A novel video game--based device for measuring stepping performance and fall risk in older people.

摘要

OBJECTIVE: To determine whether a dance mat test of choice stepping reaction time (CSRT) is reliable and can detect differences in fall risk in older adults. DESIGN: Randomized order, crossover comparison. SETTING: Balance laboratory, medical research institute, and retirement village. PARTICIPANTS: Older (mean age, 78.87+/-5.90y; range, 65-90y) independent-living people (N=47) able to walk in place without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reaction (RT), movement, and response times of dance pad--based stepping tests, Physiological Profile Assessment (PPA) score, Digit Symbol Substitution Test (DSST) score, time to complete the Trail Making Test (TMT) A+B, Fall Efficacy Scale International (FES-I) score, Activities-specific Balance Confidence (ABC) Scale score, and Incidental and Planned Exercise Questionnaire (IPEQ) incidental IPEQ activity subscore. RESULTS: Test-retest reliability of the dance mat CSRT response time was high (intraclass correlation coefficient model 3,k=.90; 95% confidence interval [CI], .82-.94; P<.001) and correlated highly with the existing laboratory-based measure (r=.86; 95% CI, .75-.92; P<.001). Concurrent validity was shown by significant correlations between response time and measures of fall risk (PPA: r=.42; 95% CI, .15-.63; P<.01; TMT A: r=.61; 95% CI, .39-.77; TMT B: r=.55; 95% CI, .31-.72; DSST: r=-.53; 95% CI, -.71 to -.28; P<.001; FES-I: Spearman rho=.50; 95% CI, .25-.69; ABC Scale: Spearman rho=-.58; 95% CI, -.74 to -.35; P<.01). Participants with moderate/high fall-risk scores (PPA score >1) had significantly slower response times than people with low/mild fall-risk scores (PPA score <1) at 1146+/-182 and 1010+/-132ms, respectively (P=.005), and multiple fallers and singleonfallers showed significant differences in RT (883+/-137 vs 770+/-100ms; P=.009) and response time (1180+/-195 vs 1031+/-145ms; P=0.017). CONCLUSIONS: The new dance mat device is a valid and reliable tool for assessing stepping ability and fall risk in older community-dwelling people. Because it is highly portable, it can be used in clinic settings and the homes of older people as both an assessment and training device.