While browsing Facebook a couple of weeks ago (a thing I am ashamed to admit I spend far too much time doing) I came upon a thought-provoking article about the dangers of falls in the elderly (I justify my time on Facebook by the useful articles and news stories I would otherwise not find). As a physical therapist, and especially as an acute care therapist working with an acute and chronically ill population, who are also often elderly, risk for falls are always near the forefront of my mind as I examine, evaluate, treat, and assess my patients. It is in fact one of the most important things I consider when determining whether or not someone is safe to return home, and what services they may need when they get there (a walker? home health PT? 24-hour supervision? 24-hour assistance?).
One thing that I have struggled with in my practice, which I know almost all PTs struggle with, is finding outcome measures that give the most bang for your buck. In more technical terms, are they valid, reliable, evidence based, provide useful information, and easy and quick enough to make them worth measuring. In acute care, where you may only have one visit with a patient before being asked to make discharge recommendations, the time and useful information components are especially important.
In an age where caseload and productivity expectations put pressure on therapists to see more patients in the same amount of time it is very difficult, and sometimes impossible, to perform some of the gold standard balance tests with patients. Equipment and space requirements for some tests and screening measures can also make them prohibitive in the acute care environment. And so as I moved from student to resident and now to independent practice as a travel therapist, I found myself trying to figure out how I can most effectively screen my patients’ risk for falls when I will be changing environments and facilities every few months.
There were quite a few screening measures that came to mind as I tried to find ones I could easily implement: Timed Up and Go, 10 meter walk test, Dynamic Gait Index, Short Physical Performance Battery, 5 Time Sit To Stand, Berg Balance Test…but as I pondered further the list gradually dwindled. The Timed Up and Go requires a chair, a stopwatch, and a 3 meter measured distance. This seemed like a good option until I realized that it would require me either bring all my patients to a designated place where I had pre-measured the 3 meters, or carrying a tape measure around and measuring it out each time, so I put that one aside as a maybe. The 10 meter walk test and Short Physical Performance Battery have the same measured distance problem as the Timed Up and Go. Administering a complete Berg test is quite lengthy, and therefore the time required is prohibitive to regular use in acute care. And so my list narrowed to the 5 Time Sit To Stand and the Dynamic Gait Index.
There is evidence to support that these are both decent for screening risk for falls or need for further balance assessment. They are both fairly quick to administer with relatively little equipment and don’t require an exact distance that the patient has to walk while being timed thus allowing me flexibility of where I can administer them. For now, I think that these measures, combined with my clinical judgement have been working, but I can’t help but wonder, is there a better test I could be using? Is there something more I should be doing?