@article{ref1,
title="Stepping impairment and falls in older adults: a systematic review and meta-analysis of volitional and reactive step tests",
journal="Ageing research reviews",
year="2020",
author="Okubo, Yoshiro and Schoene, Daniel and Caetano, Maria Jd and Pliner, Erika M. and Osuka, Yosuke and Toson, Barbara and Lord, Stephen R.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.   DATA SOURCE: PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.   STUDY SELECTION: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).   RESULTS: A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.   CONCLUSIONS: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.<p /> <p>Language: en</p>",
language="en",
issn="1568-1637",
doi="10.1016/j.arr.2020.101238",
url="http://dx.doi.org/10.1016/j.arr.2020.101238"
}