Google Scholar

KatohM, IsozakiK. Reliability of isometric knee extension muscle strength measurements of healthy elderly subjects made with a hand-held dynamometer and a belt. J Phys Ther Sci. 2014;26(12):1855–1859.25540481

 PubMedGoogle Scholar

AndréHI, CarnideF, BorjaE, RamalhoF, Santos-RochaR, VelosoAP. Calf-raise senior: a new test for assessment of plantar flexor muscle strength in older adults: protocol, validity, and reliability. Clin Interv Aging. 2016;11:1661–1674.27895473

 PubMed Web of Science ®Google Scholar

GreeneBR, O’DonovanA, Romero-OrtunoR, CoganL, ScanaillCN, KennyRA. Quantitative falls risk assessment using the timed up and go test. IEEE Trans Biomed Eng. 2010;57(12):2918–2926.20923729

 PubMed Web of Science ®Google Scholar

MuirSW, BergK, ChesworthB, SpeechleyM. Use of the berg balance scale for predicting multiple falls in community-Dwelling elderly people: a prospective study. Phys Ther. 2008;88(4):449–459.18218822

 PubMed Web of Science ®Google Scholar

SantosGM, SouzaAC, VirtuosoJF, TavaresGM, MazoGZ. Predictive values at risk of falling in physically active and no active elderly with Berg Balance Scale. Rev Bras Fisioter. 2011;15(2):95–101.21789358

 PubMedGoogle Scholar

MurphyMA, OlsonSL, ProtasEJ, OverbyAR. Screening for falls in community-dwelling elderly. J Aging Phys Act. 2003;11(1):66–80.

 Web of Science ®Google Scholar

TruebloodPR, Hodson-ChennaultN, McCubbinA, YoungclarkeD. Performance and impairment-based assessments among community dwelling elderly: sensitivity and specificity. J Geriatric Phys Ther. 2001;24(1):2–6.

 Google Scholar

Abu SamahZ. Discriminative and Predictive Ability of Physical Performance Measures in Identifying Fall Risk Among Older Adults. Penerbit Universiti Kebangsaan Malaysia; 2018.

 Google Scholar

AlexandreTS, MeiraDM, RicoNC, MizutaSK. Accuracy of timed up and go test for screening risk of falls among community-dwelling elderly. Rev Bras Fisioter. 2012;16(5):381–388.

 PubMedGoogle Scholar

ChantanachaiT, PichaiyongwongdeeS, JalayondejaC. Fall prediction in thai elderly with timed up and go and tandem walk test: a cross-sectional study. J Med Assoc Thai/Chotmaihet Thangphaet. 2014;97(Suppl 7):S21–5.25141522

 PubMedGoogle Scholar

CriterRE, HonakerJA. Identifying balance measures most likely to identify recent falls. J Geriatric Phys Ther. 2016;39(1):30–37.

 PubMed Web of Science ®Google Scholar

CriterRE, HonakerJA. Fall risk screening protocol for older hearing clinic patients. Int J Audiol. 2017;56(10):767–774.28541763

 PubMed Web of Science ®Google Scholar

IbrahimA, SinghDKA, ShaharS, OmarMA. Timed up and go test combined with self-rated multifactorial questionnaire on falls risk and sociodemographic factors predicts falls among community-dwelling older adults better than the timed up and go test on its own. J Multidiscip Healthc. 2017;10:409–416.29138571

 PubMed Web of Science ®Google Scholar

KojimaG, MasudT, KendrickD, et al. Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial. BMC Geriatr. 2015;15:38.25887660

 PubMed Web of Science ®Google Scholar

ShimadaH, SuzukawaM, TiedemannA, KobayashiK, YoshidaH, SuzukiT. Which neuromuscular or cognitive test is the optimal screening tool to predict falls in frail community-dwelling older people?Gerontology. 2009;55(5):532–538.19776609

 PubMed Web of Science ®Google Scholar

ArnoldCM, FaulknerRA. The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis. BMC Geriatr. 2007;7:17.17610735

 PubMedGoogle Scholar

RoseDJ, JonesCJ, LuccheseN. Predicting the probability of falls in community-residing older adults using the 8-foot up-and-go: a new measure of functional mobility. J Aging Phys Act. 2002;10(4):466.

 Web of Science ®Google Scholar

HofheinzM, MibsM. The prognostic validity of the timed up and go test with a dual task for predicting the risk of falls in the elderly. Gerontol Geriatr Med. 2016;2:2333721416637798.28138492

 PubMedGoogle Scholar

MiddletonA, FulkGD, HerterTM, BeetsMW, DonleyJ, FritzSL. Self-selected and maximal walking speeds provide greater insight into fall status than walking speed reserve among community-Dwelling older Adults. Am J Phys Med Rehabil. 2016;95(7):475–482.27003205

 PubMed Web of Science ®Google Scholar

Holbein-JennyMA, Billek-SawhneyB, BeckmanE, SmithT. Balance in personal care home residents: a comparison of the Berg Balance Scale, the multi-directional reach test, and the activities-specific balance confidence scale. J Geriatric Phys Ther. 2005;28(2):48–53.

 Google Scholar

ViveiroLAP, GomesGCV, BachaJMR, et al. Reliability, validity, and ability to identity fall status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in older adults who live in nursing homes. J Geriatric Phys Ther. 2019;42(4):E45–e54.

 Web of Science ®Google Scholar

ApplebaumEV, BretonD, FengZW, et al. Modified 30-second Sit to Stand test predicts falls in a cohort of institutionalized older veterans. PLoS One. 2017;12(5):e0176946.28464024

 PubMed Web of Science ®Google Scholar

MartinezBP, BatistaAK, RamosIR, et al. Viability of gait speed test in hospitalized elderly patients. J Bras Pneumol. 2016;42(3):196–202.27383933

 PubMed Web of Science ®Google Scholar

HarsM, AudetMC, HerrmannF, et al. Functional performances on admission predict in-hospital falls, injurious falls and fractures in older patients: a prospective study. J Bone Mineral Res. 2018.

 Web of Science ®Google Scholar

ChowRB, LeeA, KaneBG, et al. Effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools for geriatric fall risk assessment in the ED. Am J Emerg Med. 2019;37(3):457–460.29910184

 PubMed Web of Science ®Google Scholar

BautmansI, JansenB, Van KeymolenB, MetsT. Reliability and clinical correlates of 3D-accelerometry based gait analysis outcomes according to age and fall-risk. Gait Posture. 2011;33(3):366–372.21227697

 PubMed Web of Science ®Google Scholar

BruyneelAV, GafnerSC, FerrariS, et al. Intra-rater reliability of hip abductor isometric strength testing in a standing position in older fallers and non-fallers. Eur Rev Aging Phys Activity. 2018;15:9.

 Web of Science ®Google Scholar

GafnerS, BastiaenenCHG, TerrierP, et al. Evaluation of hip abductor and adductor strength in the elderly: a reliability study. Eur Rev Aging Phys Activity. 2017;14:5.

 PubMed Web of Science ®Google Scholar

GafnerSC, BastiaenenCH, FerrariS, et al. Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study. Clin Interv Aging. 2018;13:1–8.29317804

 PubMed Web of Science ®Google Scholar