Physical Therapists and Balance Assessments

How serious are falls?  In 2002, adults 65 years of age and older reported 3.7 million single falls and 3.1 million recurrent falls.  Of those falls, 2.2 million resulted in a medically injurious fall.  Only 48% of fallers reported falling to a health care provider.  Of those that did report a fall, only 60% received any fall prevention information.

Why do physical therapists perform balance assessments?  Is the goal to predict falls... or to gather baseline data to capture change in balance... or to assist in determining use of assistive device... or to determine where a patient should live?  What is included in a balance assessment?  Are you familiar with the population in which the balance measure was designed?  Are you familiar with any data that might exist on the minimal clinically important difference of that measure for the population you are using the measure?  (Here's an example of gait speed after hip fracture.)   Should the components of a balance assessment be the same no matter where a physical therapist practices or should the components of a balance assessment be standardized based on practice setting or should the components of the balance assessment be based on certain characteristics of the individual patient?  Will a single balance outcome measure be adequate for these five scenarios?  a:  If I am practicing in an outpatient setting and I have a 72 year old female beginning to notice slight changes in her balance when she dresses and undresses in the locker room after swimming and is beginning to notice she is feeling slightly unsteady when she gets out of her car and turns to close her car door,  b:  If I am practicing in an outpatient setting and I have a 66 year old male who has a co-morbidity of diabetic peripheral neuropathy (especially in his feet) and is reporting more and more unsteadiness to the point where he is hanging onto furniture and touching walls,  c:  What if I have a patient with the exact same complaint in b and he also has peripheral neuropathy (in his feet) but the peripheral neuropathy is a side effect of chemotherapy treatments,  d:  If I am practicing in an outpatient setting an I have a 75 year old lady who is reporting unsteadiness and lightheadedness and at times vertigo, and e:  I am practicing in an outpatient setting and I have a 68 year old lady with hip and knee pain, more difficulty getting in and out of chairs, reports fear of falling and reports being more unsteady.

So, if this type of topic intrigues you, there will be a session during the American Physical Therapy Association Combined Sections Meeting devoted to discussing these issues and developing a first draft consensus agreement on optimal balance outcome measures across practice settings.  Leslie Allison, PT, Melissa Fong, PT and Tammie Johnson, PT will be presenting and leading the development of the agreement on February 18 from 12:30-2:00 pm.

photo by LonelyBob via Flickr

~Selena