Falls assessment kits

There are two versions of our falls assessment kits: a comprehensive or long version and a screening or short version. The comprehensive version is suitable for rehabilitation, physical therapy and occupational therapy settings and for dedicated falls clinics, and takes 45 minutes to administer. The screening version takes 10-15 minutes to administer and is suitable for acute hospitals and long-term care institutions.

The table below describes the test items for the comprehensive version. The screening version contains five of these items: a test of vision (edge contrast sensitivity), peripheral sensation (proprioception), lower limb strength (knee extension strength), reaction time using a finger press as the response and body sway (sway when standing on medium density foam rubber). These five items were identified from discriminant analyses as being the most important for discriminating between fallers and non-fallers.

Long form tests

High and Low Contrast Visual acuity – Visual acuity is measured using a chart with high contrast visual acuity letters (similar to a Snellen scale) and low (10%) contrast letters, (where contrast = the difference between the maximum and minimum luminances divided by their sum). Acuity is assessed binocularly with subjects wearing their glasses (if needed) at a test distance of three metres and measured in terms of the minimum angle resolvable (MAR) in minutes of arc.

Contrast sensitivity – Edge contrast sensitivity is assessed using the Melbourne Edge Test. This test presents 20 circular patches containing edges with reducing contrast. Correct identification of the orientation of the edges on the patches provides a measure of contrast sensitivity in decibel units, where dB=-10log₁₀ contrast.

Depth Perception – The depth perception test presents two vertical rods, the objective being to align these rods side-by-side. The subject is seated 3 metres away and pulls on the string to move the right rod while the left rod remains fixed. Any discrepancies in the position of the rods are measured in millimetres.

Tactile sensitivity – Tactile sensitivity is measured with a pressure aesthesiometer. This instrument contains eight nylon filaments of equal length, but varying in diameter. The filaments are applied to the centre of the lateral malleolus and measurements are expressed in logarithms of milligrams pressure.

Vibration sense – Vibration is measured using an electronic device which generates a 200 Hz vibration of varying intensity. The vibration is applied to the tibial tuberosity and is measured in microns of motion perpendicular to the body surface.

Proprioception is assessed by asking seated subjects with eyes closed to align the lower limbs on either side a 60cm by 60cm by 1cm thick clear acrylic sheet inscribed with a protractor. Any difference in matching the great toes is measured in degrees.

Lower limb strength – The strength of three leg muscle groups (knee flexors and extensors and ankle dorsiflexors) is measured while subjects are seated. In each test, there are three trials and the greatest force is recorded.

Reaction time is assessed using a light as the stimulus and depression of a switch (by either the finger or the foot) as the response. Reaction time is measured in milliseconds.

Postural sway – Sway is measured using a swaymeter that measures displacements of the body at waist level. The device consists of a 40cm long rod with a vertically mounted pen at its end. The rod is attached to subjects by a firm belt and extends posteriorly. As subjects attempt to stand as still as possible, the pen records the sway of subjects on a sheet of millimetre graph paper fastened to the top of an adjustable height table. Testing is performed with the eyes open and closed on a firm surface and on a piece of medium density foam rubber (15 cm thick). Total sway (number of square millimetre squares traversed by the pen) in the 30 second periods is recorded for the four tests.

For both the short and long forms, a computer software program has been developed to assess an individual’s performance in relation to a normative database complied from large population studies. This program produces a falls risk assessment report for each individual which includes the following four components:

• A graph indicating an individual’s overall falls risk score.
• A profile of the individual’s test performances. This allows a quick identification of physiological strengths and weaknesses.
• A table indicating the individual’s test performances in relation to age-matched norms.
• A written report which explains the results and makes recommendations for improving functional performances and compensating for any impairments identified.

Details of each of the tests used in the PPA can be found in the following paper: Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Physical Therapy 2003;83:237-252.

Pricing of access to the falls risk web page depends on frequency of use. Please view our terms of sale prior to order.

To order a falls assessment kit, or for further information please email us.

Questionnaires

Iconographical Falls Efficacy Scale (Icon-FES)

• Measures concern about falling during a range of daily activities, including indoor, outdoor, social and risky activities
• Employs an innovative way of assessing fear of falling using pictures to describe a range of activities and situations.
• The items are scored on a 4-point scale with 1 = not at all concerned to 4 = very concerned along with facial expression icons.
• Two versions:
  • Long 30-item version
  • Shortened 10-item version
• Reference: Delbaere K, Smith S, Lord S. Development and Initial Validation of the Iconographical Falls Efficacy Scale. J Gerontol A Biol Sci Med Sci 2011;2011(doi: 10.1093/gerona/glr019)

Incidental and planned exercise questionnaire (IPEQ)

• Self-report questionnaire that measures type and amount of physical activity
• Provides estimates of the frequency and duration of planned exercise and more casual day-to-day activities
• Outcome: hours of planned exercise per week
• Two different formats:
  • Estimating physical activity during the past week
  • Estimating average weekly during past 3 months
• Reference: Delbaere K, Hauer K, Lord SR. Evaluation of the incidental and planned exercise questionnaire (IPEQ) for older people. British Journal of Sports Medicine. 2010;44(14):1029-1034

Mobile Applications

Some mobile applications have been developed for the Apple iPad. Currently three are available for purchase in the Apple App Store. The apps include:

• iconFES, a clinical tool to help assess a patient’s fear of falling.
• IPEQ, a clinical tool to help assess a patient’s incidental and planned exercise levels.
• PPA Sway Path, a clinical tool used to asses a patient’s postural sway.
• Trail Making Test, a clinical tool used to assess a patient’s visual attention and task switching abilities.
• Low Contrast Sensitivity Test, a clinical tool used to assess a patient’s visual contrast sensitivity.

Book – Falls in older people: risk factors and strategies for prevention 2nd Edition (Lord, Sherrington, Menz, Close)

Since the first edition of this very successful book was written to synthesise and review the enormous body of work covering falls in older people, there has been an even greater wealth of informative and promising studies designed to increase our understanding of risk factors and prevention strategies. This new edition is written in three parts: epidemiology, strategies for prevention, and future research directions. New material includes the most recent studies covering: balance studies using tripping, slipping and stepping paradigms; sensitivity and depth perception visual risk factors; neurophysiological research on automatic or reflex balance activities; and the roles of syncope, vitamin D, cataract surgery, health and safety education, and exercise programs. This new edition will be an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.

Sample chapter

If you would like more information about these resources, please email us.