Can a newly -established test for assessing standing and balance function be an alternative to the timed up-and-go test? -Functional assessment of gait and balance in elderly patients for a comprehensive geriatric assessment initiative named 'Dr. SUPERMAN'

Aim: To identify elderly patients who are at high risk for falls, we used the timed up-and-go test (TUG) as an assessment tool for gait and balance function in a comprehensive geriatric assessment (CGA) initiative named 'Dr. SUPERMAN'. However, this test is difficult to perform in a small area because it requires at least 3 meters of movement space. Therefore, we investigated whether another, newly-developed test, based on the Berg balance test, could be an alternative to the TUG test. Methods: We enrolled a total of 99 eligible subjects out of 105 elderly patients with disorders such as Alzheimer disease, Parkinson disease, cerebral infarction, osteoporosis and vascular risk factors, and administered the TUG test and the newly -developed standing and balance test (SBT). Of these 99, 6 patients could not stand independently. While the time to accomplish TUG was determined, any unsteadiness during TUG was also recorded. The SBT consists of 3 components: standing up independently, standing on a narrow base for 15 seconds without any swaying of the trunk, and a timed one-leg standing test (TOLS) for 15 seconds on both sides. Taking more than 14 seconds to accomplish the TUG or abnormal unsteadiness during the test was defined as positive, and each cut-off point was measured on the TOLS, with or without swaying of the trunk. Results: The time to accomplish TUG significantly increased with age, and positive TUG findings were observed in 43 subjects. The mean TOLS time significantly and suddenly worsened at over 75 years of age, including among those subjects who showed swaying of the trunk and who could only perform the TOLS for less than 1 second. The receiver operating curve indicated that a TOLS cut-off point of less than 3 seconds, together with standing with help or swaying of the trunk during the SBT, most efficiently determined a positive TUG score, with high sensitivity (86%), high specificity (87.5%), and a high positive predictive value (84.1%). Conclusion: In a narrow space, the SBT can adequately determine gait and balance abnormalities among elderly patients, indicating it to be an alternative to the TUG test. Subjects who could stand dependently, who showed swaying of the trunk in SBT, or who had a TOLS cut-off point of less than 3 seconds, were at high risk for falls. Further assessment of similar patients is necessary.