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Simone Chantal Gafner,1,2 Lara Allet,3,4 Roger Hilfiker,4 Caroline Henrice Germaine Bastiaenen2 1Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland; 2Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands; 3Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland; 4School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, SwitzerlandCorrespondence: Simone Chantal GafnerGeneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, SwitzerlandEmail simone.gafner@hesge.chBackground/Objectives: Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons’ fall risk.Methods: Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.Results: Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.Conclusion: The review’s results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures’ reliability is sufficient. However, the included tests’ discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.Keywords: aged, falls, criterion validity, post-test probability, clinical application

Simone Chantal Gafner,1,2 Caroline Henrice Germaine Bastiaenen,2 Serge Ferrari,3 Gabriel Gold,4 Andrea Trombetti,5 Philippe Terrier,6,7 Roger Hilfiker,8 Lara Allet1,8,9 1Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland; 2Department of Epidemiology, Research Line Functioning and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands; 3Department of Internal Medicine Specialties, University Hospitals and University of Geneva, Geneva, Switzerland; 4Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland; 5Division of Bone Diseases, Department of Medicine, University Hospitals and University of Geneva, Geneva, Switzerland; 6School of Health Sciences, ARC Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland; 7Department of Thoracic Surgery, University Hospitals and University of Geneva, Geneva, Switzerland; 8School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland; 9Department of Community Medicine, University Hospitals and University of Geneva, Geneva, SwitzerlandCorrespondence: Simone Chantal Gafner Rue des Caroubiers 25, CH-1227 Carouge, Geneva, SwitzerlandTel +41 22 388 34 70Fax +41 22 388 34 24Email simone.gafner@hesge.chBackground/Objectives: Early detection of fall risk in persons older than 65 is of clinical relevance, but the diagnostic accuracy of currently used functional tests (eg short physical performance battery [SPPB] and timed up and go test [TUG]) to assess older persons’ fall risks remains moderate. Recent literature highlights the importance of strong hip abductors to prevent falls. We thus aimed to assess the diagnostic accuracy of hip abductor strength measures to assess older persons’ fall risks.Methods: Hip abductor maximum voluntary isometric strength (ABD MVIS), rate of force generation (ABD RFG), and the SPPB and TUG functional fall risk assessments were assessed in 60 persons aged over 65 years (82.0 ± 6.1 years). The diagnostic accuracy (area under the curve [AUC], sensitivity [sens], specificity [spec], positive predictive value [PPV], negative predictive value [NPV], and positive and negative likelihood ratios [LR+, LR−]) was evaluated at a clinically important 90% sensitivity level. Cut-off values for clinical use were calculated.Results: In our population, hip ABD MVIS (AUC 0.8, sens 90.6%, spec 57.1%, PPV 70.7%, NPV 84.2%, LR+ 2.1, LR- 0.2, and cut-off value ≤ 1.1 N/kg) and hip ABD RFG (AUC 0.8, sens 90.6%, spec 46.4%, PPV 65.9%, NPV 81.3%, LR+ 1.7, LR- 0.2, and cut-off ≤ 8.47 N/kg/s) show diagnostic accuracy comparable to other fall risk assessments (SPPB and TUG) and a high net sensitivity when used in a test battery.Conclusion: Hip ABD MVIS or RFG shows good diagnostic accuracy to differentiate between older fallers and nonfallers compared to the chosen external criterion history of falls. The high net sensitivity when hip ABD MVIS or RFG is combined with currently used fall risk assessments shows promise in contributing value to a test battery and should be investigated further in longitudinal studies.Keywords: measurement study, muscle strength, hip, functional performance, accidental falls, aged

Simone C Gafner,1,2 Caroline H Bastiaenen,2,3 Serge Ferrari,4 Gabriel Gold,5 Philippe Terrier,6,7 Roger Hilfiker,8 Lara Allet1,91Department of Physiotherapy, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland; 2Department of Epidemiology, Research Program Functioning and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands; 3Department of Health, School of Health Professions, Zurich University of Applied Sciences, Winterthur, 4Department of Internal Medicine Specialties, 5Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, 6Department of Research, Clinique romande de réadaptation SUVACare, 7Department of Research, Institute for Research in Rehabilitation, Sion, 8Department of Physiotherapy, School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts of Western Switzerland, Valais, 9Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland Background: Hip muscle weakness in older people seems to be an influencing factor of falls. Currently, it is unclear which muscles out of the hip muscle group play an important role in older people. A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question.Objective: Firstly, we aimed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling. Secondly, we aimed to compare the same outcomes and questions for hand-grip strength in relation to the same external criterion.Design: This study was a cross-sectional validity study.Methods: The maximum voluntary isometric strength (MVIS) and the rate of force generation of hip abductors (ABD), adductors, internal and external rotators, extensors, and flexors were measured with a dynamometer fixed to a custom-made frame as well as hand-grip strength with a Martin Vigorimeter in 60 older people aged over 65 years (38 females and 22 males).Results: The area under the curve (AUC) and the results of the mean decrease in Gini index assessed by random forest approach show that of all the assessed parameters, hip ABD MVIS showed the highest discriminative value regarding the chosen external criterion in older people (AUC ABD MVIS 0.825, 95% confidence interval: 0.712–0.938).Conclusion: Results indicate that ABD MVIS is a useful measure to distinguish between older adult fallers and non-fallers regarding the chosen external criterion.Keywords: hip muscle strength, accidental falls, older adults, hand-grip strength, measurement study