Development of a clinical multiple-lunge test to predict falls in older adults

Objective: To develop a new Multiple-Lunge Test to distinguish between fallers and nonfallers in community-dwelling older adults. Design: A cross-sectional design was used to establish the sensitivity and specificity of the test to predict faller status based on retrospective self-reported fall history. Setting: Local retirement villages. Participants: Community-dwelling older adults (N=130; mean age ± SD, 77±7y) with (n=40) and without (n=90) a history of falls. Interventions: The Multiple-Lunge Test required individuals to lunge forward to a step length determined as 60% of their leg length, and return to start, for 5 consecutive repetitions. Interday and intraday test-retest reliability of the Multiple-Lunge Test was established across 2 testing occasions. Main Outcome Measures: Number of steps performed correctly, total time to complete 5 steps. Results: The Multiple-Lunge Test was found to be reliable across trials (Intraday: intraclass correlation coefficient [ICC]= .79 -.81 for steps, ICC=.86 -.88 for time; Interday: ICC=.77 for steps; ICC=.84 for time). Sensitivity and specificity values were calculated as 73% and 63%, respectively, for predicting multiple fallers using the measure of all 5 steps done correctly. Conclusions: The test is easily administered and because of its challenging nature, it may be well suited to detect subtle differences in abilities of higher functioning, communitydwelling older adults. A practitioner can be confident in 7 of 10 cases that an older adult who cannot complete all 5 steps of the Multiple-Lunge Test is at high risk of falls. The results suggest that there is potential for the Multiple-Lunge Test to be used in clinical practice; however, additional research on how to further increase its validity appears warranted.